Mater Misericordiae Hospital annual report 1995.
Item Type Report
Authors Mater Misericordiae Hospital, Dublin
Citation Mater Misericordiae Hospital. 1996. Mater Misericordiae Hospital annual report 1995. Dublin: Mater Misercordiae Hospital.
Publisher Mater Misercordiae Hospital Dublin
Download date 07/10/2021 12:58:02
Link to Item http://hdl.handle.net/10147/575140
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MATER MISERICORDIAE
, -
HOSPITAL,
ANNUAL REpORT 1995
01": •• : r'"- .... _: .. :. :.:,:.£.-~:::-,.
, ' ..1111 .... I I I • Cover painting reproduced with the kind permission of Mr. Thomas Ryan, R.H.A.
Annual Report designed and printed by Future Print MATER MISERICORDIAE HOSPITAL ANNUAL REpORT 1995 ...
CONTENTS
Page No. Board of Management ...... 4 Executive Council ...... 4 Executive Committee of the Medical Council ...... 5 Address of the Archbishop of Dublin ...... 6 Address of the Executive Chairperson of the Board of Management ...... 9 Report of the Chairman of the Executive Council ...... 12 Address of the Chairman of the Executive Committee of the Medical Council ...... 20 Address of the Provinical of the Sisters of Mercy. South Central Province ...... 22 Financial Report and Accounts for 1995 ...... 24 H.I.P.E. Unit ...... 39 Management Services Department ...... 40 Safety. Health & Welfare Unit Report ...... ,42 Schools Education Programme ...... ,45 Statistics ...... ,4 7 Department ReportS: Accident & Emergency ...... 56 Adult Psychiatry ...... 57 Anaesthesia and Intensive Care ...... _.. _...... _...... 60 Chaplaincy Department ...... 68 Child and Family Psychiatry ...... 70 St. Paul's Hospital ...... 76 St. Paul's Special School ...... 77 Diabetes/Endocrine ...... 78 Eccles Breast Screening Programme ...... 80 Gastrointestinal Unit ...... _...... 82 Infection Control Committee ...... 84 Institute of Radiological Sciences ...... 86 Nephrology ...... 91 Neurophysiology ...... 93 Nursing ...... 94 Occupational Therapy ...... 100 Out-Patient Department Clinics ...... 10 1 Otolaryngology/Head & Neck Surgery ...... 105 Department of Orthopaedic Surgery ...... 1 12 Department of Pathology ...... 1 15 Histopathology ...... 1 15 Microbiology ...... I 19 Biochemistry ...... 121 Pharmacy ...... 125 Physiotherapy ...... 128 Radiology ...... : ...... 130 School of Nursing ...... 136 School of Physiotherapy ...... 142 Speech and Language Therapy ...... 145 Surgery: General ...... 146 General Colorectal ...... 150 Gynaecology ...... 152 Plastics and Reconstructive Surgery ...... 1S4 Vascular Surgery ...... 155 Hospital Staff ...... 156 Development of Hospital ...... 160 Sisters of Mercy ...... 162 _1_ MATER MISERICORDlAE HOSPITAL ANNUAL REPORT 1995
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 hospital 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 the hospital as a beneficiary.
"2'" MATER MISER/CaRDIAE HOSPITAL ANNUAL REpORT 1995
MATER MISERICORDIAE HOSPITAL ECCLES STREET DUBLIN 7
Proprietors Mercy Generalate. Sisters of Mercy. Eblana Avenue. Dun Laoghaire. Co. Dublin.
Superior General Sr. Dervilla Byrne
Superior, Mater Sr. M. Bernarde Misericordiae Hospital
Foundress of Order Mother Catherine McAuley Born: 29th September 1778 Died: 11th November 1841
_3_ ------~
MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995
1 I
BOARD OF MANAGEMENT
Chairman Most Rev. Dr. Desmond Connell Archbishop of Dublin
Executive Chairman Sr. M. Margherita Rock
Secretary Mr. D.j. O'Flynn
Members Ms. D. Bernal Sr. M. Bernarde Mr. EA Clarke '.' Professor ].T. Ennis Sr. M. of the Incarnation Sr. M. joseph Professor]. Kelly Dr. P. Kelly Mrs. E. Lovatt·Dolan Mr. M. Lucey Mr. G. Magee Professor D. Moriarty Mr. G.S. MacGabhann Sr. E. McAuliffe Mr. j. O'Connor Mr. E. O'Malley Dr. D. Sugrue
EXECUTIVE COUNCIL
Chairman Mr. M. Cowley
Members Professor ].T. Ennis Sr. M. Margherita Sr. M. of the Incarnation Mr. K. O'Malley Mr. E.A. Clarke MATER MISERICORDJAE HOSPITAL ANNuAL REPORT 1995
Ill ••
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
__ 5" MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995
ADDRESS OF THE MOST REVEREND DESMOND CONNELL, D.D., ARCHBISHOP OF DUBLIN
ON THE OCCASION OF THE TWENTY THIRD ANNUAL GENERAL MEETING OF THE BOARD OF MANAGEMENT OF THE MATER MISERICORDIAE HOSPITAL
- ~ \ ••. ,;. : I ,;.' • _ ,:.. • The kind of society in which,this Hospitalwas founded and flourished for'. mo~~ chan .-~e~tury differedprofoundlyirom the kind of~oci';ty d.at'the rapid changes of recent times has been shaping. I am not thinking so much of advances in medical science or of the consequent increase in state assistance or even of the economic conditions of the people we serve. I am thinking of deeper changes in social organisation and attitudes that are making their impact on our very sense of identity.
The Ireland of the recent past would now be described as a relatively closed society. certainly it was more close knit in itself and distinct in its identity. The ties of the extended family were firm. People grew up with a strong feel for their own local community. Even Dublin was more like a collection of villages than the conurbation it has since become. Rootedness in family and in local community helped us to grow in our sense of identity to know who we are and where we have come from. All this was good and important in its human significance. but no society is perfect. The old order had its disadvantages too. One might feel that other people knew one too well. that one could hardly escape notice or censure if one refused to conform to accepted standards of behaviour. All that was symbolised for us in the image Most Rev. Dr. Desmond Connell. Archbis/rop of Dublin of the squinting windows. Much of the anger and bitterness, especially in our literature and journalism. can be traced to this kind of resentment.
More recently we have been changing into what is termed an "open society". I would rather call it a "mass SOciety". This indeed is the kind of society that values individual freedom above all. But it too exacts its toll in human terms with the loosening of family and community ties. Insecurity about personal identity may induce disquietude about selfworth for ~e c~nvict!o~ ab9ut selfworth is not j~st a matter about pe~onal satisfaction wi~ a chosen lifestyle .• it.is.i~~~itably dependent on endorsement by others as well. That is why the society which exults individualJreedom still feels the need to frame its own norms of social respectability. what has come to be called· politicai correctness. ..
Of course the mass society has its squinting windows too. One only has to think of the media interest in the Dungarvan Affair. No ferret of the old society would begin to match some elements in the media once they have scented a story. A great need is coming to be felt for courses to help people in developing a sense of selfworth. Many are available. and I am unable to say how successful they are. Of one thing, however. I am sure, the true remedy that people are seeking can only be the work of love. The mass society, with its widespread experience of ruthlessness and isolation, has need of the vojce of love, of the love which is able sincerely to say: "you are worth the whole world to me."
At the deepest level of all this is the voice of God who didn't spare his own Son, but gave Him.up for us all. In response to that voice the Church is able to say in the words of St. Paul ')live in the Faith of the Son of God who loved me and gave Himselffor me'.
The love of God which every disciple of Christ is called to bear in his or her heart so as to overflow to others is the reason why the work of our Hospital continues with its mission intact and renewed in our society today. -=6==- MATER MISERICORDlAE HOSPITAL ANNUAL REpORT 1995
! !
The forthcoming celebration of second millennium of the coming of Christ invites us to set out on a period of preparation. This is to be the theme of the programme of pastoral renewal in this Diocese over the next few years.
In celebrating the second millennium of the coming of Christ we are not just recalling the birth of a historical person who left behind an inspiring life story and teaching, as other great figures in history have done. In describing Himself as the Good Shepherd, Christ said "I know my own and my own know me. Just as the Father knows me and I know the Father." This knowledge of Christ is the simple reality of the Christian life.
It is one thing to know about a person but it is an entirely different thing to know a person. We may know much about other historical personages from accounts of their lives and teachings that have been handed down, but there is no way in which we can come to know them once they are dead.
St. Augustine explains this when he says that one comes to know a person only through friendship. The communion of life and of love which is friendship can exist only between persons who are alive and that is why the knowledge we have of Christ proclaims that He is alive and in knowing Him we have a kind of experimental knowledge of his resurrection from death. Yes, Christ is alive and with us in the Church.
The whole history of the Church bears witness to this wonderful truth. No-one has ever been loved as Christ has been loved throughout the ages and will continue to be loved until the end of time. Ever since He lived on earth and rose again from death He has been present amongst us, captivating hearts and inspiring them with His love.
He has dwelt in the hearts of young people as they come to consecrate their married love in his presence. He has dwelt in their homes as they taught their little ones to love Him. He has come close to the lonely and abandoned, brought strength to the tempted. hope to the dying, comfort to the bereaved. He has drawn the hearts of many to follow Him in lives of complete dedication and service and He has accompanied them as they have gone out even to the ends of the earth for His sake.
Over and over again, men and women and little children have suffered and died rather than deny that they love Him. There is nothing to compare with this. All that is merely human in this world will inevitably perish. If the love of Christ is imperishable and always present, it is because there is something more than human here.
In our knowledge of Christ, in our awareness that He knows each one of us, in the wonderful reality of His love we have the beginnings of our experience of God.
We all live today with what might be described as illusions of intimacy, the kind of illusion created by radio and television. I don't begrudge the great good accomplished in this way or the comfort that many who are lonely derive from this appearance of human contact. The illusion, indeed, often seems more real than the empty reality to which they must return after the programme is over. You know what I am talking about. You've been watching a show on television and just before it closes the presenter takes his leave with 'see you next week'. J've often noticed the readers of the News saying that. In your heart of hearts you know very well that he has never seen you in his life and if he did see you or sat beside you in the bus he wouldn't know you from Adam.
Our hearts weren't made to live on illusions of this kind, they cry out for what is real. We have all of course tasted something of the reality in our intimacy with those we have loved but that too is a fragile reality, subject to the ups and downs of all human relationships. Above all it is perishable. As we grow older those who have been close to us are taken from us by death. Once again our hearts weren't made JUSt to live on a perishable reality of that kind, they cry out for what is enduring. "Thou hast made us for thyself, Oh Lord" says St. Augustine, "and our heart is resdess until it rests in thee." "I know my own and my own know me, just as the Father knows me and I know the Father." The knowledge of which Christ speaks is the imperishable reality because it is a sharing in the knowledge of God. To be intimate with Christ is to enter into the intimacy of Father and Son. "In the beginning and before anything was made, the Word. that is the Son was with the Father."
Notice that "with", the "with" of deepest intimacy, the "with" of knowledge and understanding, of joy and contentment, of the abundance of life of the love of the Holy Spirit. That's why we cannot remain isolated and alone, why we long to be With, because we are made in God's image and the grace of God is that He has made us to be with Himself. This is the message that we have to proclaim anew throughout_7_ the Diocese as we prepare to celebrate the second millennium. MATER MISERICORDJAE HOSPITAL ANNUAL REPORT 1995
It lies at the origin of the Ethos of this Hospital and I invite the Hospital to join in the forthcoming preparation and renewal which is to be our programme in the years ahead.
It gave me much pleasure to hear of the election of Sr. Helena as Provincial Superior. I wish her God's blessing and I assure her of my s~pport in all that concerns the Hospital and the many responsibilities of the Province. I congratulate Sr. Margherita and the members of the Board of Management on the completion of another successful year in the life of the Hospital.
I thank Mr. Cowley and the Executive Council for their dedicated service. I wish to express my admiration for the medical, nursing and the support staff. It is the willing co-operation between many. with their various skills and diversity of professional excellence that continues to maintain in the public esteem the exceptional reputation of the Hospital as one of the most sincerely appreciated institutions of the city of Dublin_
'.'1" .110 •. , ~_ _. MATER MISERICORDIAE HOSPITAL ANNUAL REpORT 1995
• I
ADDRESS OF THE EXECUTIVE CHAIRPERSON OF THE BOARD OF MANAGEMENT
It is indeed a great honour for me to have an opportunity once again to present the Annual General Report so thoroughly prepared by our Chief Executive, Mr. Martin Cowley and his team.
It is encouraging to note the progress achieved and the successes accomplished. Of course, there are some aspirations which have not been realised as well as some unresolved issues which serve to keep us striving until solutions are found.
Successful organisations frequendy attribute their successes to the foresight. intelligence and skill of their managers. Conversely, when things go wrong, problems are often blamed on what is perceived to be lack of foresight. lack of planning. lack of communication and/or lack of consultation on the management's part.
The truth is, however, that both these assumptions miss the mark. Such factors as the structure of the organisation. irs aims and objectives. its distribution of authority and responsibility, the accountability and proficiency of its staff, its Sr. Margherila Rock, Executive corporate culture as well as its strategies and decision making practices, all tend Chairperson ojlhe Board 0/ Management. to influence, fashion and shape outcomes, whether positive or negative.
Organisations such as our own are also invariably influenced and driven by other considerations such as economic factors, new technologies etc. and anyone of these can have a profound impact on outcomes. Above all. it is also true to say that a culture of excellence in a context such as this hospital is decidedly contingent upon the commitment and performance of a committed. energetic. task-orientated staff who subscribe to the same goals as those of the Management Team.
The question is: how is such and environment created~ We have been fortunate in the Mater to have always had a tradition and a culture in which staff have preformed at very high levels of excellence.
For us. the question is then: how can we ensure the preservation of this tradition, this culture of professionalism. of dedicated caring for the sick. a service which is itself characterised by uniqueness, diversity, complexity and sensitivity.
In our management strategy, we firmly believe in the principle that where 'power' is dispersed, and where the process of decision-making is shared, initiative invariably thrives.
This is reflected in the invaluable contribution of the Medical Executive to policy and decision making. It is reflected in the commitment and resourcefulness of the many staff who are members of the various sub-committees on which the Hospital's infrastructure is based. Ultimately, it is reflected in the very impressive range of developments which are recorded in successive annual reports and 1995 is no exception.
The report for 1995 portrays a period of innovation, expansion and development in physical plant. in facilities and services. as well as in the areas of education. training and research. It establishes the extent to which we achieved targeted goals and dealt with unplanned or unexpected demands. Key areas requiring urgent attention as soon as funding becomes available are outlined. Deficiencies and challenges are identified.
Throughout the year, much attention was directed to the ongoing programme of refurbishment of the main hospital. Vacated areas have been re-designated, re-designed and refurbished to meet new needs. The Development Brief for the future development of the Hospital has been successfully completed by the Joint Mater/Department of Health Project Team. Here, I would like to acknowledge the work of the Project Team under the Chairmanship of Mr. Michael Lucey. - 9 - MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995
The work of the over-all Education Committee has also advanced. The major elements of the Hospital's Education Programme were identified and the extent of the Hospital's involvement in training was established. A review to the levels of supervision and facilities necessary to meet the requirement of accrediting bodies and higher committees on training in the health related professions was undertaken. Areas of special need were identified and discussions are in train to devise ways of meeting them.
During the course of the year, numerous seminars and in-house training events took place in addition to the standard in service programmes and staff development courses. Among the highlights were the management training programme organised in partnership with the Institute of Public Administration in which a large number of key staff participated. New initiatives included the introduction of a diploma course in Medical Informatics in conjunction with University College Dublin. and a new diploma course in Family Therapy in conjunction with the U,niversity of limerick. Work on the development of the curriculum for the Pre-Registration Diploma Course in Nursing in conjunction with University College Dublin also commenced.
A number of specialist conferences were held at which many professionals from prestigious centres of excellence abroad were in attendance. Many scientific presentations by our staff together. with scientific papers and publications are listed in the report. We acknowledge the support 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 Board of Management also acknowledges the sterling work of the Chief Executive and his management team. Thanks to their combined expertise and commitment, an enhanced level of activity and performance was realised and a satisfactory financial outturn for 1995 was achieved. Our congratulations to each of you and our appreciation for your dedication. loyalty and commitment to the hospital and its objectives.
I wish to thank in a special way the members of the Board of Management whose single-minded interest. wisdom and expertise. are of immeasurable benefit, With full confidence in this support. the members of the Executive ~ouncil are enabled to progress the day-to-day management of the affairs of the Hospital.
The role to the Executive Committee of the Hospital's Medical Council is manifestly of enormous importance - both to the performance of the Hospital as a whole and the quality of service it delivers to its patients. Under the leadership of its Chairman. Professor Joe Ennis. the Medical Executive exercises a pro-active and pivotal role in strategic planning. decision making and indeed in every aspect of the Hospital's functioning. On behalf of the Board of Management, I wish to acknowledge the high level of academic and medical expertise of our Consultants. their international reputation for professional excellence. and their concern for the continued growth and progress of the Hospital for the benefit of patients.
I wish to convey our gratitude to Sister Mary of the Incarnation. Director of NurSing. to'the Nursing Administration Team. to the Principal and Staff of the Mater School of Nursing. to the Ward Sisters and Departmental Sisters. On behalf of the Board of Management, I wish to express our appreciation of the high standard of nursing care provided to patients who so frequently express in writing their own personal appreciation of the care and concern they have experienced during their hospital stay..
I also wish to express our thanks to the staff of the Finance and Personnel Departments. the Management Services Department; the Patient Services. Technical Services. and General Services Departments; the Heads of Department and Clinical Divisions. members of the various sub-committees which constitute the infra-structure of the Hospital and on which it depends so much.
As in previous years. the Board of Management continues to endeavour to manage the Hospital in an efficient and cost effective manner and in co-operation with the Deparunent of Health to make maximum use of scarce resources to the best possible benefit of the patients.
Our thanks to the Minister for Health for the level of funding afforded to the Hospital and to his officials for their continued interest and support.
Our thanks to the President and Registrar of UniverSity College Dublin. to the Dean of the Faculty of Medicine of University College Dublin. and to the many other agencies and profession~1 bodies with which the Mater is associated.
~10~ MATER MISERICORDIAE HOSPITAL ANNUAL REpORT 1995
A source of great encouragement to the Hospital is the work of the Mater Foundation. Under the Chairmanship of Mr. Declan McCourt and managed by Mr. Joe McAvin, the various sub-committees work toward raising funds for a variety of projects in the Hospital. We are grateful not only for this, much appreciated, 'extra' funding but for the support and commitment which the efforts of the members symbolise.
I should like to avail of this opportunity to thank our Legal Advisors, Arthur O'Hagan, Solicitors; our Auditors, R.J. Kidney & Co.; our Property Consultants, Messrs. Harrington & Bannon; our Insurers, Sedgwick Dineen Ltd.; our Public Relations Consultants, Slattery Public Relations Ltd.; the staff of the Bank of Ireland, Dorset Street; and the many other local agencies which support the Hospital.
On behalf of the Board, I wish to extend our gratitude and good wishes to our Chairman, Archbishop Desmond Connell, to Sister Dervilla, Superior General of the Sisters of Mercy (Ireland), to Sister Helena, our Provincial, and to Sister Gerard and the Community of Sisters of Mercy here at the Mater. We know that they can always be relied on for their support and this is a treasured gift.
As stated earlier, we owe a debt of gratitude to many people. To one group in particular we owe the greatest debt of all. These cannot be named except by placing them in a generalised category. I refer to the patients who have the courage to face their illnesses, who avail of the Hospital's service and in the process, bring us many blessings.
In the words of the foundress of the Sisters of Mercy, Catherine McAuley, 'It is a very great privileged to minister to the sick and relieve them of their pain'.
Thank you all for your contribution toward making it possible to experience that privileged ministry in the Mater Misericordiae Hospital.
Sister Margherita Rock. Executive Chairperson, Board of ManagemenL
September 3rd 1996.
_11_ MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995
"l! •
REPORT OF THE CHAIRMAN OF THE EXECUTIVE COUNCIL
Introduction:
In many respects 1995 was a satisfactory year for the hospital. On the credit /~ side. the hospital balanced its books. received extra funding from the I Department of Health for a number of service developments and submitted the development brief for its expansion programme to the Department of Health. Howev_er. on the debit side. the ea~ly part qf the year,was dominated by crises in the Accident and Emergency Department due to difficulties in allocating beds for emergency patients.
As in previous years, The Executive Council dealt with many issues relating to the day to day management of the hospital.
In this context I would like to acknowledge the significant contributions of all members of the Executive Council. each of whom played a significant part in the overall management of the hospital. In addition the Medical Executive and Nursing Executive are vital components in the hospital's management structure and I would also like to acknowledge the contributions of the members of these Mr. M. Cowley, ChiefExecuhl1e, Chairman of the Executil1(' Council two Executives.
The membership of the Executive Council for 1995 comprised:
Mr. M. Cowley Chairman Sr. Margherita. Executive Chairperson Mr. E. Clarke Board Representative Prof. J. T. Ennis Chairman, Medical Executive Mr. K. O' Malley. Secretary, Medical Executive Sr. Mary of the Incarnation, Director of Nursing Mr. B. Conlan. Financial Controller
•____ 12 __ ....lI •• MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995
E!
1995 Service Developments:
I. Bed Numbers:
The number of beds in late 1995 was 534 as compared to 504 beds in 1994. The increase in bed numbers significandy helped the hospital achieve its service targets and helped to avert a further Accident and Emergency crisis in the Winter months of 1995/1996.
2. Cardiac Surgery:
The hospital successfully honoured its commitment of 1,000 open heart cardiac surgery cases in 1995. However, despite this achievement, the cardiac surgery waiting list at the 31 st December, 1995 was 1,700 which is unacceptably high. The hospital will support any initiative by the Department of Health to reduce the waiting list in this specialey.
3. Additional funding totalling £430,000 was provided for the following.
(a) The opening of 12 Observation beds attached to the Accident and Emergency Department. (b) Cardiology (for stenting, angioplasey etc.). (c) The Intensive Care Unit (extra staff and facilities). (d) Plastic Surgery service (on-call service in particular). (e) Vascular Surgery (provision of a new laboratory service). (I) Rheumatology.
4. A number of other developments were funded by the Department of Health and are currendy in the advanced planning stage.
(a) Day Unit for chemotherapy patients. (b) Appointment of a G.P. liaison Nurse. (c) Proposed extension of the Infectious Diseases Unit.
As in previous years, the hospital participated on the National Waiting list Initiative. An additional 943 cases were undertaken as the hospital's contribution towards the National Waiting list Initiative.
In financial terms this resulted in an increase of £620,000 in the hospital's budget. Included in this sum was a provision for funding a new day service in the Dermatology Day Centre in 59 Eccles Street.
In addition a new Bronchoscopy Unit/Pulmonary Function Unit was commissioned during the year.
Developments - Non-Clinical:
Under this general heading, the following initiatives are worthy of mention.
I. Management training programme, mainly for middle management which was organised by the I.P.A. in conjunction with the hospital. This course was run over a number of months and comprised lectures. workshops and project work.
2. Combined Heat and Power initiative yielding future savings on energy as a result of the hospital generating its own electriciey and selling surplus capaciey to the E.S.B.
3. Skill Mix Patient Dependency study which will assess the future nursing requirements for the hospital, particularly in the context of the new diploma for pre-registration nurses. _13_ MATER MISERICORDlAE HOSPITAL ANNUAL REPORT 1995
4. A nursing curriculum sub-committee was put in place for the purpose of designing a curriculum for the new diploma course for pre-registration nurses. I would like to thank the members of this committee for their work during the year. It is envisaged that the hospital will be accepted to the new diploma course in 1997:
5. The 25th Anniversary of St. Paul's Hospital, Beaumont was celebrated during the year. I would like to take this opportunity of acknowledging the sterling work of the Medical Director (Dr. P. McQuaid), the Matron/Administrator, (Mr.. Mary Jefferies) and the School Principal (Mr. Sean Griffin) over the years in caring for autistic and emotionally disturbed children.
6. A significant achievement during the year was the establishment of an Occupational Health Department headed up by Dr. Dominick Nadn, the newly appointed Occupational Health Physician.
7. 'An Education Sub-Committee was established to'oversee all education and training activities within the hospital.- It is 'envisaged that this committee will playa very. important role in the affairs 'of the: hospital over the coming years. It is the wish of the hospital to copperfasten itS links with U.C.D. so that the Mater will enhance its reputation as a major teaching hospital.
8. Dr. Frank Powell initiated a hospital orientation programme for 4th year secondary transition students. This programme was launched by Mr. Austin Curry T.D., Minister for State at the Departments of Health and Education. The programme was over subscribed and proved very popular.
9. Safety Health and Welfare at Work Act: The hospital received additional funding totalling £247,000 for the purpose of improving facilities for staff in the context of the Safety, Health and Welfare at Work Act.
10. The Management of the hospital, assisted by the relevant committees such as the Health and Safety Committee, paid particular attention to risk management issues. Unfortunately, needlestick injuries continue to be a major cause of concern.
'1 I. Quality Improvement Committee: A Quality Improvement Committee was established for the purpose of implementing a continuous quality improvement programme in the hospital incorporating the following:
- Patient focus service - Staff involvement - Training - Examination of process and systems - Measurement and continuous improvement
12. A new creche (Suantrai) for staff members, was opened during the year in No. 62163 Eccles Street. . '.:
Casemix
The casemix index for the hospital increased to 1.48 from 1.42 in the previous year. This is the highest casemix index in the country and indicates. that for the current year the Mater Hospital treated the most complex and costly patients nationwide. As a consequence, the budget of the hospital was increased by £230,000 which rewarded the Mater Hospital for its efficiency relative to the other major hospitals wi'th whom we were compared. This was in fact the highest casemix adjustment of all the Dublin hospitals. MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995
III
Hospital Development Programme
As indicated in the introduction, the Department of Health agreed the development brief for the hospital which envisages the development of the hospital on a phased basis.
A Project Team was established under the Chairmanship of Mr. Michael Lucey, Board member, to oversee the development programme of the hospital including the preparation of the development brief and the development control plan.
I would like to acknowledge the significant contribution of Mr. Lucey and the other members of the Project Team in completing the development brief in such a short time frame.
I would like also co record, the co-option of two representatives from the Children's Hospital, Temple Street to the Mater Hospital Project Team. This is testimony to the commitment of both the hospital and the Department of Health to the transfer of the Children's Hospital, Temple Street to the Mater site as an integral component of the hospital's future development plans.
The original plan for the development of the Mater Hospital was for the provision of a 775 bed hospital. With the passage of time and changes which have taken place in healthcare it has been accepted that 600 beds would be the optimum number of beds required as a result of the advances of new technology.
The new emphasis placed on five day beds, one day beds, day surgery and ambulatory care facilities results in the quicker throughput of patients.
The Minister for Health was made aware that the hospital had formed the view that the Phase I B development as planned in 1977 was obsolete and required revision in order to reflect modern concepts in the delivery of a healthcare service.
Following formal approval from the Department of Health a new Project Team was set up in February 1995 and a revised brief for the proposed development was drawn up. The completed brief was submitted to the Department of health in November 1995 and included the follOWing areas:-
Accident & Emergency Outpatient Department/Day Procedures/Ambulatory Care Department of Medicine for the Elderly Day Surgery Unit Operating Theatre Department Catering Central Supplies Department Hospital Sterile Supplies Department Pharmacy Medical Illustration and Clinical Department Hostel Administrative Services Chaplaincy Department Medical Social Work Department Central Changing Autopsy/Mortuary Chapel Technical Services Maintenance Work X-Ray, Radio-isocope and Ultrasound Diagnostics Car Park Helipad
Due to budgetary constraints it was agreed that revised proposals should be progressed on a phased basis.
The appointment of a new Design Team is awaited. The first cask for the new Design Team will be to prepare a development control plan following which detailed_15_ plans for Phase I of the development will be drawn up. MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995
I I
Issues Impinging on the Delivery of Services
As in reports in earlier years, 1 would like to comment on a number of factors which have adversely affected service delivery in 1995, as follows:
I. Accident and Emergency Crisis
As stated in the introduction, there were significant crises in the Accident and Emergency Department in the earlier part of the year. Patients were required to spend entire nights on trollies in the Accident and . Emergency Department and the Dressings Clinic was cancelled on a number 'of occasions. This all culminated in industrial action by nurses in the Accident and Emergency Department. Similar problems were experienced in the other Dublin Hospitals. The effect on elective admissions in the hospital was at times catastrophic and the situation was exacerbated by the lack of suitable sub-acute facilities' in the community. At one stage, 77 patie'nts were'identified as awaiting beds and other facilities in'the community and in other hospitals.
However, later in the year. a number of initiatives were put in place both by the Department of Health and the hospital itself with a view to alleviating these problems.
The general physical condition of the Accident and Emergency Department continues to be a matter of concern.
As in previous years, the number of attendances at the Mater Accident and Emergency Department was the highest in the country.
A stress facilitation service for Accident and Emergency staff was initiated during the year.
2. The Board of Management and the Executive Council continues to be concerned at the extensive waiting list for OPD appointments.
3. As in most hospitals worldwide, MRSA continues to be a significant problem resulting in high cost and long lengths of stay.
4. The shortfall in theatre sessions continues to be a major problem which hopefully will be rectified as part of the hospital's development programme.
5. The facilities in the G.!. Unit are less than optimal and require urgent remedial action. A new G.!. Unit will be part of the first phase of the hospital's new development programme.
6. Ophthalmology: There are continuing problems in the Ophthalmology Department due to the non-filling of a vacant consultant post for a number of years.
7. Neurology: The absence of a significant neurology presence at the Mater continues to be a matter of serious concern.
8. C.S.SD.: The C.S.S.D. Department requires urgent upgrading for which additional capital funding is required.
9. Pain Management Clinic: The Pain Management Clinic. which provides a very important and useful service, is inadequately resourced in terms of N.C.H.D. and secretarial cover.
10. Adolescent Psychiatry: The absence of suitable accommodation for adolescent psychiatric patients continues to be an ongoing problem.
I I. Hepatitis C: The hospital continued to play its part in diagnosing and treating Hepatitis C patients affected by the problems in the Blood Transfusion Service Board. However. despite a budget of £330,000 fo~ this service, the hospital continues to experience problems in its infrastructure which makes it difficult to deliver a service in appropriate surroundings to these patients. Not withstanding this, Doctor John Crowe is to be complimented on a first class service provided under difficult conditions. MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 ....
12. Lung and Heart/Lung Transplant Service: Patients continue to be referred abroad for lung and heart/lung transplant operations. During the year, the Mater was requested to make a submission to the Department of Health for funding and facilities to provide this service.
I]. A number of services are provided in Numbers 4]-51 Eccles Street (Diabetic Day Centre. Breast Screening and Surgical Professorial Unit) in most unsatisfactory conditions. As a maner of urgency. these problems should be addressed.
14. Medical Records: During the year staffing difficulties were experienced in the Medical Records Department culminating in the abandonment of the pilot OUt of hours data collection arrangements.
15. Employment Control: The hospital employed 1.824 staff at year end which was in excess of the approved Department of Health employment ceiling. This continues to be a matter of concern for both the hospital and the Department. Unfortunately. it is not possible for the hospital to deliver the level of service required on the basis of the numbers of staff offiCially sanctioned. Staff at all levels in the hospital are under significant pressure due to our relatively low staffing levels. As an example there is a particular requirement for ward clerks and other ancillary staff at ward level.
16. Telephone System: There is a requirement to upgrade the hospital's telephone system. It is envisaged that a new system will be installed in 1996.
Developments Outside the Hospital Impinging on the Mater
I. Health Strategy: The hospital is fully cognisant of the aspirations as set out in the National Health Strategy which was published in May. 1994.
The hospital has. over the past years. embarked on a number of initiatives which would be in line with the thinking behind the Health Strategy.
Examples are:
- Affiliate membership of the Network of Health Promoting Hospitals. - Integration of psychiatric services with community services. - Greater co-ordination with G.P. services including Computer Healthlink Project and appointment of a G.P. liaison Nurse. - Initiation of a Quality Improvement Programme. - Management training and development courses. - Establishment of an Education Sub-Committee to oversee all education and training activities in the hospital. - Support for the pilot Cancer Breast Screening Project. - Ongoing review of management structures. - Culture of cost efficiency promulgated by Executive Council. - Development of information technology systems. - Upgrading of Pharmacy and Pharmacy systems to facilitate the continuing emphasis on good quality prescribing by doctors. - Fostering a culture of equitable access to services for all members of the community. - Establishment of a service for HIV/AIDS patients. - Establishment of a Department of Medicine for the Elderly. - Participation in the provision of services for persons with mental handicap through St. Paul's Hospital. Beaumont. - Establishing informal links with a major hospital in Belfast.
During the month of July. the hospital was congratulated by the Department of Health on the steps it had already taken to implement the strategy._17_ The hospital was acknowledged as a centre of excellence focusing MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995
particularly on clinical audit. clinical outcome and quality of care both in the clinical and non-clinical areas. There is a low rate of complaints. its casemix is impressive and the manner in which it prioritises its development programme were all highlighted. Other points noted by the Department were the hospitals' shift towards day work and the manner in which it controlled its finances. However. the hospital was criticised for its open door policy and its relatively high rate of return visits in the Accident and Emergency department.
2. Conciliation and Arbitration Scheme: During the year discussions took place regarding the establishment of a new conciliation an.d arbitration scheme as well as a new agency [0 co-ordinate the management of change and industrial relations activities of all health agencies.
3. Materials Management Advisory Committee: On the non-pay side a Materials Management Advisory Group was established by the Department of Health to examine and prepare a report on all aspects of materials management in the health service. I was a member of this committee, representing the Voluntary Hospitals . Sector. It is hoped that the final report of this committee will be issued to the Minister in 1996.
Consultant Appointments:
The following consultants commenced during 1995.
Dr. james Gardiner, Consultant Anaesthetist Rotunda/Mater Hospitals - 19th January. 1995.
Dr. Mary Bowen, Consultant Anaesthetist Rotunda/Mater Hospitals - 29th May. 1995.
Dr. john Sheehon. Consultant Psychiatrist with a special interest in liaison Psychiatry Mater/Rotunda/Eastern Health Board - IstJune. 1995.
Dr. Frank Chambers. Consultant Anaesthetist Mater Hospital - 10th July. 1995.
Mr. john Hurley. Consultant Cardio-Thoracic Surgeon with a special interest in Transplantation Mater Hospital - I st August. 1995.
Dr. Padraic MacMathuna, Consultant Physician/Gastroenterologist Mater/Rotunda Hospitals - I st September. 1995.
Mr. Darragh Hynes. Consultant Orthopaedic Surgeon Mater/Cappagh Hospitals - 4th September. 1995.
The following consultant posts were approved in 1995 but not filled until 1996:
Mr. W. Grant's replacement - ENT Surgeon (Mr. john Russell appointed)
Replacement for Dr. P. McCann (Dr. john Murray appointed)
Gynaecologist to replace Dr. Peter McKenna now Master of the Rotunda Hospital (Mr. William Boyd appointed)
Mr. james 0. Small. new Plastic Surgeon will take up duty in 1996. MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995
I •
Dr. C. Barry's RheumatologiSt post approved (to be filled in late 1996)
Professor of Medicine post approved but not filled until 1996
3 additional Anaesthetics posts (to be filled in 1996)
- Dr. C. Redahan - Dr. D. Carson - Dr. B. Marsh
On the Ist January, 1995, Dr. Peter McKenna took up his post as Master of the Rotunda Hospital as indicated in last years' report.
It is with deep regret members of the Executive Council noted the deaths of Professor Patrick Dwyer Joyce, Consultant Ophthalmologist and Mr. Sean Heffernan, General Surgeon.
Retirements from the Board of Management:
The following retired from the Board of Management during the year.
Mr. Gearoid MacGabhann, ex Chief Executive. Mr. MacGabhanns' significant contribution to the hOSpital both as Chief Executive and later as Board Member were acknowledged by the members of the Executive Council and the Board of Management.
Professor John Kelly, the U.C.D. representative on the Board resigned and was replaced by Dr. Caroline Hussey, the new U.C.D. Registrar.
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 management achieve a balanced budget.
Martin Cowley, Chairman. Executive Council. _19_ MATER MISERICORDlAE HOSPITAL ANNUAL REPORT 1995 -- ADDRESS OF THE CHAIRMAN OF THE EXECUTIVE COMMITTEE OF THE MEDICAL COUNCIL
The European Union is seen by some, as an example of visionary excellence uniting many disparate countries and raising standards throughout Europe. and by others as an erosion of basic democratic process of individual nations. There is little doubt that the European Union has stilled the turbulence that beset Europe for many centuries and has strength~.ned and expanded education, communication -and understanding. Programmes such'as "Erasmus" and "Tempest" have encouraged freedom of movement and help to foster cross fertilisation that has benefited every Member State. The concepts of providing better education with enhanced medical facilities and providing support for the poorer nat.ions were the principles that founded the Mater Misericordiae Hospital.
Catherine McAuley's compelling objectives in founding the Sisters of Mercy were primarily humanitarian to:
a) Eliminate the unspeakable squalor which suffocated the disadvantaged. b) Educate the impoverished population and thus remove the permanent Professor J. T. Ennis. Cluzirmon. Executi~'e Comminee oflhe Medical Council. state of dependency for many citizens of Dublin. c) To provide adequate medical care for the sick.
Visionary, compassionate. educated and driven she succeeded way beyond her predictions. When founding the Order in the early part of the 19th century with the intention of building a hospital to look after the sick poor of Dublin she had very little concept of the educational asset which would be provided for this country. She probably did not realise that her contribution would echo the sentiments expressed many. many years before by Edmund Burke i.e. "SoCiety and education is a contract; it is a partnership in all science; a partnership in all art; a partnership in every virtue; and in all perfection." He was defining a community of scholars and as such might have referred to what developed on Eccles Street with t.he foundation of Newman's Catholic University.
John Henry Newman left the Anglican Church on an October night in 1845 in the village of Littlemore, near Oxford, to embrace Catholicism. It brought to Catholicism a unique talent that remains undiminished to this day and followed on for years of deliberation, study and reason. The British Press denounced the renowned leader of the "Oxford Movement" for having entered the forbidding walls of the Church of Rome.
While Newman's intellect was awesome, his· educational concepts were brilliant and original and as a liberal theologian he was the author of the greatest tome in University Education i.e. "The Idea of a University". In a series of lectures based on this. which he delivered in the Rotunda in the mid I 850s, he crystallised his concept of a liberal education based on t.he Catholic ethos. These guidelines are still enshrined in University handbooks throughout England, Scotland, Europe and Australasia.
In the audience at the Rotunda. and impressed by the concepts of the Catholic Universi~. the then Archbishop of Dublin. Dr. Cullen. persuaded Newman to create such a Catholic University in Dublin. While he was Rector for only a short period (1854-1858) in that short time he founded Newman's Catholic University Medical School based in Cecilia Street. Hospital training for Cecilia Street Undergraduates was sporadic but all of this changed in 1861. when the Mater Hospital opened its doors in November to receive its first patient. On that same day the Medical Board met and agreed to accept medical students from Newman's Catholic University Medical School. The Mater thus became the first Teaching Hospital of what would ultimately become the Royal University and finally University College Dublin. It is this historical relationship between academic, clinical and humanitarian interests that have governed the Mater Hospital in the last 140 years.
.-L·__ 20'-- _____-. MATER MISERICORDIAE HOSPITAL ANNUAL REpORT 1995
I I
Hospital Management
Hospitals prosper when there is recognition of contributions of all special interests involved in management and patient care. It is this broad recognition that fuels the cross speciality development of excellent standards. In the Mater Hospital, the Medical Board has always played a major part in developing this partnership and played a major role in developing the broad based clinical skills that saw this hospital being the first to introduce specialisation at the end of the 19th Century, It made it possible for the Hospital to develop skills in Cardiac Surgery, Electron Microscopy, Cancer Management. Breast Cancer Screening and many other innovations.
While much has been written about the value of Clinical Directorates, very little now exists to show that these imposed paid posts succeed in developing an agreed approach to Management. Management of Hospitals require a greater degree of interdependence between the Medical Specialities and the Management Structures to prosper. The Mater Hospital's ,Constitution recognises the contribution of the medical staff in the management of the Hospital and the philosophy not only enables Consultants to participate in preserving the legacy of 1861 but actively encourages the continuation of this role. The Medical Executive, elected by their colleagues, with ex-officio membership of the Board of Management can therefore play an important role in the partnership of management of the Mater Hospital. It is this recognition that has enabled the Hospital to continue its high profile medical activity and at the same time to balance its budget over the last two years. While the one per cent levy may hinder this objective in 1996 it has not diminished the expectation that the Hospital will reach its agreed service commitment with a balanced budget.
The Development Plan
The opening of Phase I A contributed enormous benefits to patients in relation to facilities. The anticipation that Phase I B would follow was not realised and led to some disappointment. The benefits, however, was that the old Hospital was refurbished to a high degree. The Cardiac Surgical, Intensive Care, High Dependency Unit and the refurbishment of the top floor have been a unique achievement that provides the architectural excellence of the mid-19th Century with the most up to date modern Intensive Care facilities for patient treatmenL Similar developments in Psychiatry, Infectious Disease, Nuclear Medicine, Cardiology, Day Theatre, Observation Beds, Pulmonary Laboratory have all prospered in the old Hospital and have enhanced this gracious building.
However. there is a huge deficit in patient care facilities that have been tolerated for a considerable time and now need to be addressed as a matter of urgency. With the agreement of the Department of Health a Development Plan based on the requirements of the 21 st Century was completed within three months. It envisages the complete refurbishment of the Accident & Emergency facilities and the development on a phased basis of Clinical Out Patients and Ambulatory Care Facilities. It anticipates the provision of up to date Theatre facilities. it anticipates and welcomes the expansion of the Mater Campus to incorporate Temple Street Hospital within the foreseeable future. While these developments have been actively supported by the Department of Health and have been endorsed by the Minister for Health, funding needs to be a priority. Patients attending the Accident & Emergency Department or the Medical and Surgical Out Patients and Medical and Nursing Staff who have looked after them in totally inadequate conditions, have been extremely tolerant.
The Management of the Mater Hospital are optimistic that 1997 will see the development of the infrastructure that will transform the Eccles Street Campus into a major national asset. staying within its budget and delivering on agreed targets with the Department.
_ 21_ MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995
ADDRESS OF SR. HELENA, PROVINCIAL OF THE SISTERS OF MERCY, SOUTH CENTRAL PROVINCE
ON THE OCCASION OF THE TWENTY THIRD ANNUAL GENERAL MEETING OF THE BOARD OF MANAGEMENT OF THE MATER MISERICORDIAE HOSPITAL
Your Grace. Members of the Board, Sisters and Friends!
I am very happy to be here today at this Annual General Meeting. It is with a certain sense of reverence and awe that I come, because the Mater and all that it stands for is written deeply into my Mercy consciousness even though I had little personal contact with it until now. But I know of its reputation. that it is held in high esteem far and wide, and just recently met someone who was deeply affected by the quality of care and compassion received here.
I therefore feel very privileged to be associated with such a body of dedicated, professional. caring and competent people who span the vast range of activities here at the Mater. I want to assure you that my relationship in the future will be one of co-operation and support. upholding all that it is good in its strong and vibrant life.
Reading last year's report, and listening to what has been said. I am very ~) conscious of my newness and so I ask your forbearance for my limitations. But I mean to familiarise myself as much as I can with all Sr. Helena. Prtll'i"cialll!,he Si... ters of Merc),. aspects of life and service in this marvellous Hospital. The minutes of Soulh Celltral Pr()I';nce the regular Board Meetings will be of particular interest to me in this regard. However, I know enough to see that you have here a kind of a microcosm of human life. a medley of diverse services giving an overall holistic response to the health needs of many in society. This I warmly support and I congratulate the Executive. Medical. Nursing. Administrative and Pastoral staffs and all the various departments on their achievements and high standards in spite of the many pressures from inside and outside.
What I would like to refer to is the future as we get nearer to the millennial divide. It is recognised by all that we live in a time of great and rapid change. This time presents us with extraordinary opportunity. It makes pressing demands on us and yet it is one of great fragility. All spheres of life are affected: Such change requires us. to reflect again on,our identity and purpose. to articulate afresh, to evaluate ourselves against it. and to take some necessary steps on the road to achieve what we set out to achieving it in a contemporary context.
We as Sisters of Mercy. like others. have been facing this reality. For us it has resulted in re-organisation nationally and internationally in order to be more specifically and overtly true to our identity and purpose. This identity is put very succinctly in the preamble to our newly formulated Directives:
"Out of the vibrant waters of our time the pain ofhumanity calls us to be bridge builders in a broken world and so in collaboration with others we commit ourselves to ... "
LI· ______22______~ MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995
I'll
Today I would like to draw attention to the phrase "the pain of humanity calls us". This is the raison d'etre of the Sisters of Mercy, and it is the raison d'etre of this Hospital.
The pain of sickness in all its various manifestations is what moves us, what challenges us, stiffens our nerve, mellows our arrogance, and humbles our twentieth century strut. In particular, our tradition from Venerable Catherine McAuley is to hear the pain of excluded humanity. This is the core of the Mercy Ethos. In the nineteenth century, education and health care were available. but only to the few. Catherine's effort was to redress that injustice and she was deeply affected by the absence of health care for the many sick poor of her time in this city and elsewhere.
In our day of sophisticated society and welfare state we have to ask who are the excluded ones today - the pain of their humanity calls us, challenges us and humbles us. We know that their very exclusion puts them more at risk. makes them more vulnerable with regard to sickness and also puts many obstacles in their way towards getting access to services. I know that the Mater. true to its name and tradition, will continue to hear that pain and respond.
In facing the future, brought about by contemporary changes which are bigger than any of us and all of us together, the hospital communitylinstitution will do well to reflect again on its identity, to articulate in today's terms what its purpose or mission is, to review itself or engage in a self analysis against the criteria of its mission statement and set about systematic and integrated planning and action in line with that purpose. As ProvinciallTrustee with responsibility for the next six years I will take a particular interest in this development and will be most supportive of anything stemming from such review, planning and action.
I believe that the pointers for the future will emerge more clearly from such an approach and the dangers of a piecemeal, reactive, and haphazard approach can be avoided. I believe also that the philosophy and ethos of the hospital will be better protected and insured by the self confidence engendered from strong commiunent to the outcome of self reflection and self direction in such an integrated process. To do this the hospital community will need to devise a mode of operating which includes a reflection dimension in its activities. This will be at odds with the dominance of the production ethic which pervades our consciousness so much today. In a Mercy context this reflective dimension would include questions about compassion as much as questions about quality, questions about faith as much as questions about technology. In short it is about being contemplative. contemplative~in~action, in a corporate as well as an individual way.
Only a body which is secure in its identity can withstand the buffeting of the negative winds of commercialism, individualism, elitism, can withstand the cold winds of hostility to all things Catholic. or ride the searing winds of dilemma where answers are not immediately found. In the security of a clear identity the Mater can continue on its journey and carry high the banner of Mercy health care, participating in the healing work of Christ so that all may have life and have it to the full.
Friends and colleagues, we can all see that the journey is a long one, but a challenging and healing one for all of us who set out on it. The road stretches out before us and" the pain of humanity calls us".
Thank you for your attention and courtesy to me today, especially thank you for your partnership with us in the Mater Misericordiae Hospital. May each of you know the care of the God of Mercy in your own lives and in your families.
_23_ MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995
." II
FINANCIAL REpORT AND ACCOUNTS FOR 1995
Summary
Hospital expenditure net of income for 1995 was £51,474m. compared to a final allocation of £51,44.om. This left an operating deficit of just £34,.0.0.0 equivalent to .0 ..06% of net expenditure. This will be a first charge on the 1996 budget.
1995 Financial Year
On I.oth February, 1995 the hospital was notified of its Base Allocatio.n for 1995. The sum provided £49.226m. included £2.0.0,.0.0.0 for Accident & Emergency Department developments and £ I .0.0,.0.0.0 for additional Cardiovascular Department costs. It also included a positive casemix.adjustment of £ I 52,.0.0.0.
During the year the hospital received additional revenue funding under a number of headings as follows:
(a) Developments:
A sum of £41.0,.0.0.0 was allocated to provide for developments in the following areas: Oncoleg)', Rheumatology, Plastic Surgery, Vascuiar Surgery and Intensive Care.
(b) Waiting List
£62.0,.0.0.0 was provided to reduce waiting list numbers by 943 patients in General Surgery, Vascular Surgery, Urology and Ophthalmology.
(c) Hepatitis C:
To enable the hospital maintain its Hepatitis C Programme asum of £43.0,.0.0.0 was provided. This included a provision of £ I .0.0,.0.0.0 for Gastro-Intestinal equipment.
(d) Health & Safety at Work:
A sum of £247,.0.0.0 was allocated under the heading of Health & Safety at.Work during 1995. With this funding, the hospital commenced a ManualHandling Programme for all staff and was able to replace and enhance unsuitable equipment and facilities. The funding also provided for the setting up of an Occupational Health Service for hospital staff.
(e) New Technology.Medicine Initiative:
This funding provided for the supply of Taxal to Oncology patient and stenting procedures for Cardiology patients., It vvaS ~I~o utilised to purchase a Laser for the E.N.T. "I:heatre and permitted the commencement of X-Ray Imaging Technology in the Accident & Emergency Department.
(I) Other:
Further funding.was provided for streamlining the Breast Cancer Screening Services. increased blood costs, continuing education for Nurses. Accident & Emergency Services and additional Cardiology procedures. MATER MisERICORDIAE HOSPITAL ANNUAL REPORT 1995
I I
A summary of the additions to the Base Allocation is as follows:
£'000
Base Allocation 49.226
Additions:
1995 Developments 430 Waiting List 620 Hepatitis C 430 Health. Safety & Welfare at Work 247 Technology Inflation 370 Payroll Amendments 982 Capital Items 572 Other 563
Final Allocation 53,440
The above additional funding and stringent control of expenditure by all Department Managers enabled the Hospital balance its budget in 1995. Much credit must go to staff at all levels in the hospital for their support and sacrifices made during the year.
1995 Capital Programme
The Hospital received £ 1.713m. in Capital Grants during 1995. The Hospital utilised this funding to invest in major equipment and upgraded facilities. The significant elements of this were the new Cardiac Catheterisation Laboratory. Anaesthetic Monitoring Equipment in ICU, Fire Prevention and Maintenance Works as well as Air Conditioning for the Pathology Laboratories.
1995 Cash Position
The cash position of the Hospital was extremely difficult throughout 1995. This was due to a number of factors. namely. the refinancing charge accounted for in 1994. as well as significant patient-related bad debts.
Despite this, the Hospital maintained an average settlement period for suppliers of 45 days which is in line with the Department of Health guidelines. The non-settlement of the. Refinancing Charge by the Department of Health and the sizeable.increase in bad debts will have a detrimental effect on the Hospital's cash position during 1996.
1995 Service Plan
The Hospital delivered on its 1995 Service Commitments to the Department of Health. In addition. the hospital more than met its Waiting List targets. The following table summarises the 1995 position (including Waiting List).
Actual Plan Variance
In-Patient 17.044 18.457 (1.413) Day Case 15.617 13.337 2.280 32,661 31,794 867
Waiting List (included above) 1.138 943 195 - 25 - MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 ....
Clinical Budgeting
The Hospital commenced work on Clinical Budgeting in late 1994 and continued the project into the early part of 1995. Due to resource problems associated with the Staff Embargo. the Hospital decided to-put the project-on hold uritil these problems were resolved. The project recommenced in February 1996 and it is envisaged that the.new system will be introduced towards the latter part of 1996.
Employment Levels
On the staff front the Hospital's records showed that as at 31 st December. 1995 there were 1.824 wholetime equivalent staff on its books.
Employment levels at 31 stDecember. 1995 were:-
Grade/Category Number
Management/Administration 206 MedicallDental 204 Nursing 884 Paramedical 239 Support Services 255 MaintenancefTechnica! 36
Total 1,824
Other features
Other significant features of the 1995 financial year were as follows:
(a) Recruitment of Ms. Kathleen Hamill, ACCA as Management Accountant.
(b) Submission of a Heart/Heart Lung Transplantation (incorporating additional cardiac cases) costing to the Department of Health.
(c) The investment by the Hospital in Sua~trai Ltd .. the HoSpital Creche.
(d) The commencement of building works for the fourth Theatre in Phase I A.
(e) The adverse effects of the staff embargo and theforthcoming 1% budget saving in 1996.
(f) The elimination of the sizeable long outstanding debts on the Child Guidance and Breast Cancer Screening Accounts.
(g) All patient related debts in excess of one year either written off or provided for in the Accounts.
_26" MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 ...
MATER MISERICORDIAE HOSPITAL FINANCIAL STATEMENTS
Year Ended) 1st December 1995
INDEX
PAGE
Statement and Responsibilities of the Board 28
Auditors' Report 29
Balance Sheet 30
Capital Statement 31
Cash Flow Statement 32
Notes to the financial Statements 33-37
Detailed Income and Expenditure Statement 38
_27_ MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 --
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 statements for each financial year which give a'true and fair view of the state of affairs of the hospital anq of the surplus or deficit of the hospital for that period.
In preparing those 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 Accounting 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 the~ to ensure that the financial statements comply with the Standard Accounting Policy Guidelines.
They are also 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 Jist December 1995 including the Balance Sheet, Income and Expenditure Account etc. comprising pages 30 to 37, were presented and approved by the Board.
To the best of our knowledge these accounts have been compiled in accordance with both 'he Standard Accounting Policy Guideline requirements, and the conditions attached to the Allocation Letter of the Department of Health.
Signed: 5". ~ ili!tJd Signed: ______~~ _
Executive Chairperson Chief Executive
23rd July 1996.
_28_ MATER MISERICORDIAE HOSPITAL ANNUALREPORT 1995
MATER MISERICORDIAE HOSPITAL AUDITORS'REPORT
YEAR ENDED] I ST DECEMBER 1995
TO THE SISTERS OF MERCY AND THE DEPARTMENT OF HEALTH
We have audited the financial statements on pages 30 to 37 which have been prepared under the historical cost convention. as modified by the revaluation of the certain fixed assets, the Standard Accounting Policy Guidelines of the Department of Health, and the accounting policies set out on pages 33 and 34.
Respective responsibilities of the Board of Management and Auditors.
As described on page 28 the Board of Management are responsible for the preparation of financial statements. It is our responsibility to form an independent opinion, based on our audit, on those state'TIef"!ts 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 3," .assessment of the significant'estimates and judgements made by the Board of Management in the preparation of the financial statem'ents,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 necessary in order to provide-us with sufficient evidence to give reasonable'assurance that the financial statements are free from material r'!)isstatement, whether caused by fraud or other irregularity or error. In forming out opinion-we'also evaluated the overaJl"adequacy ofthe presentation of-information in the financial statements.
Opinion
In our opinion the financial statements give, in so far as concerns the pepartment of Health, a true and fair view of. the state of the hospital's affairs at jist December 1995 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 t"e hospital. The financial statements are in agreement with the books of account.
Roliert J. Kidney & Co. Chartered Accountants & Registered Auditors, 12 College Green, Dublin 2.
23rd July 1996 _29_ MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 --
MATER MISERICORDIAE HOSPITAL BALANCE SHEET
31st December 1995
1995 1994
NOTE IR£'OOO IR£'OOO
ASSETS
Fixed Assets 2 124,578 127,347 Stock 3 1,073 980 Grants Receivable 4 5,894 3,850 Accounts Receivable 5 3,419 4,341
134,964 136,518
LIABILITIES
Accounts Payable (6,838) (6,412) Leasing Commitments 6 ( 835) (1.022) Bank Overdraft 13 (3,909) (3,385) Term Loan ( 100) ( 71)
(11,682) ( I 0,890)
NET ASSETS 123.282 125,628
REPRESENTED BY:
Capital Statement (Page 31) ( 1,369) ( 1.605) Capital Reserve 7 124,651 127,233
123,282 125,628
ON BEHALF OF THE BOARD
The notes on pages 33 to 37 form part of these_30_ financial statements. MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995
MATER.MISERICORDIAE HOSPITAL CAPITAL STATEMENT
Year Ended 31st December 1995
1995 1994 Note IR£'OOO IR£'OOO
Net Expenditure (53,474) (49,092)
Revenue Grants Receivable 53,440 49,015
Operating Expenditure over Allocation (34) (77)
Non-Grantable Expenditure:
Provision for Doubtful Debts 10 (172)
Re-Financing Charge 9 (359)
Capital Expenditure e (106)
Toeal Expenditure of Allocation (206) (542)
Prior Years' Deficits Received 4 442 710
Balance Brought Forwa.rd ( 1,605) ( 1,773)
Balance Carried Forward (1,369) (1,605)
ON BEHALF OF THE BOARD
The notes of pages 33 to 37. form·part of these_31_ financial statements. MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 . ,
MATER MISERICORDIAE HOSPITAL CASH FLOW STATEMENT
Year Ended] 1st December 1995
1995 1994 Note IR£'OOO IR£'OOO
. Net Cash Flow from Operating Activities II (51.519) (50.765)
Returns on Investments and Servicing of Finance
Dividends Received 7 2 Interest Paid on Loans and Overdraft (30) (52) Interest Paid on Finance Leases (87) (105)
Net Cash Flow From Return on Investments and Servicing of Finance (110) (155)
Investing Activities
Assets Purchased by Revenue Grants (493) (877) Assets Purchased by Capital Grants ( 1;595) ( 1.460) Proceeds from Sale of Properties 477 Proceeds from Sale of Investments 70
Net Cash Flow from Investing Activities (2.088) ( 1.790)
Net Cash Flow before Financing (53.717) (52.710)
Financing
Department of Health Capital Grants 1.853 1.604 Department of. Health Revenue Grants 51.580 55.540 Increase/(Decrease).in Bank Short Term Loan 29 (29) Finance Lease Capital Repayments (269) (219)
53.193 56.896
(Decrease)/Increase in Cash and Cash E!luivalents 12/13 (524) 4.186 The nOtes on pages 33 to 37 form part of these_32_ financial statements. MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995
MATER MISERICORDIAE HOSPITAL NOTES TO THE FINANCIAL STATEMENTS
Year Ended] 1st December 1995
NOTE I. ACCOUNTING POLICIES
The Financial Statements are prepared in accordance with the historical cost convention, as modified by the revaluation of certain fixed assets. Income and. expenditure of the hospital whether of a capital or revenue nature, are written off to the Income and Expenditure Statement in the year they arise with the exception of the following:- Fixed Assets. - Land and Buildings Land and Buildings were shown in the accounts at insurance value as at 31 St December 1991. Subsequent additions are included at case - Equipment A fixed asset register was prepared to 31 st December 1992 and cost. depreciation,and net book values were shown at that date. Subsequent additions are included at COK .. 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 revenue allo~tion and'therefore not necessarily in the year to which the expense relate~. Out Patient and Road Traffic Accident Income This income,is accounted for on a cash receipts basis. _33_ MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 -- MATER MISERICORDIAE HOSPITAL NOTES TO THE FINANCIAL STATEMENT Year Ended 3 1st December 1995 NOTE I. ACCOUNTING POLICIES (Continued) (b) Government Grants - Capital Government Grants in respect of capital expenditure which are u~paid at the"accounting date are accrued and show:n as being receivable. (c) Government Grants - Revenue Government Grants in respect of revenue expenditure are shown as recove~ble 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. The stocks comprise those held in the Pharmacy, Orthopaedics. Anaesthetics, Cardiovascular, Central Surgical and Central Supplies Departments at year end. All other stocks are held on an ongoing basis and are not included in the accounts. NOTE 2. FIXED ASSETS Buildings Equipment Total IR£'OOO IR£'OOO IR£'OOO At Cost & Revaluation At IstJanuary 1995 130,172 17,900 148,072 Aciditions during the year 404 1.093 1.497 Disposals during year ( 14) ( 14) At 31 S[ December 1995 130,576 18.979 149,555 Depreciation At I st January 1995 12.366 8.359 20.725 Charge to Capital Reserve 2.955 1.306 4,261 Disposals during year (9) (9) At 31 S[ December 1995 i5.321 9.656 24,977 Net Book Value At 31st December 1995 115,255 9,323 124,578 At 31 S[ December 1994 _34_ 117,806 9,541 127,347 MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 .. Ii MATER MISERICORDIAE HOSPITAL NOTES TO THE FINANCIAL STATEMENTS Year Ended 31st December 1.995 NOTE 3. STOCKS 1995 1994 IR£'OOO IR£'OOO Pharmacy Stock 458 390 Medical and General Supplies 248 293 Orthopaedic Supplies 140 156 Anaesthetic Supplies 52 46 Cardiovascular Stock 123 54 Surgical Supplies 52 ---41 1,073 980 NOTE 4. GRANTS RECEIVABLE 1995 1994 IR£'OOO IR£'OOO Revenue Grants - Current Year 5.367 3.065 ·'Prior Years 5.367 3.065 Capital Grants S27 785 Balance due at 31st December 5,894 3,850 In addition to the above. there is an amount of IR£ I .344.000 ( 1994 IR£ 1.580.000) arisin'g from the excess of expenditure over Revenue allocation which is claimed from the Department of Health and which may be reimbursed to the hospitaL in future years. An amount of IR£442,000 was received during 1995. which related to excess expenditure over allocation in 1993. NOTES. ACCOUNTS RECEIVABLE 1995 1994 IR£'OOO IR£'OOO Patient Debtors 738 933 Other Debtors and Prepayments 2.681 3.408 _35_ 3,419 4,341 MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 MATER MISERICORDIAE HOSPITAL NOTES TO THE FINANCIAL STATEMENTS Year Ended.] 1st December 1995 NOTE 6. LEASING COMMITMENTS 1995 1994 IR£'OOO IR£'OOO Finance less repayments, net of Interest: Amounts due within one year 237 26S Amounts due after more tharl one year 598 754 8]5 1,022 NOTE 7. CAPITAL RESERVE 1995 1994 IR£'OOO IR£'OOO Opening balance 127,23] 129,356 Fixed asset additions 1.497 2,760 Fixed asset disposals (5) (747) Depreciation charge (4.261 ) (4.348) Finance lease repayments 187 212 Closing Balance 124,651 127,233 NOTES. CAPITAL EXPENDITURE This charge represents expenditure by the hospical on the Orthopaedic Ward and Theatre. which was not funded by the Department of Health. NOTE 9. RE-FINANCING CHARGE This charge represented the contribution by the hospical to the Department of Health's re-financing scheme for the health services. NOTE 10. PROVISION FOR DOUBTFUL DEBTS This charge represents a provision for debts which are in excess of one years old at the year end. _36_ ------MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 '011" MATER MISERICORDIAE HOSPITAL NOTES TO THE FINANCIAL STATEMENTS Year Ended] 1st December 1995 NOTE I I. NET CASH FLOW FROM OPERATING ACTIVITIES 1995 1.994 IR£'OOO IR£'OOO Net Expenditure (53,474) (49,092) Dividends received (7) (2) Interest paid 30 52 .Stocks (93) (73) Accounts receivable 922 (576) Accounts payable 426 (I :274) Provision for doubtful debts (172) Assets charge to revenue and capitalised 493 877 Finance lease interest payments 87 105 Finance lease capital repayments 269 219 Profit on sale of investments (59) profit on sale of properties (477) Non-grancable capical expenditure (106) Re~financing charge (359) Net cash flow from operating activities. (51,519) (50,765) NOTE 12. ANALYSIS OF THE CHANGES IN 1995 1994 CASH AND CASH EQUIVALENTS IR£'OOO IR£'OOO At I st January (3.385) (7.571 ) Net Cash (Outflow)/lnflow (524) 4.186 At list December 1995 {J,909} {J,l85} NOTE I l. ANALYSIS OF THE BALANCE OF CASH AND CASH EQUIVALENTS Change 1995 1994 IR£'OOO IR£'OOO IR£'OOO Cash at Bank 511 548 37 Bank Overdraft ( 1.035) (4.457) (3,422) (524} (l,909) (l,l85} NOTE 14. COMPARATIVE FIGURES The 1994 comparative figures have, in some cases, been adjusted to conform to 1995 classifications. NOTE 15. FINANCIAL STATEMENTS APPROVAL These Financial Scatements were_37_ approved on behalf of the Board of Management on 23rd July 1996. MATER MisERICORDIAE HOSPITAL ANNUAL REPORT 1995 MATER MISERICORDIAE HOSPITAL DETAILED INCOME AND EXPENDITURE STATEMENT Year Ended 31st December 1995 1995 1994 EXPENDITURE IR£'OOO IR£'OOO Pay Administrative 3.423 3.028 Medical 8.848 8.108 Nursing and Allied 13.662 12.071 Para-Medical 5.622 5.101 Catering. Housekeeping & Porte ring 2.780 2.535 Mai~tenance 723 685 Other 129 141 Superannuation 1.071 1.097 Employers' Social Welfare 1.726 1.543 37;984 34.309 Non-Pay Medical Expenses 13.466 12.315 Provisions 868 834 Maintenance. Power & Cleaning 3.556 4.480 Finance Charges 788 688 Office Overheads 2.305 2.244 20.983 20.561 58.967 54.870 INCOME Payroll Deductions 1.744 1.615 Cafeteria Income 656 595 Sundry Income 251 193 Patient Income 2.842 2.839 Sale of Properties 477 Sale of Investments 59 5.493 5.778 Net Expenditure 53.474 (49,092 Revenue Grants 53.440 49.015 Operating Expenditure Over Allocation (l4) {77} _38_ MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 H.LP.E. UNIT The HIPE Scheme is the system through which the hospital activity data is reported monthly to the Department of Health. The main objective of the HIPE Unit is to ensure that the data is an accurate representation of the workload of the hospital. The annual HIPE Data Quality Assurance exercise took place during the year. The aims of this exercise are to measure (aJ the completeness of the discharge summaries and (bJ the accuracy of the ICD coding of diagnoses and procedures. This is carried out on an individual specialty basis with subsequent feedback to the consultants. junior medical staff, team secretary and coder. Results showed a marked improvement generally in the discharge summary data largely achieved through computerisation and communication with the medical teams thereby increasing their awareness of the importance of the data. The overall accuracy of ICD Coding of clinical data also improved noticeably over previous years and this was brought about mainly by monitoring and in-service training of HIPE Coders. The capture rate of HIPE data, for both in-patients and day cases was 99.7%. Specific work during the year included close co-operation with the Anaesthetists to ensure that diagnoses made and procedures performed in ITU were coded and included in the HIPE data. A srudy undertaken showed that the inclusion of these items pOSitively affect the casemix index. This exercise is now on-going with the assistance of the ITU audit process. An example of one of the other projects undertaken in 1995 was a study into cases with extremely long lengths of stay and it was found that severe illness, eVA, awaiting bed placement in another institution and MRSA were the main reasons for this. The casemix index for the hospital increased to 1.48 from 1.42 the previous year, which was the highest in the country. This indicates that for that year, the Mater Hospital treated the most complex and cosdy patients nationwide. The adjustment to the budget on the basis of casemix was +£230,346 which rewarded the Mater Hospital for its efficiency relative to the other major hospitals with whom we were compared. It was the highest casemix adjustment out of all the Dublin hospitals. _39_ MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 MANAGEMENT SERVICES DEPARTMENT The development and awareness of the impact and utilisation of information and associated technology is a major feature of the delivery of healthcare today. The Management Services Department continues to ensure that the hospital and its staff remain of ~he forefront of utilising such technology for the delivery of optimum patiem care. In furtherance of this objective the following occurred during 1995. ~.\ Trend towards the use of personal computers ~': ..,:, '~"." I ---'-..--", One of the most significant trends noticed during the year was the increasing awareness of all staff of the potentiality of personal computers and the use of the hospital computer Radiolog)' Reporting Utilising the Integratcd Il1Ulging System" network and communications systems. Towards the laner end of the year the hospital decided to implement in all areas where practical. lull electronic mail and file and data sharing facilities for administrative and operational activities. These services, which takefull advantage of the power and potential of personnel computing will be an addition to the already existing services on the network. such as printer sharing, CD· Rom database access, internet access etc. Internet The hospital became the first Irish hospital to utilise the new communications media, the Internet. This will enable the hospital and its staff members utilise the resources and facilities of the Internet for sharing. researching and disseminating information of com.mon interest. as a contact point and as an electronic means to provide information in regard to the hospital and the services it provides. Maler Miserit:ordiae Ho ...pilal Home Page . Integrated Imaging System The successful implementation and utilisation of the integrated imaging system, one of the first truly integrated diagnostic imaging/hospital information systems in the world. in the ITU complex and the Radiology Department attracted widespread publicity within both the health care and information technology environments. This success has led to the hospital deciding to extend such facilities to the Accident & Emergency Department. Conference During October, a significant event in development in the awareness of healthcare informatics within Ireland occurred with the organisation of a major conference and scientific symposium on Healthcare Informatics titled "The delivery of acute health in the information age - the effective use oftechnology". To support the theme ofthe symposium, the presentations and participation by expert speakers from the USA, Europe and the hospitals own special staff, focused on the major developments taking place within the hospital in the use of information technology to support optimum patient care. Healthcare Informatics The speed of development of information and computer technology, networking and communications infrastructure and the growing awareness and acceptance of the benefits of technology has resulted in all aspects of healthcare delivery and professional and technical activity being examined in the light of these emerging computing technologies. Drawing on the expertise of the Management Services Department. the hospital established an institute of Healthcare Informatics to support the developing requirements of healthcare professionals in their use of information and associated technologies . .-11....- __40 _-->-_ MATER MISERICORDIAE HOSPITAL ANNUAL REpORT 1995 One of the Institute's first initiatives was the establishment, in conjunction with University College Dublin, of the first formally accredited academic course in Healthcare Informatics which will commence in April 1996. Systems Upgrade A significant cask involving the majority of the resources of the Management Services Department was the implementation of a full systems upgrade of the patients administration and order communications/results reporting components of the hospital information system. This upgrade. which in addition to providing additional functionality, such as point of entry billing. introduced full screen display to the users of these elements of the systems. Its introduction was quite traumatic and it had a significant impact on many departments in their ability to fully utilise the system during the period of conversion and implementation. Disaster Recovery The first phase in implementing total systems resilience and disaster recovery facilities as part of a disaster recovery plan to support all the possible points of failure in the hospital's information and communications systems. commenced through the acquisition of additional computer hardware funded by a capital grant from the Department of Health. Further phases will include the establishment of a satellite computer room and the installation of a back up communications infrastructure. Nursing Project Significant impetus to the utilisation of structured information processes by nursing staff occurred with the decision by the hospital to implement patient dependency and undertake a Quality Assurance Programme based on "Criteria for Care" and "Monitor 2000" methodologies as part of the nursing project. The work on the project will enable the hospital obtain on-going information with regard to the level of nursing care requirements and workload, define. classify and quantify all aspects of nursing time and ensure and monitor the appropriate skill mix required to maintain optimum nursing care at the highest level of quality. _41_ MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 SAFETY, HEALTH & WELFARE AT WORK ACT, 1989 "Safety is not a resource. It is not an influence and it certainly is not a programme. Rather. safety is a state of mind, and atmosphere that must become and integral part of each and every procedure that the company has. This, then, is what is meant by built~in or integrated safety. It is only the brand of safety that is permanently effective." This statement surely summarises the rationale behind the Safety. Health and Welfare at Work Act. 1989. Accidencs are caused by either carelessness or negligence and so it is vital that every member of staff, with no exception. continues to develop and sustain and integrated safety culture. To this end a very sensible and reasonable approach to health and safety is adopted by staff and management of the Hospital and a genuine commitment does exist to adhere to the numerous statutory obligations. This does not suggest that we can become complacent - on the contrary - while total safety is not achievable we must however continue to striv~ to minimise all actual and potential hazardous work situations. Consultation To ensure that staff members have a positive input in the formulation and implementation of safety policy a JOint Safety Committee has been in existence for many years. This Committee is made up of staff members appointed by the Board of Management and a member selected or elected from each of five staff groupings together with the Safety Representative. Mr. Tom Moloney. che Technical Services and Safety Manager. Mr. JA Sadlier. and the Occupational Health Physician. Dr. D.· Natin. The meetings of the Committee provide a forum for all present to raise'and discuss pertinent concerns and.to assist in the formulation of remedial actions and in the awareness creation process. Occupational Health Department In September 1995 Dr. Dominick Natin took up duty as Occupational Health Physician on a part time basis. This was a very significant milestone in the on-going development and extension of the health and safety management of the Hospital. Dr. Natin is a General Practitioner with the Higher Diploma in Occupational Health and has considerable experience in this field of medicine. Up to the end of the year Dr. Natin was working on his own and by his enthusiasm and hard work has already made considerable progress. The Occupational Health Department also ensures that staff do not present a hazard to patients and colleagues as a consequence of any ill health. The Department has an advisory and facilitatory role to the Hospital Management in ensuring that statutory obligations under current Health and Safety Legislation are adhered to. Prior to September. the Technical Services and Safety Manager was carrying out this work. The Occupational Health Department tries to fulfil these commitments by providing a comprehensive range of services which meet National and International standards of practice. Services which have been carried out to date include: I. Pre-employment Screening 2. In-post Medical Examinations 3. Carrying out the current HepatitiS B Vaccination Programme 4. Introducing a new protocol for members of staff to deal with needlesticks/sharps injuries 5. Pregnancy Regulation Assessments 6. Health Surveillance (including worksite visits) 7. Health Education/Promotion (lectures to members. of staff) on Hepatitis B. Introduction to the Occupational Health Department, SharpslNeedlestick Injuries. Pregnancy Regulations. 8. Research. MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 The Occupational Health Department will not be providing a General Practitioner practice. as our concern is only for work related issues. One of the primary aims is to get the Hepatitis B immunisation programme up and running in such a way that we can try to ensure that we have successfully immunised all of the members of staff who are at risk from Hepatitis B. To help this aim, we hope to be able to put the records on to a computer in the near future. This will allow us to automatically recall members of staff who require booster vaccination. Manual Handling Training is provided to members of staff by the hospital's core trainers who are assessed by external examiners regularly. This ensures the promotion ofsafe practice whilst lifting with emphasis on prevention, reducing the instances of back pain caused by work and compliance with legal requirements. This work is being carried out through the Technical Services Department. Plans for 1996 In the coming year it is proposed that new rooms will be developed in the hospital for the Occupational Health Physician, Occupational Health Nurse and Occupational Health Secretary. The latter two members of staff are hoped to be recruited within the very near future so that a comprehensive Occupational Health Service can be provided to all members of staff. We hope to continue to keep Hepatitis B Vaccination as a priority and to develop protocols for Tuberculosis prevention in the workplace as well as looking at different aspects of stress in the hospital. Computerisation should help greatly in increasing the efficiency and effectiveness of the Occupational Health Department. Safety Awareness Programme A Safety Awareness Week was held from Monday 13th to Friday 17th November inclusive, Onth'e Monday and Wednesday Dr. Dominick Natin made two presentations each day on the Occupational Health Department with particular emphasis on vaccinations and sharp injuries and the new Pregnancy Regulations. Ms. Terri Gallagher, Senior Clinical Psychologist made two presentations on the Tuesday entitled "Coping with Stress in the Workplace. On the Thursday and Friday meetings were arranged with Contractors engaged in work in the Hospital and with Responsible Persons in high risk departments to discuss and evaluate the risks involved and the corrective actions required. The average attendances at each of the three presentations and the meetings were good considering the work demands on all staff members. In addition all fire detector/alarm installations were tested by the appropriate Contractors and hand-on demonstrations on the use of the first aid fire extinguishers were provided twice daily. During the year twO half-day programmes on safety were provided as part of the Back to Nursing Course and one as part of the Post Graduate Nursing Education Course together with a number of modules of the Student Nurse Awareness Programme. Departmental Safety Statement To promote the need for all staff to read and understand the appropriate Departmental Safety Statement a number of short duration talks were given in different locations in the Hospital. The locations were chosen so as to minimise the time lost from work by staff in getting to and from the talks. The locations used were the Conference Room in St. Cecelia's Ward, the Freeman Auditorium and the Reception Desk, Level 6, I A Ward Block. It is planned to review the Departmental Safety Statements in each Department next year in conjunction with the carrying out of a safety audit and risk assessment in each Department. Patient Lifting/Manual Handling During the year 38 full day Patient Lifting Training Courses were provided and 386 staff attended, Only 21 staff of the total attendance did not participate fully for a variety of reasons and so these will have to undergo a full day course again. MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 4'''' A total of 8 Refresher Courses of 3 hours duration were held for Student Nurses with an overall attendance of 1,035 students. The optimum class size for each session is 16 but unfortunately the average class size was only 10 which does not maximise the time given by the two Instructors required for each session. Also 42 training courses of 3 hours duration were provided for staff with manual handling duties not involving patient lifting and a total of 399 staff attended. Again the average attendance was less than the optimum. A special grant of £247.000 was made available by the Department of Health to address shortcomings in safety. In addition to the purchase of some variable height beds. hoists and other lifting aides, a number of minor capital projects were undertaken and paid for from this allocation. Accidents All accidents or near accidents must be reported on the Hospital Health and Safety Input Forms. A total of 196 were completed of which 25 were for injuries which required an absence from work of 3 days or more. Injuries from sharps - needles. scalpels and the like - accounted for 35 while 10 were in relation to back injuries arising fr0'"!1lifting/manual handling activities and 23 were assault incidents. The remaining reports referred to slips. trips and falls. bruises. cuts, burns. and the like. Again there was a welcome decline in lifting injuries related no doubt to the on-going training programme and the introduction of the hoists and other lifting aids. The sharps injuries also showed a decline but there are still reports of carelessness in the use and disposal of sharp items. It is imperative that all staff using needles and similar sharp items dispose of them as directed in the Departmental Safety Statements. However. there was a significant increase in assaults which is very distressing and consideration is being given to the most effective means of controlling these hazards and also the treaunent of staff affected. _4'-' MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 I .. SCHOOLS EDUCATION PROGRAMME This programme was initiated in 1994 to meet the increasing number of requests from schools for "work experience" in the hospital for their transition year (4th year) pupils. A structured programme was formulated to provide a broad range of exposure to the different types of occupations available within the hospital and to introduce the students to the distinctive environment of hOSpital work. The hospital was also conscious of the need to avoid exposing the school pupils to inappropriate possibly traumatising experiences, and also clearly identify them and distinguish them from hospital employees. Thus on presentation to the hospital pupils 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 Dr. F. POM'ell and Mr. Austin Currie. The "'inifler of Slale for to seven pupils who spend one week in the Mater. Many Heallh and Education talking 10 some pupils after the officilll individuals from different areas kindly volunteered their time and opening of the Transition Year School Programme. efforts to provide a comprehensive and interesting series of talks and demonstrations of their particular skills. The pupils day begins at 10.30 a.m. and ends at 4.00 p.m. and they rotate through different areas in 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 pupils interest and behaviour whilst on the programme. 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 Endoscopy Dr. John Crowe/Sr. P. White Laboratory Mr. Tom Moloney Nursing Sr. M. o(the Incarnation/Ms. R. Ruddy/Ms. A. Carrigy 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. .: 45 __ MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 ". In 199560 pupils were accommodated in 10 different weekly programmes. There were many different schools represented, as can be seen from the following list of schools whose pupils have attended the programme to date: I. Alexandra College. Milltown. 2. Ard Scoil Ris. Griffith Avenue. 3. Belvedere College. GL Denmark Street. 4. Catholic University School, Lwr Leeson Street. 5. Castleknock College. Castleknock. 6. Colaiste Phadraig. Lucan. 7. Dominican College, Griffith Avenue. 8. Franciscan College. Gormanstown. Co. Meath. 9. Gonzaga College. Sandford Road. 10. Holy Child. Killiney. II. Holy Faith. Clontarf. 12. Holy Family. Newbridge. Co. Kildare. 13. Loreto High School. Beaufort. Rathfarnham. 14. Loreto College. Balbriggan. 15. Loreto College. St. Stephen's Green. 16. Loreto College. Swords. 17. Manor House. Raheny. lB. Mount Anville. Dublin 14. 19. Mount Temple. Malahide Road. 20. Notre Dame. Churchtown. 21. O·Connell·s. CBS. 22. Our Lady's School. Templeogue. 23. Pobal Scoil Neasin. Baldoyle. . , 24. Portmarnock Community School. 25. Presentation School, Rockford Manor, Blackrock. 26. Presentation School. Terenure. 27. Roscrea Vocational School. Roscrea, Co. Tipperary. 28. Sacred Heart, Drogheda. Co. Louth. 29. Sancta Maria College. Rathfarnham. 30. St. Andrew's College. Booterstown. 31. St. Conleth's College. Clyde Road. 32. St. Dominic's College. Cabra. 33. St. John of God. Artane. 34. St. Paul's College. Sybil Hill. Raheny. 35. St. Joseph·s. Abbeyfeale. Co. Limerick. 36. The Teresian School. Stillorgan Road. 37. Ursuline College. Sligo. The Minister of State for Health and Education, Mr. Austin Currie officially opened the programme in 1995 at a reception in the Pillar Room. The feedback from the pupils and schools is extremely positive and the great interest and enthusiasm of the pupils is obvious to all those who generously give of their time and effort to make this. MATER MISERICORDlAE HOSPITAL ANNUAL REPORT 1995 II! IN-PATIENT ACTIVITY IN-PATIENT ACTIVITY 1995 Specialty Bed Days Used In-patients Day Cases Discharges Cardiac Surgery 17831 1236 116 Dermatology 2248 174 1511 E.N.T. 5724 860 994 Gen/Colo-Reccal Surgery 4866 553 440 Gen/Hepato-Bilary Surgery 4505 545 253 GenNascular Surgery 13223 1283 553 General Medical/Cardiology 19106 1483 1050 General Medicine/Endocrine 12463 991 27 General Medicine/G.!. 13162 1392 2591 General Medicine/Liver 14 0 0 General Medicine/Respiratory 9203 743 222 Gynaecology 2996 415 357 Infectious Diseases 2755 268 0 Medical Professorial Unit 5340 594 3 Medicine for the Elderly 7260 301 314 Nephrology 402 49 3 Neurology 52 7 0 Oncology/Haematology 6770 781 1131 Ophthalmology 6231 1327 2517 Oral Surgery 463 158 76 Orthopaedic 14114 1483 493 Other 5463 260 554 Plastic 2220 362 884 Psychiatry 124 15 3 Rheumatology 2448 251 101 Surgical Professorial 6148 790 835 Urology 4003 578 423 Unknown 1110 145 166 Totals 170244 17044 15617 _47_ MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 WAITING LISTS - 1995 In-Patient Out-Patient 1995 1995 Cardiology 3 months Child Psychiatry 2 months Cardiothoracic N/A I month Diabetic 6 months I month Dermatology 6 months 3 months Endocrine 6 months 3 months EN.T. 24 months 12 months Gastroenterology 6 months I month General Resp 6 months I month Gen. Surgery 8 months 2 months Gerontology Vasc.Surg 8 months 9 months Gynaecology 9 months I month Haematology I month Infectious Diseases Nephrology 20 months 2 months Oncology Ophthalmology 6 months 6 months Orthopaedic 10 months 6 months Plastic Surgery 48 months I month Psychiatry I month Respiratory 3 months I month Rehab. Phy. 3 months S months Urology 22 months 6 months MATER MISER/CORDIAE HOSPITAL ANNUAL REpORT 1995 DEPARTMENT ACTIVITY SUMMARIES 1992 1993 1994 1995 Accident & Emergency Department New Patients 43,926 48,070 50,730 52,998 Return Patients 20,963 19,067 15,972 12,966 Total Attendances 64,BB9 67,137 66,702 65,964 Out-Patient Clinics Total Attendances 100,I7B 114,510 IIB,694 116,955 Clinical Nutrition and Dietetics Dietitians' Consultations 14,822 14,603 15,986 15,490 Pulmonary Laboratory Patients 1,455 1,330 1,348 895 Tests 7,151 6,752 6,754 4,466 _49_ MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 THEATRE ACTIVITY 1992 1991 1994 1995 General 2.115 2.173 2.020 2.118 G.U. 1.195 1.169 1.122 1.788 Orthopaedic 1.644 1,454 1.469 1.515 Vascular 261 405 406 386 Cardiac Surgery Open Heart Surgery 713 729 796 958 Pacemakers 35 30 35 39 Miscellaneous 137 185 166 140 Transplants 12 9 15 19 Endoscopies 51 36 37 90 Thoracic 84 81 86 84 Dermatology 199 Ophthalmic 2.023 2.129 1.980 2.088 E.N.T. 2.009 2.067 1.836 1.498 Gynaecology 777 807 756 741 Dental 164 167 169 218 Minor 1,708 1,846 1,795 1.954 Plastic 596 812 749 1,468 Miscellaneous 61 120 17 15 Total 11,585 14,219 1,4881 15,118 TOTAL MAjOR 10,138 10,329 9,853 9,900 TOTAL MINOR 3,447 3,890 5,030 5,418 MATER MISERlCORDlAE HOSPITAL ANNUAL REpORT 1995 • DEPARTMENT OF CHILD AND FAMILY PSYCHIATRY 1992 1993 1994 1995 New Patients 812 n2 708 699 Total Attendances 15,289 14,153 15,461 15,815 Social Work Sessions 1,886 2,021 2,039 2,429 Social Work Attendances 5,567 3,503 3,752 4,934 Psychology Sessions 3,008 2,608 2,854 2,308 Psychology Attendances 4,727 3,969 4,545 4,199 Psychiatric Attendances 3,553 3,540 3,671 3,937 Speech Therapists Sessions 1,159 1,069 1,241 1,142 Speech Therapists Attendances 2,812 2,662 3,147 2,565 Remedial, Educational and Social/Perceptual Training Sessions 105 72 56 SO Attendances 550 479 346 180 _51_ MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 • ! OCCUPATIONAL THERAPY DEPARTMENT 1992 1993 1994 1995 In Patients 608 884 1,020 1,004 Out Patients 380 480 591 709 Total Patients 988 1,364 1,611 1,713 PHYSIOTHERAPY DEPARTMENT 1992 1993 1994 1995 Patients Department 13,600 9,840 10,075 9,026 Orthopaedic 13,781 13,743 14,030 13,491 Neurological 6,333 6,741 6,547 6,550 Chest Unit 23,783 23,567 33,979 35,916 Ultra Violet 5,440 3,144 3,175 2,864 Hydrotherapy 1,049 3,436 2,655 2,236 Geriatrics 3,011 2,502 3,576 3,375 School 3,091 3,717 4,628 4,536 Total 70,088 66,690 79,902 81,565 .Treatments Department 40,182 26,932 27,629 25,669 Orthopaedic 37,660 36,734 37,059 37,048 Neurological 20,696 19,785 20,407 21,642 Chest Unit 39,891 38,930 53,986 52,053 Ultra Violet 5,342 5.'\57 3,290 2,864 Hydrotherapy 2,750 7,489 6,633 5,942 Geriatrics 5,661 3,703 7,362 6,824 School 12,298 9,401 10;369 10,039 M.R.S.A. 6,469 Total 164,480 148,431 167,539 168,550 . MATERMISERICORDIAE HOSPITAL ANNUAL REpORT. 1995 I I E.E.G .. UNIT 1994 1.995 In,Patient' .201 203. 187 149 Out Patient 532 432 424 566 1 J ~ Total 732 635 611 715 Departrrie'nt 717 465 592 697 Portible 18 20 24 21 Anorectal Physiology 13 16 18 Brain Stems 3 7 G.I.UNIT 1992 19.93 1994 1995 G~tr,osc.opes , 2,560 2:804 2,999 2,555 : Colcinoscopy. (total) 1,181 1,270 1,405. "1.1.54 E.R:C.P. 273 278 285 313 Papiliatomy' 38 31 13 41 Other Procedures 478 661 377 873 Total Procedures 4,530 5,044 5;079 4,936 -",------ .. , I~' r, MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 DEPARTMENT OF CLINICAL PHOTOGRAPHY 1992 1993 1994 1995 lecture. Demonstrations. Publications. - Slides 15.942 15.427 19.722 19.875 - Prints 4.663 5,255 4,867 5,480 Clinical Patient Slidesl Retinal Slides. Angiograms. 4,730 5.416 5,725 6,400 Total 25,335 26,098 30,314 31,755 E.C.G. UNIT 1992 1993 1994 1995 In Patients 9,856 10,859 12,095 13,944 Out Patients 6,194 7,657 6,759 6,612 Effort Tests 987 1,229 1,248 1.749 Pacemaker Checks 979 1,269 1,371 1,975 Rehab Stress Tests 20 196 181 Total 18,016 21,034 21;699 24,461 MATER MISERICORDIAE HOSPITAL ANNUAL REpORT 1995 •• SOCIAL WORK DEPARTMENT 1992 1993 1994 1995 Total Interviews 7,064 8,809 8,756 9,219 New Patients 2,801 3,019 2,924 3,473 Return Patients 1,187 1,283 1,144 1,298 Total Patients 3,988 4,302 4,068 4,771 RADIOLOGY DEPARTMENT 1992 1993 1994 1995 Main Department General Work 50,185 53,652 57,579 63,623 Specials 1,426 1,633 1,197 1,414 Barium Meals 2,181 2,263 1,951 1,537 Barium Enemas 775 1,086 789 708 1.y.P.s 1,099 1,330 1,128 972 G.B.s 362 329 233 234 Scanning 3,875 4,614 6,075 6,852 Ultrasound 5,218 6,Q43 6,006 6,478 Nuclear Medicine 2,804 3,052 3,463 3,255 Orthopaedic O.P.D. 9,134 8,952 Dopplers 195 Total 68,124 83,194 87,555 94,220 Cardiovascular X-ray Patients 1.560 1,901 1,742 2,210 Procedures 4,462 5,314 4,829 6,424 Accident/Emergency Department X-Rays 43,723 33,860 34,163 34,120 Grand Total 117,869 122,368 126,547 134,764 _55_ MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 ACCIDENT & EMERGENCY DEPARTMENT The Accident & Emergency Department continued to provide the usual service to its catchment area. Early in 1995 the 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 particularly the nursing staff. worked heroically in the face of almost overwhelming odds to maintain a safe and efficient service. Such was the great strain placed upon the nursing staff that they were obliged to take industrial action to bring the crises to the full attention of everybody concerned. 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. We look forward to the appointment of a 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. In 1995 the Department of Health provided funding for the provision of a number of short stay beds. Initially these beds were placed under the care of the Accident & Emergency Department. It became apparent however, that the current staffing resources in the Department could not provide the necessary 24 hour 7 day cover necessary. While the beds continued to be used for short stay Accident & Emergency patients. the day-to-day control of the beds had been transferred to the admining surgeons and physicians. 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 in 1996 should the upward trend of patient attendances contin.ue. Dr. O'Connor attended the Annual Meeting of the BAEM in Torquay during 1995. MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 11: •• DEPARTMENT OF ADULT PSYCHIATRY Introduction The Academic Department of Psychiatry provides a service to the Mater Misericordiae Hospital. It also provides a sector 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 divided between 10 for the sector and 5 for the liaison and tertiary referral patients. The service is provided by three consultant psychiatrists. Dr. John Sheehan is the Consultant in Liaison Psychiatry, Dr. Miriam Gannon is a Locum Consultant providing 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 Dr. lohn Sheelwn, ConsulUmt PsychiaJrisl wilh Q Consultants. special interest in Liaison PsychiaJry. MaJer/Rotundo/Eastern Health Board. Commenced lsi June 1995. The service provides 5 out-patient clinics each week and twO special interests i.e. pain and somatization once per month each. 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 the rotational training scheme in psychiatry. 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. Special Interests The Liaison Psychiatry Service provides a specialist service to physicians and surgeons within the hospital. In addition, Dr. Sheehan has a special interest in the psychiatric aspects of refractory pain and in somatization disorder and established a Cognitive Behavioural Treatment Programme for people with chronic pain in 1995. Dr. Sheehan has also assisted the Accident & Emergency Staff in organising a staff support group and is conducting a survey of work stress with Dr. Dominic Natin, Occupational Health Physician. Professor Casey has a special interest in the management of refractory depression and research (see below). New Developments The appointment of a Consultant in Liaison Psychiatry is the first of its kind in Ireland and will, therefore, provide a model for similar developments throughout the country. In the last 18 months, a Clinical Psychologist has been appointed to the Department and the University has approved the appointment of a Statutory Lecturer in Psychiatry which will take place in late 1996. This person will then cover the sector service as well as expanding the academic aspects of the Department. The recent expansion in the Department has neceSSitated the appointment of a second secretary to provide a back up to both the sector and liaison service. _ 57·_ MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 Ongoing Research Projects Professor Casey has recently received an EU grant as one of the six centres throughout Europe investigating the prevalence of depressive disorders in the community. This will be the first project of its kind in Ireland and the multi centre study represents the first project of its kind in Europe. This project will begin in October 1996 and will necessitate the appointment of two research assistants. . 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 population. 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. alexythymia and parasuicige. Dr. Sheehan has collaborated with Dr. Crowe and the Gastro-Enterology Department investigating depression in Crohn's Disease and Dr. Tim O·Neili. in conjunction with Dr. Sheehan. conducted a study of patient's knowledge of General Practitioners' prescribing entitlements. Presentations and Publications Books: "A Guide to Psychiatry. in Primary Care": 2nd edition due for publication in September 1996. Publisher: Wrightson BioMedical Petersfield. P. Casey. "Applied Psychiatry in Law": Due for publication in September 1996. Publisher: Oaktree Press. P. Casey. "Parasuicide in the General Hospital Setting": P. Casey. "Psychiatry in Medical Practise": Editors: Katona. C and Robertson. M. Due for publication in August 1996. "The treatment of Personality Disorders" in Seminars in Psychiatry. Gaskell. Editors: Wilkinson and Stein. Anticipated publication date March 1996. "Personality Disorder" in Seminars in Psychiatry. Editors: Wilkinson and Stein. Gaskell. Anticipated publication date March 1996. "Social Functioning; The hidden axis of classification". Editors: Tyrer and Casey. Wrightson BioMedical Petersfield. 1993. "Treatment of post-abortion syndrome" in the Psychological Aspects of Abortion. Editors: Doherty. P and Taylor. P. Blackhall Publications 1995. Papers: "The effects of personality on· response to ECT in major depression". 1995. Journal of Personality Disorder. Vol. 9.2. 134-142. "Reliability of General Practitioners in the Diagnosis of Depressive Illness" by Fitzpatrick and Casey. Accepted for publication in the Psychiatric Bulletin. 1996. ··Personality. functioning and recovery from depressive illness". Casey. P.. Butler, E.. Meagher. E. 1996. Journal of Nervous and Mental Disorders. Accepted for publication. "Anti-depressant prescribing in General Practice". 1995. Fitzpatrick. D. and Casey. P. Primary Care Psychiatry. Submitted for publication. MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 ""' .. "The Coverage of Psychiatry in the Irish Print Media". 1995. Meagher, D., Newman, A., Fee, M. and Casey, P. Psychiatric Bulletin. 19, 10. 642-644. "New Patient Non-Attenders". 1995. Meagher, D. and Casey, P. Submitted for publication. Journal of Clinical Psychiatry. "Practical strategies in the management of confusional states". 1995. British Journal of Psychiatry. Submitted for publication. "Working with the Media". 1994. Casey, P.R. Psychiatric Bulletin. 18. 294-295. "Assessment of personality in a clinical setting". 1996. Casey P.R. Advances in Psychiatric Treatment. "Suicide in Kildare". 1996. Walsh, D., McGauran, S., Loane, R., Sheehan, J., O'Donnell, B. Irish Journal of Psychiatry. Accepted for publication. "Social deprivation, ethnicity and violent incidents on acute psychiatric wards." 1995. Sheehan, J., Handie, T., Watson, J.P. Psychiatric Bulletin, 19.10.597-600. "Abnormal clinical nutrition in psychiatric patients." Journal of the Irish Colleges of PhYSicians and Surgeons, 1995; 24: I 1-16. Gannon, MA, Ahmed, I., Lyons, R., Fitzgerald, R., O'Boyle, J., Tormey, W.P. "Late paraphrenia - a review." British Journal of Hospital Medicine. 1995; 53: 128-130. Gannon, MA, Wrigley, M. "New Longstay Patients in an Irish Health Board Area." Psychiatric Services. 1995;46:394-398. Gannon, M.A., Meagher, D.M., Johnson, J., Mirza. J., Farron, C. Review Articles: Depression and Anxiety. 1995. Irish Medical Times supplement. April p.5-6. Psychiatry in the Year 2000. 1995. The Consultant. The treatment of reactive depression. Irish Medical News. Feb. 20th, 1995, p.20. Using newer anti-depressants. 1995. Irish Medical News. Vol.12, 32, pp 20. Criteria for compulsory detention and treatment of psychiatric patients. Sept. 8th, 1995. Irish Medical Times. Book Reviews: Foundations of Clinical Psychiatry. Eds: Bloch, S. and Singh, B.S. 1994. Melbourne University Press. British Journal of Psychiatry. 1995. 166. p.689. Presentations: I. Motor Neuron Disease Society, November, 1995, Dublin. "The distinction between depression and sadness in those with motor neuron disease." P. Casey_ 2. Biomed II: Consent to treatment in psychiatry - Berlin. September, 1995. P. Casey. 3. Fianna Fail's Women's Conference: Psychiatric Aspects of Unemployment. May 1995. P. Casey. 4. Committee of Royal College of Psychiatrists: Research and the Psychiatric Trainee. Belfast. September 1995. P. Casey. S. Department of Health invited speaker on The Workings of the Fitness to Practise Committee to paramedic organisations in Ireland. September 1995. P. Casey. In addition, Professor Casey is a regular contributor to the written media as well as to radio and television in relation to social and health related issues. Conferences Hosted: June 1995: Professor Casey was host to the International_59_ Conference for the Study of Personality Disorders. MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 .... DEPARTMENT OF ANAESTHESIA AND INTENSIVE CARE Introduction The Department has a wide range of activities which are interlinked with most hospital functions. Anaesthesia related skills and background playa large role in the smooth operation of a major modern hospital and medical school. All Consultants and Senior NCHDs take part in an active under-graduate and post-graduate education programme. The range of duties outlined below involves clinical anaesthesia and a range of other services which include ICU, HDU, Pain Management (acute and chronic), Parenteral Nutrition, CPR Training, Research and Administration. This diversity has raised various issues. Subspecialties The roles of the Pain Management and Intensive Care Medicine services are outlined below. These services consume 20-25% of consultant time and a corresponding proportion of the Department's NCHD allocation. This drains Dr. Frank Chambers, Consultant Anaesthetist. the core anaesthesia service and redress is required. The fact that 25% of the Commence 10th July 1995. NCHD complement is provided by supernumerary doCtors reflects this. The Pain Management Service in particular have made detailed submission calling for specific planning and resourcing. This is now accepted as a hospital priority and is the subject of discussion with the Department of Health. General Professional Training Accreditation Committee This visitation is scheduled for 1996. The development of the clinical practice has afforded a wide range of training opportunities. This has been rewarded in the past by accrediting an expanded trainee capacity for the hospital, ego six Senior Registrar positions now recognised. The need to maintain adequate staffing levels at Consultant and NCHD level commensurate with the Department's range of activities is now important in terms of continued quality anaesthetic service and training. A new proposed link in Senior Registrar training with Temple 5treet Children's Hospital is welcomed. CLINICAL ANAESTHESIA SERVICE Clinical anaesthesia is the core activity and consumes the major service and teaching responsibilities of the Department. The increasing and diversifying surgical activity in the hoSpital is welcomed and supported. The need for extra theatre, anaesthetic and recovery facilities is evident as is the need to maintain efficiencies in the hoSpital emergency surgical, anaesthetic and critical care services. Increased Operating Theatre Facility The Department is very supportive of the need to bring into service a fourth operating theatre in the Phase I A suite. Its position paper presented during the year points to the increasing demands (in-patient and out-patient) on the surgical specialty services, ego ophthalmology and the need to facilitate the development of plastic surgery and the hand/upper limbs expertise as a regional service. The changing practice of anaesthesia with a greater demand for local/regional anaesthesia, ego for eyes and upper limbs make the need to open the new theatre/anaesthetic areas more pressing. Expertise in regional ophthalmic anaesthesia has developed but the new consultants required to service this area are anticipated to bring further expertise. The huge overruns in current theatre time as a result of limited theatre space should not be a feature of the efficient use of the expanded Phase I A faCility. 1L...-• __60 ___ 1_ MATER MISERICORDIAE HOSPITAL ANNUAL REpORT 1995 _.. Day Case/Out-Patient Service The Department notes the demand for shorter hospitals stay and recognises the immense value to the hospital in terms of workload and efficiency of the day and S·day wards. However, compromise to clinical standards and delays can occur if patients have not had adequate pre-op/pre-anaesthesia evaluation. This development has been supported by the Department's document of this year which outlines the appropriate categories of patients for these services. describes a questionnaire to facilitate evaluation and oudines laboratory tests needed (and not needed) depending on patient category. The document points to the need to prioritise the development of an out-patient anaesthesia service to respond to the growing needs of day case and short stay admissions. Cardiac Anaesthesia Continues to be a major service and training commitment. It is anticipated that new part time consultants due to start next year, Drs. Carson and Redahan, will provide further strength in depth in dealing with the increasing demands of the aging population including those requiring reoperation. The transplantation service imposes a particular out of hours demand. New expertise, ego transoesophageal echocardiography is being developed in conjunction with the Cardiology service and will bring benefit to a range of perioperative patients including those for major vascular surgery. INTENSIVE CARE UNIT/HIGH DEPENDENCY UNIT The expanded Intensive Care and High Dependency Unit complex were fully utilised in 1995. The additional bed space facilitated the increase in the number of Cardiothoracic Surgery patients with minimal cancellations during the year. Indeed, a major difficulty in admitting new patients this year has been finding sufficient beds in the general hospital for patients who have been discharged from the ICU or HDU. The development of High Dependency Unit has been one of the outstanding features of the year. In a very short space of time, the HDU has become fully integrated into the hospital practice. This has been welcomed by the Intensive Care Unit staff and indeed the primary physicians and surgeons admitting patients to the Unit. The huge number of admissions to the HDU during the year attests to the original plans for the Unit and the very real clinical requirements for the service. 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. INTENSIVE CARE UNIT Oanuary - December 1995) Number of admissions = 1,497 HIGH DEPENDENCY UNIT Oanuary - December 1995) Number ofadmissions = I, I 12 The demand for isolation room facilities remains high for immunosuppressed patients and patients colonised by MR5A. We are indebted to the staff in the Microbiology Department for their attentive suppOrt throughout the year and to the staff in the Department of Radiology for their prompt response to requests for diagnostic imaging studies in our patients. The digital imaging system has been used extenSively during 1995 and the daily radiology review has provided a focus for the clinical activity in the UniL Dr Brian Marsh has completed his critical care training in Perth. Western Australia and we look forward to him joining the Intensive Care Unit consultant staff in January 1996. In 1995. a dedicated biomedical technician for the Intensive Care Unit was appointed. At a time of increased reliance on technical and electronic equipment. we are delighted to welcome Mr Andrew Kennedy to the staff. In conjunction with Mr Tony Colgan, Mr Kennedy has been responsible for the upkeep and servicing of the varied equipment in the Unit and we foresee significant cost savings in service contracts for our equipment during the coming years. _61_ MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 The Irish Board of Intensive Care Medicine has actively encouraged the expansion of educational opportunities in the Intensive Care Unit for trainees from surgical, internal medicine and anaesthesia rotations. The Board will be sponsoring the first examination for Diploma in Intensive Care Medicine in 1996. Presently. all three trainees in the ICU/HDU complex are seconded from the Department of Anaesthesia I Intensive Care. Discussions with the Department of Medicine regarding rotating Internal Medicine trainees into the Intensive Care Unit training programme are ongoing. The Postgraduate Intensive Care Nursing Course has continued throughout 1995. Patients in ICU/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 of 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 9ur patients. We.urgently require a full time secretary to support this on-going activity in the ICU/HDU. Meetings/Audit/Education • Senior Staff / Audit meeting monthly. • Clinical Case Conference weekly (Fri.07.30). • Intensive Care Nursing Diploma course (twice yearly). • Undergraduate Medical Lectures (Carton/Phelan). • Approach to critically ill (resp failure/shock) Brain death I organ donation PAIN MANAGEMENT UNIT The Pain Management Unit has evolved from within the Department of Anaesthesia and Intensive Care and is responsible for the co-ordination and provision of acute and chronic pain service within the hospital and for patient referrals locally and nationally. The chronic pain component is primarily outpatient based with emphasis on day case procedures. However. there is an increase in demand for day ward and diagnostic facilities. Currently three clinics are held per week with plans for expansion which are contingent on the provision of full-time secretarial and nurSing assistance. The practice of allocating a dedicated Senior Registrar to Pain Management together with improved nursing assistance has facilitated the running of the acute Pain service. Both intravenous PCA and epidural infusions are used routinely. There are daily in-patient ward rounds. In summary. we provide a comprehensive Pain Service to all in-patients in the Mater Hospital together with treating approximately 1,000 outpatients. We provide both for a regional, national and international referral basis. This essential service can only continue i(funding is provided for a full time nurse, secretary and NCHD. Clinical statistics: Total Number of out-patients 900 Total Number of in-patients 1000 Procedures (including epidurals. nerve blocks. facet blocks) 300 MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 • CARDIOPULMONARY RESUSCITATION TRAINING CENTRE In 1995, 380 people were trained in CPR. • Basic Cardiac Life Support (BCLS) certified for orie year 264 • BCLS certified for two years 38 • Advanced Cardiac Life Support (ACLS) certified for two years 15 • Heartsaver and other courses 63 Other in-services provided for hospital staff include: • Checking and reassembly of bag-valve-mask (Ambu) device CPR Training Centre. • Dysrhythmia recognition Sr. GlenruJ Woods, CPR Training Suler. • Cardiac arrest management Traditional ACLS (Advanced Cardiac Life Support) courses are run every six months and prove very popular. The Irish Heart Foundation has granted permission for the Mater Misericordiae Hospital to pilot an ACtS course run over divided sessions due to commence this summer. Cardiac Arrest trollies are checked regularly and contents were updated in 1995. Further changes are foreseen for 1996 with the planned introduction of standardised contents devised by The Irish Heart Foundation. CPR training is now available to all hospital staff. PARENTERAL NUTRITION SERVICE There were 126 requests for Parenteral Nutrition, covering 1,604 TPN days. There were 286 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 sixth year, the service is well established with Staff Nurse 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 information 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. UNIVERSITY DEPARTMENT OF ANAESTHESIA Developments have included: Research activity in conjunction with the Departments of Pharmacology and Physiology in University College Dublin and with the Department of Clinical Pharmacology in Trinity College Dublin. Initiation of courses in Pharmacology and Physiology for the Fellowship examinations held jointly by the University Departments of Physiology and Pharmacology and the Department of Anaesthesia, Mater Hospital. _63_ MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 -- Undergraduate Lectures Introduction to Anaesthesia. Prof. D. Moriarty. Anaesthetic Pharmacology, Prof. D. Moriarty. Management of Patients in the Theatre, Prof. D. Moriarty. Visiting Professor University of the West Indies, Trinidad, June 1995. D.C.Moriorty. Magill University, Montreal, October 1995. D.C. Moriarty. Extern Examiner, M.Med (Malaysia). R. MacSullivan. M.D. Thesis Effect of Halothane on Local Anaesthesia Action in Cut End Frog Skeletal Muscle Fibre .. Frizelle H, O'Connor J and Moriarty DC. Departments of Anaesthesia and Physiology University College Dublin. M.D. TheSis The Effects of the Anaesthesia Agent Propofol on Behavioural and Molecular Aspects of Memory: Are Neotrophic Agents Possible Adjuvants to Anaesthesia Treatment with Memory Sparing Effects1 O'Gorman D, O'Connell A, Regan C and Moriarty DC. Departments of Anaesthesia & Pharmacology University College Dublin. M.Sc. Thesis A Study of Plasma Protein Drug Binding in Different Intensive Care Patient Populations. J Browne, WP Blunnie, J Feeley and DC Moriarty. Department of Anaesthesia. Mater Hospital. Department of Clinical PharmaCOlogy, Trinity College Dublin. Student Projects Reversal of Muscle Relaxation: A Comparison of Different Modes of Assessment.' P Scan/on, l Norton, M Bourke, WP B/unnie and DC Moriarty. The Clinical Effects of Bowel Preparation and Assessment of Fluid Shifts. l Norton, P Scan/on, M Bourke, WP B/unnie and DC Moriarty. PRESENTATIONS AND PUBLICATIONS Presentations National Scientific Medical Meeting. 31 March and I st April 1995. European Nosocomial Infection Survey: Analysis'of Irish Data. The Irish Intensive Care Nosocomial Pneumonia Survey Group. McCrory C, Marsh B, Hone R. Phelan D, White M, Fabry J. A Novel Use of Intrathecal Baclofen by Continuous Infusion. Bergin A, O'Brien K, MacSullivan R. Quantitative Assessment of Patient Preference for Anaesthesia Face Mask. Carson KD. Blunnie Wp, Moriarty DC. Cardiac Surgery Patients: A Study of Anaesthesia Face Mask Preference. Carson KD, B/unnie WP. Moriarty DC. MATER MISERICORDIAE HOSPITAL ANNUAL REpORT 1995 I • A Review of the Utilisation and Demands on a Newly Opened Intermediate Care Facility. O'Gorman 0, Fitzgerald). Phelan D. Low Peri-Operative D02 in Cardiac Surgery - Effect of Dopexamine. Walsh F. McCann J, McDonagh p. White M, McGovern E, Luke 0, Phelan D. Pulmonary Haemorrhage and Barotrauma in Homocystinuria. Murphy 0, Clarkson K. Carton E Routine Manganese Supplementation is Unnecessary During Short Term Parenteral Nutrition. Staunton M, Phelan D. Annual Scientific Meeting. FacultY of Anaesthetists. R.CS.I., Dublin. 19 May 1995. Efficacy of a single dose of Aprotinin in Reduction of Blood Loss and Transfusion Requirements in Patients Undergoing Total Hip ReplacemenL Murphy 0, Hayes A, McCarroll M. A Comparison of Regularly Administered Oral Morphine and Intramuscular Morphine in the Treatment of Pain Post Total Hip Arthroplasty. Bourke M, Hayes A, Doyle M, McCarroll M. Anaesthesia for Craniofacial Reconstruction Complicated by Pneumocephalus. O'Gornam 0, Colreavy F. Early M, Magner JB. Aprotinin & Blood Conservation in High Risk Patients Undergoing Repeat Open Heart Surgery and Continuous Haemofiltration. K Carson, P Keartland, A McCarthy, A Wood, WP B/unnie and DC Moriarty. Winter facultY Meeting, 1995. The Patient with a Liver Transplant - the Anaesthetic Implications. Wellcome Medal Presentation. Naughton p. Moriarty DC. South of Ireland Anaesthetists Meeting Major Pulmonary Embolism following TonSillectomy. I st Prize. Leonard I, Biunnie WP and Moriarty DC. October 1995. American SocietY of Anesthesiologists Ultrasound Examination of the Stomach Contents of Post Partum Patients. M. Bowen. Atlanta, 1995. Arterial Pressure in Obese Patients: Comparison of Measurements at the Arm. Forearm and with a Radial Artery Catheter. M. Bowen. Atlanta, 1995. INVITED LECTURES Transport of the Critically III. Seminar on the Trauma Patient, UCD School of Diagnostic Imaging, January 1995. Phelan D. Health Hazards in the Operating Theatre. Irish Society of Occupational Medicine, April 1995. Moriarty DC. Sepsis in Total Parenteral Nutrition Patients.Dublin Castle Infectious Diseases Symposium, 3 May 1995. Phelan D. Pain Management for Cardiothoracic Surgery. University of West Indies, Trinidad, June 1995. Moriarty DC. Advances in Cardiac Anaesthesia. Malaysia, Kuala Lumpur. June 1995. MacSullivan R. Gastric Function in Pregnancy. M. Bowen. Autumn Faculty Meeting, September 1995. Advances in Pain Management, U.CC .. September, 1995. MacSullivan R. Changes in Training for Medical Doctors. Magill_65_ University, Montreal, October 1995. Moriarty DC. MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 -- Reciprocity in Examinations.Royal_College of Anaesthetists. London. November 1995. Moriarty DC. Withdrawal of Invasive Interventions in leu. Intensive Care Society of Ireland. Autumn Meeting. (Waterford), 4 November 1995. Phelan D. Complications following Anaesthesia. Royal College of Physicians and Surgeons, Edinburgh, December 1995. Moriarty DC Coordinator. Part III Course, Faculty of Anaesthetists, RCSt. MacSullivan R. Advanced Cardiac life Support Course Teacher (Mater), 27-29 july 1995. Phelan 0, McCarroll M, Bawen M, Carton E. INVITED ARTICLES Anaesthesia 1970-1995. Modern Medicine, 1995,25 10:49-58. Mariarty DC ABSTRACTS/LETTERS Haemodynamic Changes from the Laryngeal Mask. Canadian journal of Anaesthesia. December 1995. Colbert S, Flanagan F., Moriarty DC Teaching Airway Management Skills. Anaesthesia, 1995,50: 571. Carson KD, Moriarty DC Haemodiafiltration during Aortic Valve Replacement in a Patient with Chronic Renal Failure and Addison's Disease. J. Cardiothoracic Surgery, july 1995. K Carsan, A McCarthy, H Singh, £ McGovern, WP Blunnie, DC Mariarty. Continuous Haemofiltration and Aprotirin in High Risk Patients Undergoing Revision Valvoplasty. j. Cardiothoracic Surgery, july 1995. K Carsan, P Keartland, A McCarthy, A Woad, WP Blunnie, DC Mariarty. Cardiac Surgery Patients: A Study of Anaesthesia Face Mask Preference. Irish journal of Medical Science, 164, 1995. KD Carson, WP Blunnie, DC Mariarty. Patient Preference - A Comparison of a New Fresh Scent Face Mask with a Standard Ruffer Mask for Pre-Oxygenation. British journal of Anaesthesia, 74(1); 1995. KD Carsan, WP Blunnie, DC Moriarty. The Haemodynamic Effects and Catecholamines Release in Response to Bypass with Heparin Coating. Ir. j. Med. Sc., 1995; 164: 12 (Suppt.). O'Donnell A, Carsan K. McGovern £, Phelan 0, McBrinn S, McCarthy D, Javadpour H, McCarthy j. Ne/igan M. The Avoidance of Manganese Toxicity in Patients Receiving Total Parenteral Nutrition. Anaesthesia, 1995; 50 (7): 665 (letter). Staunton M, Phelan D. PEER REVIEW PUBLICATIONS/BOOK CHAPTERS Cardiorespiratory Effects of Laparoscopy with and without Gas Insufflation. Arch. 5urg. 1995: 130: 984-988. McDermott JP. Regan MC, Page R. Stokes MA, Barry K. Moriarty DC, Caushaj PF, Fitzpatrick jM, Gorey TF. Post-Operative Analgesia After Lumbar Laminectomy: Epidural Fentanyl Infusion Versus Patient-Controlled I.v. Morphine. Anesthesia Analgesia, March 1995: 80(3): 51 1-4. josphi G, McCarroll M, O'Rourke K. Prolonged Unilateral Lower Limb Paresis Following Abdominal Surgery with Epidural and General Anaesthesia. MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 0=, .. Anaesthesia Intensive Care. Aug 1995; 23(4): 507-9. Lyons B. Phelan D. McCarroll M. Stack). Hopeless Cases in Intensive Care. Care of the Critically III. Sept/October 1995; I 1(5): 196-197. Phelan D. Intra-Articular Pethidine for Arthroscopic Menisectomy. British Journal of Anaesthesia, Nov 1995; 75(5): 552-5. Lyons B, Hohan D, Flynn K, McCarroll M. Laryngeal Mask Airway Positioning is Related to Mallampati Grading in Adults. Anaesthesia and Analgesia, 1995, 81 ;6: I 00 1- 1004. McCrory C. Moriarty DC. Application of Pharmacokinetic and Pharmacodynamic Principles in Critically III Patients. Critical Care Textbook, American Society of Critical Care Anaesthesiologists, I 995.Carron E, O'Connor M. The Haemodynamic Effect of Prophylactic Perioperative Dopexamine in Coronary Artery Bypass Patients. European Heart Journal, 1995; 16: 1705-1709. Hurley). McDonagh P. Cahill M, White M, Luke D, McGovern E. Phelan D. Analgesia and Sedation after Cardiac Surgery. In Sedation & Analgesia in the Critically III. Ed. G. Park, 1995, Blackwell Science, London. Taylor A, Phelan D. _67_ MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 CHAPLAINCY DEPARTMENT What is Pastoral Care? "I believe in the Sun· even when it does not shine; I believe in Love - even when it ;s 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 Scaff 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 (or each person. Acceptance. hope, forgiveness. peace, healing and love are the traits we seek to call forth in people's lives. Who are we? 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 specialised 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 here? We are here in response to God's and the church's call as part of the healthcare team recog'nising that the spiritual dimension of our lives needs healing just as our body needs healing. Chaplaincy Services are available to 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 followed by distribution of Holy Communion throughout the Hospital. • Sacrament of Reconciliation and Anointing of the Sick available. MATER MISERICORDIAE HOSPITAL ANNUAL REpORT 1995 ... p Other Eucharistic Celebrations: • On First Friday of the month as support for the bereaved; • Each year, two broadcasts from the Hospital Chapel via R.T.E. for the sick and housebound; • The annual "Heartbeats" remembrance and thanksgiving Mass, organised by the Mater Hospital Transplant Club; • Recommissioning of Ministers of the Eucharist. Education: • Involvement of pastoral training of students from various theological colleges including the Church of Ireland; • Supervision of students in pastoral formation in a theological college; • Pursuit of further studies i.e. B.A. in Theology and Philosophy; Involvement in: a) Student Nurse Training; b) Post Registration Courses i.e. Accident & Emergency; Operating Theatres; Coronary Care; Intensive Therapy and Diabetes; c) "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 Interests: Membership of the National Association of Hospital Chaplains. One chaplain is an elected member of the Executive Committee. Membership of the Diocesan Hospital Chaplaincy Association. Two chaplains are on the Executive Committee. _69_ MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 DEPARTMENT OF CHILD & FAMILY PSYCHIATRY Scope of Services The Department provides assessment and treatment for children. adolescents and their families with a range of difficulties. Assessment. diagnosis and treatment of children and adolescents and their families presenting with emotional disorders. educational and language difficulties form the main activity of the staff. The Department maintains a well established expertise in the assessment of the development parameters - language, cognition, and personality of pre-school and latency aged children. Intensive remediation services are available within the clinic for young children with speech and language and associated educational difficulties. The north and north-east sectors of Dublin City and County are provided for by three multi-disciplinary teams are linked to specific geographical areas. Since January 1995. the Department operates three multi-disciplinary teams aligned to Community Care Areas 6. 7. and 8. A satellite Child & Family Centre is incorporated into a new health centre currently being build in Swords. This,development will significantly advance the traditional core ethos of the Deparunent in the provision of a community based service, and it is hoped to develop a satellite clinic in due course in Coolock. Organisation of services. around areas of particular disadvantage of needs, remains a feature of departmental strategy. An increasingly important linkage with the Children's Hospital, Temple Street and. in particular, St. Frances Clinic and St. Clare's Unit, has provided a new departure in the development of a comprehensive and co-ordinated programme of services incorporating the Children's Hospital, Temple Street. A Liaison Committee comprising representatives from both hospitals have now provided the two hospitals with a Development Plan. Mater Child and Family Centre, Ballymun The centre. which was opened in 1972. is located in the Seven Towers Shopping Centre and serves the Ballymun. Santry and Beaumont areas. It has an above average young population. and hence is an ideal setting for a Child & Family Clinic. The population. especially that of Ballymun. has a high unemployment level. and material and social deprivation contribute to many family problems and behavioural. emotional and learning problems for the children. Single parent families from more than half the clients who are referred to the centre. The centre: (a) is in regular contact with the 14 schools in the area which consist of primary. post primary and special schools; (b) provides service to special nurseries and the well developed playgroups. The Speech and Language Therapist provides one weekly session on site in the community pre-school. Early identification and remediation of communication disorders is fostered. as is prevention of more serious problems through liaison and training with pre-school staff: (c) liaises closely with different professional groups in the area. such as the community care social workers, public health nurses, home school liaison officers, etc.; (d) runs groups for children. This year it was a group of 8-12 year old children who needed therapy for child sexual abuse; (e) liaises with the many community groups which are flourishing in the area and provides training in child management to them; (f) runs monthly Journal Club which provides an opportunity for the professionals in the area to meet. MATER MISERICORDIAE HOSPITAL ANNUAL REpORT 1995 Mater Special School This Special National School, funded by the Department of Education, situated in the Child Guidance Clinic, caters for 10 children with communication disorders and associated educational/behavioural difficulties. During the past year. meedngs were organised for the parents of the children attending the school, by the Speech and Language Therapy, Social Work and Psychology disciplines attached to the clinic, as well as the Senior Registrar and the School Principal. A decision was made by the Board of Management of the school to run 10 music therapy sessions in 1996 for the children attending the school. Psychology - Educational Assessment All prioritised referrals for this service were seen before the end of the school year 1995. The anticipated expansion of the Department of Education Schools Psychological Service did not fully materialise during 1995 because of the embargo on new posts in the public service. However, many primary schools in the North Dublin Catchment Area now have a service available. For the most part, this service seems to be applied to north city schools in disadvantaged areas. New referrals (n=61) were accepted during the period September to end December 1995. It is expected that appointments will be offered to each of these before June 1996. Family Therapy Department This department offers a range of training programmes, on and off site, to professionals working in a variety of mental health disciplines. Annually, the department has approximately 70 trainees participating in the different programmes which allows for engagement with a wide range of clinical presentations. The department retains a group of 12 faculty members on an annual basis, half of which are departmental staff. The developmental focus of the department has been to provide an expanding family therapy service in conjunction with. and as part of, these training schemes. Trainees come from all parts of Ireland and abroad to undertake our Masters in Psychotherapy (2 years), Diploma in Family Therapy (3 years), Foundation Year in Systemic Therapy (I year) and Training Supervision Programme (2 years) programmes. The department is serviced by an Acdng Director of Training and a part-time administrator. The department receives referrals for family therapy from schools, general practitioners, clergy, medical specialists, community care personnel as well as a small number of self-referrals. While the greater proportion of the department's clients reside in the catchment area of the Department of Child & Family Psychiatry, referrals are often accepted from outside this boundary, including the referral of couples for marital therapy. Consultations to: i. University of Limerick and Mid-Western Health Board on the setting up of post graduate academic and clinical programmes in psychotherapy. ii. Queens University, Belfast reo foundational training programme in Systemic Therapy. iii. Consultation and Teaching in Systemic Therapy Training to Southern Health Board in Northern Ireland. iv. Advanced supervision to professionals in Family Centre, Stanhope Street. v. Consultation to Northside Community Counselling Centre reo training curriculum New Developments I. Restructuring of consultant posts on the northside of Dublin has had the effect of beginning the process of change and developments as outlined in the Foley Report of December 1989. This was the report of a Working Group on Child & Adolescent_71_ Psychiatric Services of the E.H.B. area and effectively provides a blue- MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 -- print for the way that services may be delivered throughout the E.H.B. area. In due course the expectat~on of a unified programme encompassing the Community Care Areas 6, 7, and 8 may emerge. Paediatric liaison psychiatry. assessment and treatment of child sexual abuse is the main activity of St. Frances and St. Clare's Units in the Children's Hospital, Temple Street. All out-patient and community based referrals are undertaken by Mater-Ballymun out-patient multidisciplinary teams. 2. Funding for two additional N.CH.D. posts at registrar level were granted to the Department from the E.H.B. 1994 development budget. One of these posts is aligned to the rotational training scheme in Adult Psychiatry. It is anticipated that a budgetary allocation for other essential resources i.e. social worker and speech and language posts will be included in the 1995 budget for the Departmen~ 3. The provision of three hospital beds for emergency care of acutely disturbed adolescents at risk of serious self harm and fatality was a generous interim measure by the Hospital Executive. Plans are now underway to develop a six bed in-patient facility in St. Joseph's Adolescent Unit, Fairview. 4. Educational approval for a period of three years (November 1995 - November 1998) was granted for Senior Registrar training by Joint Committee on Higher Psychiatric Training. Training for the next cycle will follow the guidelines set out in The Caiman Report. Ongoing Projects I. Children of Separated Parents: Members of the Social Work discipline organised the first group work sessions for children whose parents had separated. These were held over a six-week period. A parallel group was run for the parents during this time, with an emphasis on sharing up-to-date literature and research findings with the parents on relevant aspects of separation. It is planned to continue these groups in the year ahead. 2. N_I_A_P. (North Dublin Inter-Agency Project): The North Dublin Inter-Agency Abusers Project is based at the Mater Child Guidance Clinic. The project team comprises three Mater staff (two social workers and one psychologist), two health board staff from Community Care Areas 6, 7 and 8, and one senior social worker from S~ Clare's Unit. The Children's Hospital, Temple Street. The team run a weekly group treatment programme for adolescents who have sexually offended, and a fortnightly group for their parentslcarers. The team have also a commitment to training and encouraging the development of similar programmes throughout Ireland. A one-day conference entitled "Treating the Abusive Adolescent" was held in the Mater Hospital in October 1995. Gail Ryan, Programme Director, Kempe National Centre for the Prevention and Treatment of Child Abuse and Neglect, Denver, Colorado, was the main speaker and 150 people attended. In December 1995, two members of the team travelled to Kilkenny to give a training day for 30 health board personnel. The group also maintain ongoing contact with similar programmes in Northern Ireland. 3. Group work with sexually abused children run by Genevieve Tobin and Susan Waterstone. 4. Adolescent Group Therapy Project between the different services on the northside for adolescent sex abusers continues. 5. Cross-border Consultation and SuppOrt between the Northside Inter-Agency Project (Dublin) and the Project Team (Craigavon). For a number of years the Northside Inter-Agency Project has been providing treatment for adolescents who have sexually abused and their families, through group therapy for these adolescents (which deals specifically with their sexually abusive behaviour) and through group therapy for the parents and carers of these young people to provide them with the knowledge and suppOrt they need to cope through this difficult time. _72~ MATER MISERICORDlAE HOSPITAL ANNUAL REPORT 1995 . - A similar group is run by colleagues in Northern Ireland, which is also inter-agency run by staff from child protection and therapeutic services. Each year we have endeavoured to meet with our colleagues in Northern Ireland to share our common experiences in providing therapy for this group of young people and their parents. In April 1995 we met to share our current experiences of working with these adolescents. and exchange resources and materials particular to this area Sexual offense specific treatment for adolescents in a group context is still rare in Ireland despite the need for intervention with this population and our contact with colleagues carrying out the same type of work, in the North of Ireland, has been most beneficial. This is just one of the contacts that the Northside Inter-Agency Project members have with many colleagues throughout the country. 6. At Oberstown Girls' Remand and Assessment Centre, a sector team provides a consultant psychiatric and clinical psychological service for remand and assessment of young people. This service extends also to the Boys' Centre and Trinity House School, Lusk. 7. Consultative services continue to be provided to the Children's Homes and a wide variety of facilities are supported by the involvement of various members of the staff of the department. 8. Ongoing work continues in the Diabetic Project piloted by Mr. A. Conway and Dr. N. Healy. Educational Training The following operates: • Undergraduate teaching - Child & Adolescent Psychiatry medical students. • Social Work students - UC.D., U.C.C .. T.C.D. • Psychology students - U.C.D. and other universities. • Speech and Language Therapists from Department of Remedial Unguistics, T.C.D. • Post-Graduate Training - Diploma in Family Therapy; Masters in Systemic Psychotherapy (Child & Family) - UC.D. • Lectures to nurses, undergraduate and postgraduate. • Child Care students - Cathal Brugha Street. • Montessori students - Montessori Training College. • Physiotherapy students - Mater Hospital. Academic Programme Journal Clubs, Academic presentations and Seminars are held on a twice monthly basis. Invited distinguished speakers regularly present. Academic Work "Psychotherapy as Narrative: A Critical Approach to Paul Ricoeur's Philosophy of Narrative to Psychotherapy." PhD. dissertation submitted to the Department of Philosophy, University College Dublin. November 1995. Sheehan, J. Research Projects E.U. Socrates Programme: Com en ius Action 3. Participation by Department. St. Kevin's & Collinstown Park Community Schools (Clondalkin) in a four country intervention project. Byrne, N. & Tobin, G. Audit of E.E.G. Abnormalities in children presenting to Mater Child Guidance Clinic over 5 year period. Coakley, G. & Healy, N. Suicidal ideation in Irish Adolescents: Safety and Fear Enquiry (SAFE Project). Houlihan, B. An epidemiological profile of urban/rural difference in the Mental Health of the adolescent population. Houlihan, B. Development of assessment protocol in custody and access dispute, using a systemic perspective. Houlihan. B. & Byrne. N. _73_ MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 The exploration of the associations between cultural and parental identity and adolescent depression. Houlihan, B. & O'Sul/ivan, M. Audit lCD-I O. Revision of item sheet data to meet criteria of lCD-I O. Mandos, J. Annual Item Sheet Audit: based on all new cases referred to the Department in 1994. Mandos, j. Story-telling as a therapeutic intervention with children. O'Sullivan, M. & Tobin, G. Northside Inter-Agency Project - Research Study. "A Treatment Outcome Study, evaluating the efficacy of group therapy for adolescents who have sexually abused. The Northside Inter-Agency Project has provided group therapy for adolescents who have sexually offended for the last five years. This year. the group have undertaken research to look at ( I) the characteristics of the adolescents who comprise the clients who attend therapy, and (2) have asked the question "has group therapy been effective in preventing these adolescents from re-offending sexually?" In order to address the question of the characteristics of the adolescents who attend therapy, a final year trainee from the M. Psych. Science course run by U.C.D. has undertaken this aspect of the research. This piece of work will be submitted by him as part requirement of the M. Psych. Science Degree in Clinical Psychology. The latter part of the research has been undertaken by the clinical psychologiSt with the Northside Inter-Agency Project and the rest of the members of N.I.A.P. It is expected that the results of the research will be available in summer-autumn 1996. Invited Workshops: Families experiencing violence and sexual abuse. Child & Adolescent Psychiatry Unit, Sundsvall, Sweden. 2 Day Workshop. February 1995. Byrne, N. & McCarthy, I. The development of Parent-School co-operation using 'The Fifth Province Approach'. I Day Workshop, February 1995. Byrne, N. Contexts of Disadvantage. Parapluie Network Project, Vasteras, Sweden. Workshop presented in Mater Hospital to 35 Swedish multidisciplinary professionals in Adult and Child Psychiatry. October 1995. Byrne, N., Kennedy, Sr. j., O'Brien, II Stress: Recognition and Management. MSF Union Members, Dundalk. Conway, A. Issues in work with travellers. c.Y.c., Arran Quay. Conway, A. Custody and Access Dilemmas. Limerick. October 1995. Support Network for professionals in Child Protection. Houlihan, B. Psychological problems in Adolescents with Diabetes. Mater Hospital, November 1995. Specialist Nurses in Diabetes Care. Healy, N. Solution-Focused Therapy. I Day Workshop. April 1995. Family Therapy Faculty and Students, Mater Hospital. Furman, B. (Finland). Narrative in Social Work Practice. Workshop presented to Masters in Social Work Students. University College Dublin. Sheehan.). Narrative and Memory: The Truth of Remembered Pasts. Paper presented to U.C.D. Department of Philosophy, Inter University Faculty Seminar. Lectures Given Individual Work with Children. Child Protection Diploma Course, Trinity College. Clarke, M. MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 ! I Lifespan and Family Life Cycle. Diploma in Counselling Course, Trinity College. Garke, M. Marital Breakdown. AGM of Accord, Wexford. Conway, A. Children in the home and in school. AGM Parents' Assoc. Divine Word N.S. Rathfarnham. Conway, A. Normal Child Development. 4 Seminars conducted with C.Y.c. Youth Workers, Finglas. Conway, A. What are they watching: A survey of 1,000 adolescents in Dublin and rural areas. Presented at AGM of Child Psych. Section of the Royal College of Psychiatrists with M. Murray. September 1995. Healy, N. and Murray, M. Adolescence: A fine line to tread. Interview with Anne Byrne, Irish Times E & L Supplement. Healy, N., Murray, M., Breen, T., Burke, K. Violence in Children and Adolescents. Interview with C. Holmquist. Irish Times. Healy, N., Murray, M. The Dangerous Adolescent. Annual Essex Psychiatric Meeting, November 1995. Houlihan, B. Lectures in Child Psychiatry. St. Paul's Special School, In-house Training. Houlihan, B. & O'Sullivan, M. Development Child Psychiatry. Lectures given to U.C.D. graduate psychology students and Montessori Special Teachers. McQuaid, P. National Conferences Treatment of Sensory Integration Dysfunction. Presented by Sensory Integration International, Torrance. California in Salthill, Galway. October 1995. Brennan, S. International Conferences Annual American Academy of Child Psychiatry, New Orleans. October 1995. Houlihan, B. Siung, P. Annual International Child Protection Conference, San Diego, CA. November 1995. McQuaid, P. Publications A Spell in the Fifth Province: Its becween meself, herself, yerself, and yer cwo imaginary friends! in S. Friedman (Ed) The Reflecting Process in Action. New York: Guilford Press, 1995. Colgan McCarthy, I., O'Reilly Byrne, N. Illuminations from the Margins: Poverty & Multiculturalism in M. McGoldrick (Ed) Multiculturalism and Therapy. New York: Guilford Press 1996. (In Press) Colgan McCarthy, I., O'Reilly Byrne, N. St. Paul's Special Hospital & School: A Review of Graduate Population. Irish Journal of Psychological Medicine. (In Press). Dowling, B., McQuaid, P. Diamond Absolutes: A daughter's response to her mother's abortion. Human Systems (in press). O'Reilly Bryne, N. Needs of the Young. Health Services News 7:4, November 1995. McQuaid, P. _75_ MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 ST. PAUL'S HOSPITAL AND SPECIAL SCHOOL FOR AUTISTIC AND EMOTIONALLY DISTURBED CHILDREN, , BEAUMONT, DUBLIN 9. St, Paul's Hospital was established in 1970, under the aegis of the Board of Management of the Mater Misericordiae Hospital as an assessment and residential centre for autistic and emotionally disturbed children from allover Ireland. In addition. services are provided on a non-resident basis for children in North Dublin City and County. 1995 saw the commemoration of the 25th Anniversary of the establishment of St. Paul's and was celebrated by three events: • Mass and Party for all children and parents, past and present • Staff Party • Inagurallecture by Dr. Mairin Doherty, Consultant Child Psychiatrist, Our Lady's Hospital for Sick Children and St. John of God Service - The Future of Child Psychiatry in Ireland. The highly skilled staff of the hospital aim to give the resident children a supportive environment in a family like atmosphere. Programmes in the life skills, social training and behavioural management are opened while giving each child a high degree of individual attention. The assessment faCility is multi-disciplinary and comprehensive. In addition to the professional facilities accorded by the Department of Child and Family Psychiatry, Mater Hospital, assessments include neurological and sensorial investigations, blood tests. E.E.G .. and X-Ray examinations, as well as psychological and intellectual testing. Parental counselling is provided throughout the period of the young person's treatment and educational programme. Children and their families who have been for assessment and who may be under consideration for admission are involved in guidance and training programmes, using the wide variety of specialist therapeutic skills available at St. Paul's Hospital. Full paediatric review and investigation are available under the auspice of the Children's Hospital. Temple Street, Dublin I. St. Paul's Special School St. Paul's is a recognised Special School under the Department of Education. administered by a ,Board of Management. Education is provided for approximately sixty children ranging in age from 4 to 18 years. A very high percentage of the children have been diagnosed as suffering from autism and related developmental disorders. Some have additional disabilities. such as impairment of hearing and vision. Many are mentally handicapped. The curriculum includes all primary school subjects, as well as personal development. life skills, and social training at levels appropriate to individual needs. The education programme is individualised to meet the needs of each child, with the aim of minimising handicaps and maximising potential. Progress is monitored at regular case conferences and problems are discussed by a multidisciplinary team to ensure a uniform and consistent approach in all aspects of education and development. Plans for a school extension have been approved and better facilities for adolescents will be available when this is completed. -=76-=-- MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 .... 1F St. Paul's Hostel Six or seven adolescents reside in a semi-detached house in Santry. This hostel provides as normal an environment as possible where the adolescents are encouraged to live more independent and self-sufficient lives within the community. With the support of house parents they attend local social clubs and are integrated in recreational activities with their normal peers in the community. Services Needed I. Pre-School There is an urgent need for a developmental programme for young children. Early diagnosis followed by intervention and organised social and educational activities would help families to cope with the problems of autistic and disturbed children and given hope for the future. 2. After Care!Training In 19S5 a group of parents formed a management committee to deal with increasing concerns regarding placement of'" adolescents leaving St. Paul's School. Proposals for establishment of an adult training centre were sent to the Department of Health. While considerable progress has been made, there is still no appropriate service for multi handicapped past pupils of St. Paul's and some are inappropriately placed in psychiatric hospitals. ST. PAUL'S SPECIAL SCHOOL for Children with Autism and EmotionailBehaviourai Disorders. St. Paul's Special National School has 43 pupils (30 day; 13 residential) between the ages of 4 and IS. There are S teachers (including an administrative principal and a home economics resource teacher) and two part-time teachers (P.E. and Woodwork). The teacher pupil ratio is 1:7 at present. A major development occurred during the past year when St. Paul's Special School was listed in the 1995 budgetary estimates for a capital building programme for a long awaited extension to the school. After a consultation process involving architect. Board of Bi<;hop James Morinrty, Orlo McGuirk, Mary Jefferies. Management and staff, plans have now been drawn up which will Sr. "~erger. Sean Griffin. The lArd Mayor ofDublin provide for an additional wing to the school containing three extra John Gonnely. Dr. Paul McQuaid, celebrating 25 Jears of .<;ervice. classrooms and two large craft room workshops. The new wing will also include an enclosed play space courtyard. The school's goals for 1995/1996 are to provide: (i) a draft individualised educational programme for each child through a consultative mUlti-disciplinary process, and (ii) to engage in meaningful staff development towards improving the quality of service to other pupils. During the year the school, together with St. Paul's Hospital celebrated 25 years of service. The celebrations began in May with the First Communion of an individual child; in June all past and current pupils and their parents were invited to a lunch in the school in the presence of the Lord Major and Sishop James Moriarty - 350 people sat down to an exceptional meal in our small building! In November, present and past staff celebrated a gala dinner in the Regency Hotel and presentations were made to staff who have been with St. Paul's from the beginning. Also in November, the St. Paul's Anniversary Inaugural Lecture by Dr. Noreen Doherty, National Children's Hospital, Crumlin was held in the Mater Hospital Auditorium. Publications REACH Journal of Special Needs Education continues to be edited by Mr. Sean Griffin, Principal of the School. Two articles on Autism were published in the January issue. - 77 .:. MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 , , DIABETES/ENDOCRINE DEPARTMENT Scope of Service The Diabetes/Endocrine service continued to expand in 1995. 532 new patients were seen in the out-patients department where the total number of patient visits was 6.455. In addition there were 6.917 patient visits to the Diabetes Day Centre. This centre complements the very large volume of work being undertaken'in the clinic where the emphasis is geared towards helping people with Diabetes cope with their condition. The Chiropody Unit is also located here. During 1995, the number of chiropody sessions in the Day Centre doubled through the appointment of a second part time chiropodist. The high prevalence of Diabetes in the community is also reflected in the in-patient population where 1.888 patients with Diabetes were admitted to the Mater Hospital with various medical and surgical problems during 1995. All of these patients were seen and managed by the, medical and nursing staff in the Diabetes Unit under the supervision of Dr. O'Meara and Dr. Firth. In addition to looking after the needs of the large diabetes population in the Mater HoSpital. Dr. O'Meara and Dr. Firth continued throughout 199.5 to provide a diabetes service in all three maternity hospitals in Dublin. In October 1995, Mrs. Margaret Brennan retired having spent more than twenty years working as Principal Dietitian in the Mater Hospital and in particular within the' Diabetes Unit. She gave a tremendous service to all our patients during those years and oversaw a very significant expansion in the size and workload within the Unit. She was well noted for her kindness to and great interest in all the patients whom she encountered. This was apparent to all who came in contact with her. She will be sorely missed by both staff and patients in this Unit and we would like to join in wishing Margaret a very long and happy retirement. Publications Heparin-induced lipolysis in hypertriglyceridameic subjects results in the formation of atypical HDL particles. J lipid Res 1994; 39: 2178-2190. O'Meara, N., Cabana, v., Lukens,)., Loharikar, B., Fone, T., Polonsky, K., Getz, G. Non linkage of the glucagon-like peptide I receptor gene with maturity onset diabetes of the young. Dabetologia 1994: 37, 721-724. Y. Zhang,).T.E. Cooke, A.T. Hattersley, RG.R Firth, PJ. Siaker, M. Warren-Perry, M. Stoffel, RC. Turner, Phase-locking regions in a forced model of slow insulin and glucose oscillations. Chaos 1995: 5: 193-199. ). Sturis, C. Knudsen, N. O'Meara,}. Thomsen, E. Moseklide, E. Van Cauter, K. Polonsky. Alterations in the patterns of insulin secretion before and after diagnosis of IDDM. Diabetes Care 1995: 18:568-571. N. O'Meara,). Sturis, K. Herold, D. Ostrega, K. Polonsky. Insulin secretion in insulin resistant women with a history of gestational diabetes. Metabolism 1995; 44:1067-1073. M. Byrne,). Sturis, N. O'Meara, K. Polonsky. The secretion and metabolism of insulin, proinsulin and C-peptide. ENDOCRINOLOGY, 3rd Edition, De Groot L.J. Ed .. Saunders Publishers 1995, p 1354-1372. K. Polonsky, N. O'Meara. Thyroid dysfunction following combined therapy for laryngeal carcinoma. Clin.Otolaryngol 1995, Vol. 20, p 1-4. M.). Donnelly, N. O'Meara, T.P. O'Dwyer. ~78~ MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 III! •• ABSTRACTS AND PRESENTATIONS I. Macrovascular Disease in Non-Insulin Dependent Diabetes Mellitus (NIDDM): A Preliminary Report from the Mater Hospital Diabetes Database. National Scientific Meeting, Royal College of Physicians, March 1995. K. Nikookam, P. Keenan, D. Cregan, R. Firth, N. O'Meara. 2. Risk Factors for Peripheral Vascular Disease in Type 2 Diabetes. Irish Endocrine Society Meeting, Belfast City Hospital, November 1995. K. Nikookam, P. Keenan, D. Cregan, R. Firth, N. O'Meara. 3. Physiotherapy: A Novel Intervention in Diabetic Pre-Ulceration. 2nd International Symposium on Diabetic Foot. Noorwikerhout. Holland, March 1995. F. Curran, K. Nikookam, M. Garrett. N. O'Meara, R. Firth. 4. Polyglandular Endocrinopathies - An Unusual Presentation. Irish Endocrine Society Meeting, Belfast City Hospital, November 1995. M. Griffin, K. Nikookan, N. O'Meara. 5. Insulin Dependent Diabetes Mellitus and Down's Syndrome. Irish Endocrine Society Meeting, Belfast City Hospital, November 1995. M. Griffin, K. Nikookam, T. Fulcher, R. Acheson, R. Firth, N. O'Meara. 6. Physiotherapy; A Novel Intervention in Diabetic Pre-Ulceration. Irish Endocrine Society Meeting, Belfast City Hospital, November 1995. F. Curran, K. Nikookam, M. Garrett, N. O'Meara, R. Firth. 7. Dobutamine Stress Echocardiography in the detection of asymptomatic ischaemic heart disease in patients with Insulin Dependent Mellitus and Nephropathy. Mater Hospital Medical Student Symposium, October 1995. Winner of Oral Presentation in Medicine. M. Teh. H. McCann, N. O'Meara, R. Firth. _79_ MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 -- THE ECCLES BREAST CANCER SCREENING PROGRAMME The completion of the first and second rounds of breast cancer screening in October 1994 enabled the European Reference Centre Group at Nijmegen to evaluate the Eccles Breast Cancer Screening Programme on the basis of quality assurance and to establish whether this programme could operate as an independent European reference centre for the development of a National Breast.Cancer Screening Programme. The site visit was made in March of 1995. The group representing pathology. epidemiology. physics and radiology was chaired by Dr. Alistair Kirkpatrick. director of the Southern Scottish Breast Cancer Screening Programme. The visitors. looked into all aspects of quality assurance in relation to breast cancer screening and furnished a report to the parent body of Europe Against Cancer. The committee was satisfied that the quality assurance achievements of t~e Eccles Breast Cancer Screening Programme were optimal. They recommended that the Eccles programme would be recognised as European Reference Centre capable of establishing and organising a National Breast Cancer Screening Programme. The European Reference Centre Advisory Body informed the Mater Misericordiae Hospital of this recommendation and strongly recommended that this should form the basis for any national breast screening programme. The European Reference Centre ... What is it? In 1988 when the pilot projects from six European countries; Greece. Portugal. Spain. Belgium. France. and Ireland commenced, the objectives were to establish a pilot breast cancer screening programme in each of these countries which to date did not have breast cancer screening available, although mOSt other European countries had widespread mamm?rgraphic facilities available. The intention was that the quality of breast cancer screening in these countries would be brought to a standard similar to that in Holland and Sweden, and that these centres would then form the basis for extending the programme towards a national breast cancer screening programme. The result of the Eccles Breast Cancer Screening, in particular the results of the second round of screening. which showed a participation rate of 86%; recall rate of I. 7%: benign to malignant biopsy ratio of 0.4: I met all the criteria for recognition as a European Reference Centre. The recommendation is that there would be a national centre for quality assurance and education that would guarantee uniformity of excellence in any extension of the screening programme. Extending Breast Cancer Screening Programme on a Phased Basis. During 1995. the opportunity to study breast cancer screening facilities in other countries was availed of. Visits to Wales. Northern Ireland. Holland. Sweden and the United Kingdom allowed a comprehensive plan for the phased introduction of breast cancer screening that would meet the requirements from a financial and-quality control objective in this country. This plan was presented to the Department of Health at their request. and after deliberation and discussion this was accepted in principle. In October of 1995, the Minister for Health at a Europe Against Cancer meeting in Molesworth Street announced the acceptance of the phased introduction or"breast cancer screening in Ireiand. based on the results of the Eccles Street project. New Developments in Breast Cancer Screening Over the last number of years the developments that have taken place relate to greater efficiency in diagnostic mammography. including improved technology. The development of digital mammography. which will significantly reduce radiation and eliminate examinations. offers potential in the future. The introduction of core biopsy to supplement fine needles aspiration could eliminate unnecessary surgical referrals for surgical biopsy. The new MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 developments in ultrasound including the introduction of contrast medium: the application of scintimammography and the refinement of M.R. imaging and spectroscopy all (ocus on the ability to only refer those patients for surgery who have a malignant lesion. The Eccles Street Programme has pioneered many of these developments and this is reflected in the recommendations from the European Advisory Group. It is anticipated that some or all o( these developments will be introduced into any national programme to obviate the need for surgical intervention. The »ru/ing Room in Ille Eccles Breast Screening Centre. European Reference Advisory Group At the Florence meeting in 1994. Professor J.T. Ennis and Dr. Phillipe Autier were elected by their colleagues in the seven European Pilot Breast Cancer Screening Programmes to represent them on the central European Reference Advisory Centre. The Centre meets annually to make recommendations on the continuing developments of quality control in Breast Cancer Screening. It is responsible (or updating guidelines. both on mammography. pathology and epidemiology which have a significant importance in the introduction of national breast cancer screening in this country. The National Breast Cancer Screening Programme - When will it happen? The Minister for Health and the Department of Health are committed to the introduction of breast cancer screening in this country. Problems to be overcome include a population data register and the concerns of the Commissioner for Data Protection. These may delay the project, but they will not obstruct it. __ 81 ___ MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 ,GASTROINTESTINAL UNIT Regional CIinic,.jService The Gastrointestin..al Unit continues !o provide a comprehensive out-patient and endoscopy service to local and regional . referring g,,'neral practitioners. The policy of direct access for G.P.s (536 referrals in 1995) to endoscopy facilities pioneered by the Mater continued to exp.and with the arrival of Dr. P. MacMathuna. The endoscopy service is now available on a 5 day basis. Tertiary Referral Given the availability of advanced therapeutic clinical and endoscopic expertise, the G.!. Unit continued to accept patients from Regional and General Hospitals throughout the country. The majority of these patients were referred for therapeutic biliary endoscopy and endoscopic palliation of gastrointestinal cancer. Expansion of Endoscopy Facility The number of patients treated is as follows: Upper G.I. Endoscopy 2,555 Lower G.!. Endoscopy 1,154 E.R.C.P. 313 Dilatations 61 PEG Feeding Tubes 46 Mesh Stents 23 The arrival of Small Bowel Enteroscopy has enhanced our ability to access occult G.I. bleeding. The choledochoscope enables direct access to the biliary tree for bile and histological analysis in addition to facilitating laser fragmentation of intrahepatic bile duct stones. The acquisition of the first video endoscopic ultrasound technology (the first in Europe) is a major innovation and will form the basis of more accurate staging for gastrointestinal cancer particularly in the oesophagus and pancreatic biliary areas. The introduction of a comprehensive motility and Ph laboratory makes the Mater among the premier G.I. facilities in the country. Research Both clinical and laboratory based studies are ongoing in the areas of Haemochromatosis, colorectal cancer, Hepatitis C, interventional biliary endoscopy and early gastric cancer. Under the supervision of Dr. Eleanor Ryan the clinical Registrars together with a PhD student have expanded to include up to date molecular biology technology. There is close collaboration with the Department of Pathology and Surgery in addition to links with Dublin City University's Chemistry and Biochemistry Departments. The commitment to research has been reflected in podium and poster presentation at both national and intemational meetings (see below). Grant applications have been submitted to the Health Research Board and European Biomed Programme. Other proposed studies include coloreeta! cancer screening. biosensor technology in inflammatory bowel disease and early diagnosis of pancreatico biliary malignancy using PCR technology. Quality ControUClinicai Trials Under the supervision of Ms. Kay Ennis, appointed in 1992. good clinical practise and international standards have been introduced with a view to achieving ISO 9000 accreditation. Papers Published/Submitted The acute and long term effect of balloon sphincteroplasty on papillary structure: an animal study. Gastrointestinal Endoscopy 1995. MATER MISERICORDIAE HOSPITAL ANNUAL REpORT 1995 . - Endoscopic balloon sphincteroplasty (dilatation) for bile stones: efficacy. safety and follow-up in 100 patients. Gastrointestinal Endoscopy 1995. Combined expandable metal endoprosthesis and radiotherapy palliation for malignant dysphagia. Gastrointestinal Endoscopy 1995. The prognostic significance of Rb gene product expression in colorectal cancer. Gut 1995. Presentations to Scientific Societies Irish Society of Gastroenterology - Dublin - November 1995 Haplotype analysis in Irish Haemochromatosis patients: a correlation of haplotype with phenotypic expression of the disease. Clinical and Biochemical expression of the genetic abnormality in Hereditary Haemochromatosis. Temporary and Long Term Biliary Stenting for retained bile duct stones in an Irish population. Combination therapy for eradication of helicobacter pylori in patients with duodenal ulcer disease; a comparison of two regimes. Other presentations were made at Society Meetings of: Irish Association ofCancer Research British Sodety of Gastroenterology American Gastroenterology Assodation United European Gastroenterology Week _83_ MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 INFECTION CONTROL COMMITTEE The 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 relevant action recommended. Hospital policies in relation to patient management are formulated and circulated. 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 disinfectants 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) Varicella/zoster. (d) Multiple Resistant Staphylococcus Aureus. (e) Acquired Immunodeficiency Syndrome. S. 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 Theatres. (e) Endoscopic Procedures. (I) 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 of Non Consultant Hospital Doctors Each July. Courses Six monthly post-registration course for Nurses Dr. R. Hone and Sr. Ruddy Monthly orientation courses for newly appointed Nursing Staff Sr. R. Ruddy Health and Safety Courses for all new staff members Dr. R. Hone Introduction to Asepsis - 4th Year Medicals Dr. R. Hone and Sr. R. Ruddy MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 .... - Committees Advisor to the North Eastern Health Board Infection Control Workshop Dr. R. Hone Meetings Hospital Infection Society, Spring Meeting. London, April 1995. R. Ruddy, R. Hone. Seminar: European Union Directives on Sterile Supplies. Dublin, August 1995. R. Ruddy. Invited Lectures Control and Prevention of ' MRS A'. Seminar: Northside Interhospital Education Group. Dublin, February 1995. R. Ruddy. Clinical Significance and Management of 'MRSA' Infections. Seminar: Northside Interhospital Education Group. Dublin, February 1995. R. Hone. Incidence and Control of Nosocomial Infections. Seminar: European Union Directives on Sterile Supplies. Dublin, August 1995. R. Hone. Care and Management of 'MRSA' Patients. Seminar: E.H.B. Community Care Study Programme. Dublin, August 1995. R. Ruddy. Incidence and Significance of 'MRSA' Infections. Seminar: E.H.B. Community Care Study Programme. Dublin, August 1995. R. Hone. _85_ .' MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 • I THE INSTITUTE OF RADIOLOGICAL SCIENCES THE PROFESSORIAL DEPARTMENT OF RADIOLOGY, UNIVERSITY COLLEGE DUBLIN. In 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 developments, by undergraduate education at University College Dublin medical school in post fellowship Radiology training. and in research into functioning imaging. The objective of the Institute was to create an environment for academic excellence for young radiologiStS and scientists training to maximise their academic potential and to and to stimulate an interest in prospective radiological research. There are many ways in which this has been achieved: - Education The continuing development of functional parameters in radionuclide imaging and the introduction of single photon emission gamma cameras capable of imaging Positrons. and the rapid developments of functional M.R. imaging and . M.R. spectroscopy open up large areas of scientific developments. In discussions with the science faculty at University College Dublin in 1987 a proposal to introduce a ~aster of Science Degree Course in Radiological Sciences was accepted. The objectives were to introduce post fellowship radiology trainees to the scientific and functional developments that were rapidly changing the face of diagnostic radiology. The intention was to create a working relationship between radiologists. physicists. mathematicians. computer scientists and biochemists. The first course commenced in October of 1988. The course of 180 hours of didactic lectures supplemented by a computer module with a project leading to a mini-thesis has been successful. One of the then external examiners and the then Registrar of the Royal College of Radiologists wrote to Professor Alex Montwill. Head of the Experimental Physics at University College Dublin. to state that the MSc course was a blueprint for Post Fellowship Radiological Training. . To date. more than twenty two Irish Graduates have been awarded the MSc in Radiological Sciences representing a 100% success rate. There were four First Class Honour awards and six Second Class Honours. One of the major advantages of the course is that the curriculum can be. and has been changed as new develop~ents take place in diagnostic imaging. The additions of modules in information technology. computed radiography and functional imaging have all been easily achieved in the last twO years. Breast Screening The decision to relocate mammography at 46 Eccles Street in 1986 recognised the importance of stand alone mammographic units is the ultimate development of breast screening facilities. The appointment of a dedicated radiographer in charge to oversee quality control in mammography improved this technique considerably. The first conference in Ireland on breast cancer screening was held in june of 1986 in the Freeman Auditorium. Mater HOSpital. The principal speakers were: Dr. Colm Parsons from The Royal Marsden. Dr. Audrey Tucker from St. Bartholomew's Hospital. and Dr. jocelyn Chamberlain who was the principal advisor in regional cancer development in the United Kingdom. This conference introduced the newest techniques and the potential developments and the physical requirements for breast cancer screening to a large audience. In 1988 a submission was made from the Institute of Radiological Sciences supported by the Mater Foundation to the Europe Against Cancer Committee for the development of breast cancer screening in this country. In july of that year MATER MISERICORDlAE HOSPITAL ANNUAL REPORT 1995 JliEIJ:r Professor Ennis presented the case for breast cancer screening in Ireland. The result was a significant contribution of funds in excess of £200,000 to establish a pilot screening programme at the Mater Misericordiae Hospital. The 'fund raising' supported by the Mater Foundation raised more than £750,000 and enabled the Eccles Breast Screening Programme to initiate and complete a successful Breast Cancer Screening Programme in October of 1994. The recognition of the Mater based Breast Cancer Screening Programme as a European Reference Centre in May of 1995 acknowledged that there was a centre capable of organising a quality controlled Breast Screening Programme in Ireland. This recognition was accepted by the Department of Health. European Activities a Professor Ennis was appointed as the Irish Representative on the Breast Cancer Screening Committee of the Europe Against Cancer Campaign. This organisation meets annually in various European centres to consider the quality control assurances for the introduction and establishment of a National Breast Cancer Screening Programme. Gamf1UJ Camera b The development of M.R. Spectroscopy techniques and the many presentations that resulted from these techniques in relation to clinical management of patients resulted in the Mater Hospital being recognised as a WH.O. Reference Centre for the clinical applications of M.R. Spectroscopy. European Concerted Action Group The Mater Hospital spectroscopy team became an integral part of the European Concerted Action Group in quantifying spectroscopic results and in absolute measurements of T I and T2 values. This enabled the Mater to participate at advanced workshop conferences and to include changes in research protocols at a very early stage. The Mater Hospital's contribution was made by Dr. Una Redmond and Mr. P. Gilligan at severnl international seminars. Research The principal research developments have been in relation to functional imaging using advanced radionuclide techniques and Magnetic Resonance Spectroscopy. The introduction of a dual-headed gamma camera with the possibility of high energy collimation (511 KeV) introduces the concept of imaging metabolic agents using Positron emitters. The future developments of functional and metabolic imaging in M.R. I. offers opportunities to ascertain functional abnormalities prior to morphological changes. In the 10 year period, the Institute has published over 140 scientific papers and made over 200 scientific presentations on a national and international level. Numerous prizes have been won by trainee radiologists at national and international levels. Technological Developments 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 c.T. together with the functional capability of M.R. has provided the Mater with a unique opportunity to develop research at the highest level. The financial support from University College Dublin for the Professorial Unit has considerable enhanced the radiological science laboratory. MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 The Mater Hospital was the first hospital to provide a link between teleradiology and a hospital information system. After some teething problems this has worked exceptionally well and provides instant access to informatio-n for critically ill patient in Intensive Care and the High Dependency Unit. The number of repeat x·rays has dropped to less than 2%. The continued development of this technique in Accident and Emergency Department and ultimately in the Radiology Department will have major impact in patient management. Overseas Developments A grant provided initially by the Department of Foreign Affairs through the support of the late Brian Lenihan who was then Minister for Foreign Affairs enabled an educational link to be formed with the University of the West Indies. This gram is currently administered by ICOS (Irish Council for Overseas Studems). To date six young radiologists from the West Indies have spent a Fellowship Year in the Mater Hospital before returning to the Caribbean. All have successfully completed their M.D. examination in Radiology at the U.w.1. and are currently in consultant positions throughout the Caribbean. This support was publicly acknowledged by the Minister for Health in Jamaica at the November Cemenary Commemoration of Roentgen's discovery of X-Rays. Scientific Papers Tardive Dyskinesia in Schizophrenia Relationship to Minor Physical Anomalies, Frontal Lobe Dysfunction and Cerebral Structure on Magnetic Resonance Imaging. Journal of Psychiatry (1995), 167,94:457: 1-5. john L Waddington, Eabahard O'Callaghan, Peter Buckley, Cathy Madigan, Oonagh Redmond,john P. Stock, Anthony Kinsella, Conall Larkin,joseph I Ennis. Basal Ganglia T2 Relaxation Times in Schizophrenia: A Quantitative Magnetic Resonance Imaging Study in Relation to Tardive Dyskinesia. Psychiatry Research: Neuroimaging 61 (1995) 95-102. P. Buckley, E. O'Callaghan, F. Mulvany, C. Larkin,). Stock, O. Redmond, ). I Ennis, P. Thompson,).L Waddington. Digital Subtraction in Gd-DTPA Enhanced Imaging of the Breast. Clinical Radiology (1995) 50:848-854. F. Flanagan.}. Murray, P. Gilligan,). Stack,j.I Ennis. A multicentre trial of test objects and protocols for performance assessment in Clinical MR Spectroscopy. Magnetic Resonance Imaging, 1994 Vol 13 No I pp 139-157. S.F. Keevil, Barbiro/i, DJ. Collins, E.R. Danielson,). Hennig, 0, Henriksen, M.O. Leach, R. Longo, M. Lowry, C. Moore, E. Moser, C. Segebaith, W Bovee, F. Podo. The Health Care system in the information age. Business and Finance, October 1995, 28-3/. ). I Ennis. Abstracts Published The Relationship of Minor Physical Anomalies and Other Putative Indices of Developmental Disturbance in Schizophrenia to Abnormalities of Cerebral Structure on MRI. Society of Biological Psychiatry 1995: 21 :006:06-00 13. Eabahard O'Callaghan, Peter Buckley, Cathy Madigan, Oonagh Redmond,john P. Stock, Anthony Kinsella, Conall Larkin,joseph I Ennis,john L Waddington. Assessment of Cerebral Abnormalities in Discordant Twins with Schizophrenia using MR Imaging Spectroscopy. 9th European Congress of Radiology, March 1995. Book of Abstracts Supplement to Vol. 5 European Radiology No. 1341 PS269. P. Gilligan, D. Cotter,).P. Stock,). W Waddington,). I Ennis. The Impact of Ascending Lymphoscintigraphy in the Evaluation of Lower Limb Oedema. 9th European Congress of Radiology, March 1995. Book of Abstracts Supplement to Vol. 5 European Radiology No. 1348 PS270. D. Soores,). I Ennis. Imaging Techniques for Persistent Gestational Trophoblastic Disease. "-88:" MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 'I'D 9th European Congress of Radiology. March 1995. Book of Abstracts Supplement to Vol. 5 European Radiology No. 158 PS32. M.P. O·Sullivan. P.e. Lorigan. RJ. Peck, B. W Hancock, R.A Nahie/ny. The impact of Ultrasound: Fine Needle Aspiration (FNA) and Supplementary Radiography in a Breast Cancer Screening Programme. 9th European Congress of Radiology. March 1995. Book of Abstracts Supplement to Vol. 5 European Radiology No. 531. PS I 08. D. Campbell. U. Winters. M. Dowling. O. Laird.}. Stack, T. Garey.}. T. Ennis. An Audit of the Impact of C.R. and the Electronic Patient Record on I.C.U. Radiology. Roentgen Centenary Congress. Birmingham, June 1995. M.P. O'Sullivan, K Peters,}. MacEnri,}.T. Ennis. EndoscopiC Balloon Dilatation of the Sphincter of Oddi (SO Sphincerteroplasty). British Journal of Radiology. Vol. 68 Assessment by Quantitative Biliary Scintigraphy. Roentgen Centenary Congress, Birmingham, British Journal of Radiology. Vol. 68 Birmingham, June 1995. P. Gilligan, D. Cotter, J.P. Stack,]. Waddington, J. T. Ennis. M.R. Imaging in Reflex Sympathetic Dystrophy Syndrome: Improved Diagnostic Efficacy with Digital Image Subtraction and MR Spectroscopy. 81 st Assembly and Annual Meeting of the Radiological Society of North America, November/December 1995. Radiology. 187 Suppl. P. Kavanagh, P. Gilligan, P. Kelly, S. San~].T. Ennis. Morphometry and Metabolism in Monozygotic Twin Pairs Discordant for Schizophrenia Measured by using MR Imaging and Spectroscopy. (Accepted). 81 st Assembly and Annual Meeting of the Radiological Society of North America, November/December 1995. Radiology. 187 Suppl. P. Gilligan, 8. Coburn, D. Cotter,]. Stack, E. O'Callaghan, e. Larkin,]. Waddington,].T. Ennis. Dose Reduction Advantages of Computed Radiography in Abdominal Imaging. 81 st Assembly and Annual Meeting of the Radiological Society of North America, November/December 1995. Radiology. 187 Suppl. P. Kavanagh, P. Kenny, AM. Cahill,}. MacEnri,]. T. Ennis. Presentations Dose Reduction and Other Advantages of Computed Radiography in Abdominal Imaging. Imaging Symposium, Faculty of Radiologists, The Royal College of Surgeons in Ireland, February 1995. P. Kavanagh, P. Kenny, AM. Cohill,]. Donoghue,]. MacEnri,].T. Ennis. MRI Mammography - An Assessment of the Clinical Role and of Problems Associated. Imaging Symposium, Faculty of Radiologists, The Royal College of Surgeons in Ireland, February 1995. M.P. O'Sullivan,]. Stack,]. T. Ennis. Hybrid Magnetic Resonance Fat Suppression Sequences. Imaging Symposium, Faculty of Radiologists, The Royal College of Surgeons in Ireland, February 1995. M. Banks, P. Gilligan,]. T. Ennis. Low Cost Photically Stimulated Functional Imaging on a MRI Scanner with Poor SNR and Homogeneity. Imaging Symposium, Faculty of Radiologists, The Royal College of Surgeons in Ireland, February 1995. P. Gilligan. E. Robinson, D. Mcinerney, B. McCraith, B. Law/ess,J.T. Ennis. Assessment of Cerebral Abnormalities in Discordant Twins with Schizophrenia using MRllmaging. Imaging Symposium, Faculty of Radiologists, The Royal College of Surgeons in Ireland, February 1995. P. Gilligan, D. Cotter,].P. Stack,].L Waddington,].T. Ennis. Functional Applications of 3D Imaging. Workshop in Techniques and Clinical Applications of Three Dimensional Imaging. Institute of Radiological Sciences/Mater Misericordiae_89_ Hospital, May 1995. ]. T. Ennis. MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 f I 3D Imaging in Nuclear Medicine. Workshop in Techniques and Clinical Applications of Three Dimensional Imaging. Institute of Radiological Sciences/Mater Misericordiae HoSpital, May 1995. PA Kenny. 3D MR Imaging of the Brain. Workshop in Techniques and Clinical Applications of Three Dimensional Imaging. Institute of Radiological Sciences/Mater Misericordiae Hospital, May 1995. P. Gilligan. Pre-Operative Applications of 3D Imaging. Workshop in Techniques and Clinical Applications of Three Dimensional Imaging. Institute of Radiological Sciences/Mater Misericordiae Hospital, May 1995. B. Coburn. Early Experience in Craniofacial 3D CT - Techniques and Pitfalls. Workshop in Techniques and Clinical Applications of Three Dimensional Imaging. Institute of Radiological Sciences/Mater Misericordiae Hospital, May 1995. H. Fenlon. An Audit of the Impact of C.R. and the Electronic Patient Record on I.C.U. Radiology. Roentgen Centenary Congress, Birmingham, June 1995. M.P. O'Sullivan, K Peters. j. MacEnri,). T. Ennis. Endoscopic Balloon Dilatation of the Sphincter of Oddi (SO Sphincteroplascy): Assessment by Quantitative Biliary Scintigraphy. Roentgen Centenary Congress, Birmingham, June 1995. P. Kavanagh, R. Merriman, M. Behan, j. Crawe, j. T. Ennis. Computed Tomography During Arterial Portography: A Comparison of Spiral and Non-Spiral Techniques. Roentgen Centenary Congress, Birmingham, June 1995. P. Kavanagh, A. Brannigan, G. McEntee, E. Breatnach. Radiological Audit - Control of Emergency CT Requests by a Peer Review Method. Roentgen Centenary' Congress, Birmingham, June 1995. P. Kavanagh, M. Behan. Assessment of Cerebral Abnormalities in Discordant Twins with Schizophrenia using MR Imaging. Roentgen Centenary Congress, Birmingham, June 1995. P. Gilligan, D. Cotter,).P. Stack,j. Waddington,). T. Ennis. Transanal Ultrasound of Sphincteric Muscles Using a 120 Degree Sector Scanner. Roentgen Centenary Congress, Birmingham, June 1995. D.M. Campbell, V. Donnelly, C. O'Herlihy, P.R. O'Connell, M. Behan. Proton Spectroscopy in Pre-Pathological Assessment of Breast Lesions. 5th International Conference of Anti-Cancer Research, Corfu, Greece, October 1995. P. Gilligan, F. Flanagan, O. Redmond, B. Coburn, M.P. O'Sullivan, j.P. Stack, D. Carney, j. T. Ennis. M.R. Imaging in Reflex Sympathetic Dystrophy Syndrome: Improved Diagnostic Efficacy with Digital.lmage Subtraction and MR Spectroscopy. 81 st Assembly and Annual Meeting of the Radiological Society of North America, November/December 1995. P. Kavanagh, P. Gilligan, P. Kelly, S. SanU T. Ennis. Anal Sphincter Endosonography with use of a 120 Sector Scanner. 81 st Assembly and Annual Meeting of the Radiological Society of North America, November/December 1995. D. Campbell, V. Donnelly, C. O'Herlihy, R. O'Connell, M. Behan. Morphometry and Metabolism in Monzygotic Twin Pairs Discordant for Schizophrenia Measured by using MR Imaging and Spectroscopy. 81 st Assembly and Annual Meeting of the Radiological Society of North America, November/December 1995. P. Gilligan, B. Coburn, D. Cotter,j. Stack, E. O'Caliaghan, C. Larkin,). Waddington,).T. Ennis. MATER MISERICORDIAE HOSPITAL ANNuAL REpORT 1995 _I. NEPHROLOGY DEPARTMENT Scope of Service The department fulfils an intensively consultative role together with a wide scope 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 haemodialysis therapy, acute peritoneal dialysis, and the newer form of renal replacement therapy, continuous veno-venous haemodiafiltration (CWHD). This latter type of acute dialysis intervention is now being applied more frequently in the intensive care setting. It is particularly well suited to the need of the critically ill and "unstable" patient. It facilitates the safe removal of 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 (Gambro AK I 00) are available for 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 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 renal function in these patients. There is an active renal biopsy service. This procedure is now routinely performed using ultrasound imaging. Biopsies are carried out during regular Wednesday sessions which facilitates our own Department and the Departmentof Radiology. Emergency renal biopsies are performed when necessary. Through his association with Beaumont Hospital, the nephrologist arranges full access for Mater Misericordiae Hospital patients with chronic renal failure to the National Renal and Transplantation Unit. These patients continue on his direct care at Beaumont Hospital. Special Interests: Acid-base and electrolyte problems. Renal hypertension and renovascular disease. ACE inhibitors to slow progressive chronic renal failure. Research Activities in Progress: I. End stage renal disease in diabetes. J. Donohue, R. Firth, N. O'Meara. 2. Salvaging functional renal tissue through revascularization. T. Corrigan, J. Donohue. Conferences/Study Days Renal biopsy review conference (in association with Beaumont Hospital). Mondays 12.00 - 1.00 p.m. Nephro-Urology Conference Wednesdays, Radiology Conference Room 12.00 - 1.00 p.m. Research review session Wednesdays 2.00 p.m. - 3.00 p.m. Nephrology Out-patient Clinic: Monday 2.00 p.m. - 5.00 p.m. _91_ MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 Podium and/or Poster Presentations were made at the following Meetings: CAPD versus Haemodialysis. Gleneagles. March 1995. National Scientific Meeting. RCPI. April 1995. "Are you being served in Nephrologyt' Chemical Pathology Association Meeting. Dublin University Medical School. May 1995. Irish Nephrological Society Annual Meeting. St. Vincent's Hospital. Dublin. May 1995. Chairman. Renal Bone Disease Update. Dublin. August 1995. UK/Ireland Nephrology Study Group. Templepatrick. Northern Ireland. September 1995. Nephrology Forum (for Kidney International). Edinburgh. September 1995. Update in Nephrology Symposium. Edinburgh. September 1995. "Lupus and the Kidney". Irish Lupus Support Group. Dublin. October 1995. Publications: CMV as a side-effect of OKTJ in renal transplant recipients. Irish Journal of Medical Science. 161: 630-632. 1992. Conlon P, Smyth E, Spencer S. Carmody M. Donohue J. Walshe 11. Sequential Tc99m mercaptoacetyl-triglycine (MAG3) renography as an evaluator of early renal transplant function. Clinical Transplantation. 7: 245-249. 1993. Carmody E, Greene A. Brennan P. Donohue). Carmody M: Keeling F. . Oxidant depletion in non-melanoma skin cancer. National Scientific Meeting. RCPI. Apr 1994. Gibson G. O'Grady A. Leader M. Walshe 11. Carmody M. Donohue J. Murphy G. Urinary tract infections in women (Editorial). Irish Medical Journal. 88: 142-143. 1995. Donohue J. Long term outcome of renal transplantation in the pre Cyclosporine era: one centre's experience. Irish Journal of Medical Science. 164: 109-1 12. 1995. Conlon Pl. Medawar W. Hanson S. Donohue J. Carmody M. Walshe 11. Glomerulonephritis after ventriculo-atrial shunt. Quarterly Journal of Medicine. 88: 911-918. 1995. Magee C. Vella). Tormey W. Donohue J. Carmody M. Walshe 11. Myeloma and renal failure: one centre's experience. Proceedings. Irish Nephrological Society Meeting. 1995. Magee C. Vella J. Tormey W. Donohue J. Carmody M. Walshe 11. Anti-human leucocyte antigen antibody levels before and after the introduction of erythropoietin. Proceedings. Irish Nephrological Society Meeting. 1995. Vella I. Atkins N. Carmody M. Donohue J. Walshe 11. Rapidly progressive renal failure with haemolysis in a diabetic patient. Proceedings. Irish Nephrological Society Meeting. 1995. Stock AG. Campbell E. Browne O. Doyle GD. Donohue j. A thrombotic catastrophe in a renal transplant recipient. Proceedings. Irish Nephrological SOCiety Meeting. 1995. Stock AG. Leahy A, Hickey D. Donohue J. MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 NEUROPHYSIOLOGY DEPARTMENT E.E.G./E.M.G. Scope of Service Daily 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-diagnostic work with the Ophthalmic Department and the E.N.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 will be replacing the existing E.E.G. machine with Nocolet Digital equipment later in the year. A Dantec E.M.G. machine and nerve conduction equipment, and a Digitrapper with a pressure transducer for anal manometry. Equipment related to evoked responses including auditory click stimulator. Special Interests Dr. B.C. O'Moore is a member of the American Association of Electomyography and Electro-Diagnosis and is also a member of the British Clinical Neurophysiologists. Departmental Presentations Management Skills, "An Insider's View". Our Lady's Hospital, Crumlin. P. Hill. Meetings E.M.G. Conference, Montreal, Canada, September 1995. American Association of Electro Diagnostic Medicine. Dr. Brian C. O'Moore. EPTA Spring Scientific Meeting, Belfast, May 1995. K. Plaisted. EPTA Autumn Scientific Meeting, Our Lady's Hospital, Crumlin, Dublin, October 1995. P. Hill, K. Plaisted. _93_ MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 1 .. DEPARTMENT OF NURSING Nurse Complement: Within the Nursing Complement we have the following specialist nurses: • Infection Control Sister • AnaesthetidResuscitation Training Sister • Specialist Nurse for Parenteral Nutrition • Stoma Care Nurse • Cardiac TransplantiCounselior Nurse • Cardiac Rehabilitation Nurse • Oncology Nurses • Bed Manager • Hepato-Biliary Nurse • Cardiac Research Nurse • Nurse Co-Ordinator of Computer Services .• Haematology Nurse Applications for General Nurse Training: The number of applications processed for General Nurse Training for the year ending 31 st December 1995 has exceeded 2,000. .1 ..... - ADULT PSYCHIATRY DEPARTMENT Range of service: The Depa~ent provides a wide range of services including acute in-patient assessment at the request of any of the medical and surgical teams as well as two out-patient clinics each week for new and follow-up patients. In addition there is access to a senior clinical psychologist who provides assessment I.Q.lCognitive Dysfunction. Developments in the service: The service also has access to and a close working relation with the psychiatric services covering Area 7. This includes having access to a day hospital, several day centres, a range of hostels caring for patients of a low, medium and high dependency level. The use of back-up acute beds in St. Vincent's Hospital, Fairview and access to a nurse behaviour therapist. The next major development will, hopefully, be the commiSSioning of 62163 Eccles Street as community mental health head-quarters which will provide a central base. Statistics: St. Aloysius' Ward, has a bed complement of 15, 10 of which are dedicated to the sector and 5 to the liaison service. There were a total of 197 admissions to the ward during 1995 and the average length of stay was 6 weeks. Out-Patients A total of 1,453 people were seen in the out-patient department in 1995. 232 of these were new patients. MATER MISERICORDIAE HOSPITAL ANNUAL REpORT 1995 i I SPECIAL INTERESTS Post Registration Education Nursing Department The Post Registration Education Nursing Deparunent (P.R.EN.D.) was opened in 1995. It is located in Nelson Street. Its primary aim is to ensure that continuous professional education of post registration nurses be further developed to meet the challenge of advanced nursing practice in an everchanging health care environment. At present four Category II courseS are run: Coronary Care; Intensive Therapy; Theatre Technique and Accident and Emergency; and three Category I courses: Diabetes Care, Teaching and Assessing in Clinical Practice and A Systematic Approach to Nursing Care 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 and one tutor, Ms. laserina O'Connor, who collaborate together (in constant liaison with clinical staff) to achieve the aforementioned aim. 37 staff nurses successfully availed of the four Post Registration Courses during 1995 in Theatre Technique, Accident & Emergency, Coronary Care and Intensive Therapy. 40 staff nurses successfully availed of the two Post Registration Courses in Diabetes Care which were run in November 1995. We hope to extend our Post Registration Courses to include courses on Anaesthesiology. Ms. laserina O'Connor, Tutor, P.R.E.N.D. presented a paper entided "Pain Assessment and Documentation in the Myocardial Infarction Patient" at the Annual Research Conference in the College of Surgeons on Friday, 24th February I99S. The paper was submitted and published in two parts by the Intensive and Critical Care Nursing Journal 1995. Mrs. O'Connor was invited, by the Intensive Care Society of Ireland, to present a paper of "Pain Assessment" in the Royal Victoria Hospital, Belfast on 16th/17th June 1995. Mrs. O'Connor was also invited to speak at the Cardiology Symposium for Nurses and Technicians at the Grand Hotel, Malahide, Co. Dublin. The tide of her lecture was "The Evolving Role of the Cardiovascular Nurse Specialist". Ms. Mary Edger, Haematology Nurse was invited by the Academy of Medical Laboratory Science, to speak on "The Role of the Haematology Nurse and Peripheral Blood Progenitor Cell Transplantation" on 28th February 1995 in Cork University Hospital and on 6th March in Tullamore. Ms. Edger was invited, by the Irish Association for Nurses in Oncology (Cork Branch), to speak on "Peripheral Blood Stem Cell Harvesting" on 31 st May 1995. Mrs. Anne Carrigy, Deputy Director of Nursing. visited two American Hospitals, The Mary Hitchcock Medical Centre, New Hampshire and the United Hospital Medical Centre, Portchester, New York, to look at their quality assessment and continuous quality improvement programmes. Ms. Ursula Courtney, Acting Sister, St. Vincent's Ward, attended the European workshop in patient education in Sweden as an elected representative of the Executive Council for Oncology Nurses. Ms. Ursula Courtney, Acting Sister, St. Vincent's Ward has an abstract "The Oncology Nurse as Teachers, Friend and Advocate" selected for poster presentation at ECCO 8 in Paris on the 29th November 1995. Ms. Deirdre Cregan, Sister in Charge, Diabetic Day Centre, travelled to Kuwait in February in order to participate in the second Diploma Course in Diabetes for Medical Personnel there. Sr. Cregan was also asked to facilitate a counselling course run by the Irish Endocrine Society (Diabetes Section) on 20th and 21 st April 1995. _95_ MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 Sr. Pauline Donohue. Accident & Emergency Department undertook a Training Course in Pastoral Formation/Supervisory Skills for the academic year 1995/1996. Ms. Regina Browne. Nurse Tutor spoke on "Managing Your Stress" at the Irish Nurses Organisation's Student Nurse Conference held in Cork on 23rd November 1995. The Irish Society of Endoscopy Nurses Conferences was held in the Mater Hospital in conjunction with the Irish Society of Gastroenterology (Doctors) on Friday, 17th November 1995. The Annual Reunion of the Past Mater Nurses was held on Saturday, 17th June 1995. The anendance was high, and all Past Mater Nurses enjoyed the day very much. Catering for the occasion was excellent as usual. In-service Training Programme: Request (rom 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 (or experience. National Heart Foundation Nurses undertaking the Coronary Care Course attended the Coronary Care Unit for experience. Study Days for 1995: Study Days entitled "Relaxation for living" were held on 14th and 15th February for all Ward/Departmental Sisters and Staff Nurses. Proficiency Assessment Form workshops were held on I I th and 12th April 1995. Study Days on the "Systematic Approach to Nursing Care" were held on 26th and 27th September and again on 7th and 8th December 1995 for all Ward/Departmental Sisters and Staff Nurses. A Study Day on Communications and Assertiveness Training was held on 21 st November (or all Ward/Departmental Sisters. Sr. Agatha Fleming, Sister-in-Charge, St. Joseph's Ward gave a lecture entitled "Nursing Management of the Tracheostomy Patients" on 3 I st October and 1st November 1995 for all nursing staff. A Staff Orientation Programme commenced this year (or new and newly qualified nursing staff. This programme includes: General Information, Health & Safety, Infection Control, School of Nursing, Information Technology, Manual Handling. and LV Policy training and certification. Intra-venous drug therapy training and certification also commenced this year (or all qualified nursing staff. Continuous Training in Basic Cardiac Life Support continued during the year (or all the staff in the Hospital. Manual Handling and patient lifting training continued throughout the year. MATER MISERICORDIAE HOSPITAL ANNUAL REpORT 1995 If •• Conferences/Courses/Seminars: Date Held: Eurostoma advisory Board Meeting 20 January 1995 in Amsterdam. Lecture by Mr. D. Shanahan on I February 1995 Laparoscopic Techniques in London. Course on Care and Management of People 27 February 1995 affected by HIVIAIDS in St. Jame. to 10 March 1995 Hospital. 3rd Annual Conference of Department of II March 1995 Nursing Studies - Contemporary Issues in Nursing Practice with reference to Legal and Ethical Questions. Irish Association of Critical Care 21122 March 1995 Nurses 8th Annual Conference in Dublin Casde. An Bord Altranais National Conference 24 March 1995 for Nurse Tutors and Clinical Teachers held in Dublin. Two day Stoma Care Conference 30/31 March 1995 Ophthalmic Nursing Seminar in the Royal I March 1995 Victoria Eye and Ear Hospital. Dublin. British Society of Gastroenterology 5 April 1995 Meeting in London. HOSpital Infection Society Meeting 6/7 April 1995 in London. Conference on Strict Metabolic Control 6 April 1995 in Diabetes in Royal College of Physicians. London. National Conference of the Operating 19/20 April 1995 Department Nurses' Section in Limerick. 3rd European Congress on Stoma and 23 to 26 April 1995 Incontinence Care in Rotterdam. Faculty of Nursing. R.C.S.1. 28 April 1995 Workshop on Change and Challenge in Nurse Education. Wound Symposium in Belfast Royal Hospital. 10 May 1995 General Practitioner's A.G.M. in 13 May 1995 Bundoran. MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 ". .. Annual Conference of the Association 25126 May 1995 of Administrative Psychiatric Nurses in St. John of Gods. Stillorgan. Co. Dublin. Clinical Update on HIV and-AIDSIARC 25 May 1995 held in the R.CS.1. Seminar on Living with AIDSIHIV run 27 May 1995 by the Faculty of Nursing. R.CS.I. Irish Society of Endoscopy Nurses Conference 26 May 1995 in Galway. Infection Control Nurses Association 9 June 1995 Meeting in Merlin Park Hospital. Galway. National Conference for the Association for 314 July 1995 Welfare of Children in Hospital in Dublin. Spinal Injuries Course in St. Vincent's 21 July 1995 Hospital. MCR Health Care Seminar in Trinity College. 25 August 1995 Dublin. The Mackey Manufacturers of Operating 30 August 1995 Tables Germany. S.T.D. Seminar in St. James' Hospital. I September 1995 AO.RN. International Conference in 10 to 15 September 1995 Hamburg. Germany. Annual Conference of European Association I I to 15 September 1995 for the study of Diabetes in Stockholm_ AIDS and the Prison System in London_ 27 September 1995 British Diabetic Association Meeting 4 to 6 October 1995 in Harrogate. Course in Radiation Safety in Beaumont 7 October 1995 Hospital. NATN. Conference in Harrogate 10 to 12 October 1995 Symposium on the Delivery of Acute Health 13 October 1995 Care in the Information Age. The Effective Use of Technology. An Bord Altranais Seminar. Professional 18 October 1995 Regulation· Setting Standards. Study into Osteoporosis and irs treatment. 20 October 1995 Annual Conference of the Irish Diabetic 20 to 21 October 1995 Nurse Specialist Association in Dublin. MATER MISERICORDIAE HOSPITAL ANNUAL REpORT 1995 I J Confused about Confusion: Management of October 1995 Confused Elderly People in St. James' Hospital. Annual Ear. Nose and Throat Nursing Seminar 4 November 1995 in the Royal Victoria Eye and Ear Hospital. Women's Health Project Seminar in the 6/7 November 1995 Marino Institute of Education. Annual Conference on "Quality Improvement 9 November 1995 and Change" in U.C.D. CS 3000 User Group Symposium in England 21/22 November 1995 National Conference on "Nursing Research- 23 November 1995 lUxury or necessity from practice" in Dublin. Three day course on Trauma Nursing in the 24 to 26 November 1995 Mercy Hospital. Cork. Nurses' Training Course in Endoscopy 25 to 27 November 199 in London. Seminar on Long Bone Fracture Management 27 October 1995 in Dublin. Meeting on Transfusion Medicine in the 6/7 December 1995 Royal College of Pathologists. London. _99_ MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 OCCUPATIONAL THERAPY DEPARTMENT Scope of Service The Occupational Therapy Unit provides patient care service to a wide range of specialities namely Cardiac Surgery. General Medicine, Respiratory, Cardiology, Oncology, Gynaecology, Nephrology, Endocrinology, Rheumatology, Orthopaedics. General Surgery. Geriatrics and Infectious Diseases. The demand on the services has increase gready during 1995 as the special skills of Occupational Therapy and its essential functiion in rehabilitation and total patient care became more apparent. Throughout the year the in-patient waiting list continues to increase. Requests for treatment had to be prioritised and staff were continuously under pressure to see patients early during their hospital stay and initiate the treatment and planning necessary for their safe discharge. The waiting list for out-patients in Rheumatology is now six months. The Department is accredited by the Health Service Faculty in Trinity College Dublin for student placement and training. Unfortunately due to present staff levels and waiting lists. students cannot be accepted for placements. Courses & Seminars: Stroke Rehabilitation in the Elderly, Occupational Testing Training. Static and Dynamic Splinting Workshop - Adelaide Hospital. Hand Therapy Course - Beaumont Hospital. One Occupational Therapist acts as Instructor at Patient lifting/Manual Handling Courses. Departmental Activity Analysis 1995 In-Patients - 1004 Out-Patients - 709 Total Patients - 1713 MATER MISERICORDlAE HOSPITAL ANNUAL REpORT 1995 f ; Out -Patient Clinics Telephone 01-8]01122, Extension 2295, 2296,2644 CARDIOLOGY: For Dr McCann/Dr Sugrue & Anti-coagulant Appointments ••••••••••••••••••••• Extension 2353 Dr Hugh McCann/Dr Declan Sugrue ...... Monday & Tuesday 2.00pm altemate months Dr Declan Sugrue Chest Pain/Upid Clinic ...... Tuesday B.30am Dr Conor McCarthy ...... Thursday 2.00pm Mr Neligan Post Operative Clinic ...... Thursday 2.00pm Mr Neligan Pacemaker Clinic ...... First Thursday of every month 2.00pm Mr Freddy Wood ...... Thursday 2.00pm Anti-coagulant Clinic ...... Wednesday 2.00pm CHILD PSYCHIATRY Mater Hospital ...... Monday - Friday 9.00am - S.OOpm Ballymun Clinic ...... Monday - Friday 9.00am - S.OOpm DERMATOLOGY Dr Sean O'Loughlin ...... Tuesday & Friday 9.30am Dr Sean O'Loughlin (Dermatology Day Centre) ...... Thursday 9.30am Dr Frank Powell...... Monday & Wednesday 9.30am Dr Gillian Murphy (Photosensitivity) ...... First Monday of every month 1.2Spm Dr Gillian Murphy ...... Every other Monday 1.2Spm Wart Clinic (Dr Frank PowelllDr Sean O'Loughlin/Dr Gillian Murphy) ...... Tuesday 2.00pm Skin Screening Clinic (Dermatology Day Centre) (Dr Frank PowelllDr Sean O'Loughlin) ...... Every second Thursday 9.00am Cryotherapy Clinic (Dr Frank Powell/Dr Sean O'Loughlin/ Dr Gillian Murphy - Dermatology Day Centre) ...... Every second Thursday 9.00pm Patch Testing Clinic ...... Monday 2.00pm DIABETIC DAY CENTRE 48 Eccles Street ...... Telephone 8307006 EAR, NOSE AND THROAT Mr Russell ...... Monday & Friday 9.00am Mr Alex Blayney ...... Wednesday 8ASam Mr Tadgh O'Dwyer ...... Thursday 1.4Spm FERTILITY/INFERTILITY CLINICS Prof David Powell/Prof O'Herlihy (Combined Clinic) ...... Wednesday 2.00pm _101_ MATER MISERICORDlAE HOSPITAL ANNUAL REPORT 1995 -- FRACTURE CLINICS Mr Niall Mulvihil ...... Thursday a.30am Mr Frank McManus ...... Wednesday a.30am Mr Martin Walsh ...... Monday a.30am Mr Michael Stephens ...... Friday a.30am Mr Daragh Hynes ...... Tuesday a.30am GYNAECOLOGY CLINICS Mr Malachy Coughlan ...... Tuesday & Friday 9.OOam Dr Carol Barry-Kinsella ...... Wednesday 9.OOam Smear Test Clinic (Mr Malachy Coughlan) ...... Tuesday 9.OOam G.I. CLINICS Dr Padraig MacMathuna ...... Friday IAOpm Dr john Crowe (Liver Clinic) ...... Monday 2.00pm Dr john Crowe (Gastroenterology) ...... Tuesday 9.SOam Dr john Lennon (Gastroenterology) ...... Wednesday 1.4Spm HAEMATOLOGY Dr Brian Otridge ...... Monday aASam INFECTIOUS DISEASES Dr Gerard Sheehan ...... Tuesday 9.30am MEDICAL CLINICS Dr Paul Smith ...... Thursday 1.30pm NEPHROLOGY Dr john Donohoe ...... Monday I.SOpm DIABETOLOGY/ENDOCRINOLOGY Dr Richard FirthlDr Niall O'Meara ...... Monday & Wednesday 9.OOam ENDOCRINE Prof David Powell ...... Tuesday 1.2Spm RESPIRATORY MEDICINE Dr Patrick Keelan ...... Tuesday 1.30pm Dr Brendan Keogh ...... Friday aASam NEUROLOGY Dr Sean Murphy ...... 1st & 3rd Tuesday of each month 2.00pm _102~ MATER MISERICORDlAE HOSPITAL ANNUAL REPORT 1995 .'". PLASTICS Mr Michael Earley...... Monday I.sOpm Mr Declan Lawlor ...... Friday 1.4spm SURGICAL Mr Tom Corrigan - Varicose Vein Clinic ...... Tuesday I I.OOam - Vascular Clinic ...... Tuesday 9.30am - General Clinic ...... Tuesday 9.4sam Mr Kevin O'Malley - Varicose Vein Clinic ...... Wednesday 9.00am - Leg Ulcer Clinic ...... Wednesday 9.lsam - General Clinic ...... Wednesday 9.lsam Mr Gerry McEntee - Soft Tissue Clinic ...... Thursday 9.00am - General Clinic ...... Thursday 9.lsam Mr Ronan O'Connell - Colon Reccal Clinic ...... Thursday 1.30pm - General Clinic ...... Thursday 1.30pm GENERAL SURGERY Mr Gorey - Soft Tissue Clinic ...... Friday 12.00am - Varicose Vein Clinic ...... Friday IO.4sam - BreasriEndocrine Clinic ...... Friday 9.1 Oam - General/Gastrointestinal Clinic ...... Friday 9.00am RHEUMATOLOGY Dr Michael Regan ...... Tuesday, Wednesday, Thursday & Friday 9.00am HEPATITIS CLINIC Dr Rosemary Hone (Scaff Clinic) ...... Alternate Thursday 2.00pm ORTHOPAEDICS Mr Michael Stephens ...... Monday 2.00pm Mr Niall Mulvihill ...... Tuesday I.OOpm Mr Martin Walsh ...... Wednesday 2.00pm Mr F McManus ...... Thursday I.OOpm Mr Daragh Hynes ...... Friday 1.30pm UROLOGY Mr Seamus Smith ...... Monday 8.30am & Friday 1.30pm Prof Fitzpatrick ...... Wednesday 1.30pm ONCOLOGY Dr Desmond Carney - General Clinic ...... Tuesday 8.4sam - Long Term Review Clinic ...... Thursday 9.4sam _103_ MATER MISERICORDlAE HOSPITAL ANNUAL REPORT 1995 OPHTHALMIC CLINICS Mr Robert Acheson· Diabetic Clinic ...... Wednesday 9.00am · Retina Clinic ...... Thursday BASam · Laser Clinic ...... Monday & Friday 9.00am Mr Roger Bowell ...... Thursday I.ISpm Prof Eustace ...... Monday 9.00am & Tuesday 2.00pm Ms Patricia Logan· General Clinic ...... Tuesday 9.00am · Corneal Clinic ...... Thursday 9.00am Mr Michael O'Keeffe .. , ...... Monday I.ISpm Ms Donna Knight·Nannan ...... Wednesday & Friday I.ISpm Ms Elizabeth Bonner (Biometry) ...... , ...... Wednesday & Thursday 9.30am PSYCHIATRY Prof Patricia Casey· New Patients ...... Monday 9.30am . Return Patients ...... , ...... Thursday 9.30am T.B.CLlNIC Dr Valerie Foley E.H.B (Contact Patients) ...... , ...... , . , ...... , .. , .Monday & Thursday 9.30am Dr Patrick Keelan (Existing T.B. Patients) ...... Thursday IOA5am E.M.G. DEPARTMENT Dr Brian O'Moore ...... , ...... , ...... , .... , ...... , ..... Monday, Tuesday & Friday 2.00pm _104_ MATER MISERICORDIAE HOSPITAL ANNUAL REpORT 1995 E I DEPARTMENT OF OTOLARYNGOLOGy!HEAD AND NECK SURGERY INTRODUCTION/SCOPE OF SERVICE December 1995 saw the retirement of Mr. William Grant, the Senior Consultant ENT Surgeon in the Mater Hospital. having provided an excellent professional service to the hospital and its patients during his career. His expertise. particularly in the field of stapes surgery. attracted patients nationwide and gave the hospital a pre-eminent position in this field of precision microsurgery. Mr. Grant has been succeeded by Mr. John Russell. whose particular interests are in the field of rhinology. benign laryngeal conditions and paediatric laryngology. Like his colleagues. his post is now linked to the Children's Hospital. Temple Street, thus between the two hospitals providing the most comprehensive ENT service in this country. ENTSurgery 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. Over the past 5 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. In conjunction with the National Rehabilitation Board (NRB) a programme for the fitting of the new Bone Anchored Hearing Device(BAHA) was founded in 1995. the first five patients have been implanted. On the educational front, a postgraduate registrar training scheme is run under the auspices of the Royal College of Surgeons. the Mater Hospital and the MaterlTemple Street axis receiving 3 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 and developments are awaited. The Consultant Staff are active members of the RCSI Training Comminees. acts as examiners in the undergraduate examinations of University College Dublin, teach on the ReSI undergraduate teaching programme in Beaumont and examine in 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 (he open and closed (echnique. b Middle ear microsurgical reconstruction. c Otosclerosis surgery. _105_ MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 f! 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 Neurosurgery) a Temporal bone resection. b Anterior skull-base (Hypophysectomy). 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 laser surgery. otological laser surgery and uvulopalatopharyngoplasty for snoring. ONGOING RESEARCH PROJECTS Mr. J. Russell I. "The effects of prolonged otitis media with effusion on the tympanic membrane." University College Dublin. 2. Acoustic Analysis of Voice Disorders. Phonetics Laboratory. Centre for Communication and Language Studies. Trinity College Dublin. 3. The Ultrastructure of the Eustachian Tube in cleft palate mice. University College Dublin. 4. Audit of Functional Endoscopic Sinus Surgery. Mr. T. O'Dwyer A Predictive essay of chemoradiotherapy in Head and Neck squamous cell carcinoma. Work performed in conjunction with the Department of Radio-Oncology. Kevin Street College of Technology (Dr. C. Mothersill) and St. Luke's Hospital (Dr. Ian Fraser). Mr. A.W. Blayney I. "Vibro-acoustic technique for the investigation of middle ear biomechanics and its use in the validation of finite element models of the ossicular chain". MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 2. "An experimental technique for determining middle ear impedance". In co-operation with Dr. H. Rice (Department of Mechanical Engineering. T.CD.) and Dr. K. Williams (University of Cardiff). Initially supported by the Mater College and subsequently by EOLAS/British Council & Royal Society. London. PRESENTATIONS - 1995 "Laryngeal clefts". Grand Round. Great Ormond Street Hospital, London. March 1995. j. Russell. "Endoscopic sinus surgery: A quality assurance study". Irish Otorhinolaryngological Society Meeting. October. j. Russell. "Temporal Bone Fractures" (Poster Presentation). Sylvester O'Halioran Scientific Surgical Meeting. M.J. Donnelly. "Dysphonia and inhaled steroids: A prospective study". (Poster Presentation). National Scientific Medical Meeting. M.j. Donnelly. "Acute food bolus impaction: Aetiology and Management". (Poster Presentation). National Scientific Medical Meeting. P.D. Lacy, M.J. Donnelly.·- . "Cochlear Implant Clinic, Beaumont Hospital, Dublin". Irish Otorhinolaryngological Society Meeting. M.j. Donnelly. "Dysphonia and inhaled steroids: A prospective study". Irish Otolaryngological Society. M.J. Donnelly. "Acute food bolus impaction: Aetiology and Management". (Poster Presentation). National Association of Surgeons of Great Britain and Ireland, London. P.D. Lacy, M.J. Donnelly. "Acute food bolus impaction: Aetiology and Management". (Poster Presentation). National British Academic Conference in Otolaryngology. Manchester. M.J. Donnelly. "Clinical Teaching of Otoscopy". 5th European Congress of Surgery, Barcelona. M.J. Donnelly. "Sleep Apnoea and Snoring". National Study Day for ENT NurSing. M.J. Donnelly (by invitation). "Surgical Management of Drooling in the Neurologically Damaged Child". Scope Annual Scientific Meeting, Roy.al Academy of Medicine, London, june. T. O'Dwyer (by invitation). "Evaluation of Surgical Treatments of Drooling". Scope Annual Scientific Meeting, Roy.al Academy of Medicine, London, june. T. O'Dwyer (by invitation). "The Development of Otolaryngology/Head and Neck Services in the North East". Letterkenny, May. T. O'Dwyer (by invitation). "Adjunctive Chemoradiotherapy in Head and Neck Squamous Cell Carcinoma - The value of an In~Vitro Predictive Assay". Sylvester O'Halioran Meeting, Limerick, February. P.D. Lacy. T. O'Dwyer. "THRP Plating System. Is it safe and reliable!" Royal Academy of Medicine, Section of Otolaryngology, May. j. Hughes, T. O'Dwyer. "An In-Vitro Model to Predict Response of Head and Neck Squamous Cell Carcinoma to Chemoradiotherapy". Royal Academy of Medicine, Section of Otolaryngology, May. P.D. Lacy, T. O'Dwyer. "Evaluation of the Titanium Coated Hollow Screw Reconstruction Plate System (THRP) in Mandicle Reconstruction", MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 ... !R Sir Peter Freyer Surgical Symposium. September. J. Hughes. T. O·Dwyer. "Prophylactic Antibiotics POSt Tonsillectomy. Are they of benefit?" Irish Otorhinolaryngological Society Meeting. Waterford. October. M. Colreavy. T. O'Dwyer. A.W. Blayney. M.J. Donnelly. D. Nanan & M. Benamer. "Determination of a finite element model of the ear". Section of Bioengineering. Royal Academy of Medicine in Ireland. January. G. McAvoy. AW. Blayney. K.R. Williams. "ENT Surgery". Paediatric Refresher Course. R.C.S.I.. March. A.W. Blayney (by invitation). "Hearing loss in the Pseudoexfoliation Syndrome", Irish College of Ophthalmologists. May. A. Early. A W. Blayney. S. Stack. P. Eustace. "Recalcitrant psoriasis: When is tonsillectomy indicated?" National Scientific Medical Meeting. Royal College of Physicians in Ireland. March. S.W. Hone. M.J. Donnelly. F. Powell. AW. Blayney. "Paediatric Objective Tinnitus", Royal Academy of Medicine in Ireland. Section of Otolaryngology. May. M. Benamer. J. Hughes. P. Manning. A.W. Blayney. "Sensorineural Hearing Loss Associated with the Pseudoexfoliation Syndrome", Royal Academy of Medicine in Ireland. Section of Otolaryngology. May. P. Lacy. J. Stack. A Early. C. Sad lear. P. Eustace. A W. Blayney. "''!I plants versus Transplants". Face to Face. European Otological and Neurotological Winter Symposium. January/Febrw'ry. AW. Blayney. E. Offeciers (Antwerp). M. Gersdorff (Brussels) (by invitation). "A Dynamic and Harmonic Damped Finite Element Analysis Model of Stapedotomy". 3rd International Symposium on Transplants and Implants in Otology. Bordeaux. June. A.W. Blayney. K.R. Williams. "Quantifying Healthy Ear Canal Geometry using Magnetic Resonance Imaging" 3rd International Symposium on Transplants and Implants in Otology. Bordeaux. June. AW. Blayney. J. Stack. G. McAvoy. H. Rice. K.R. Williams. "Tympanic Membrane Damage and Repair as analysed by the Finite Element Method". 3rd International Symposium on Transplants and Implants in Otology. Bordeaux. June. A.W. Blayney. K.R. Williams. T.H. Lesser (by invitation). "Paediatric Objective Tinnitus", Academic Meeting in Otolaryngology. Oxford. July. A.W. Blayney. P. Mannion. "An Experimental Technique for determining Middle Ear Impedance". Collegium Oto-Rhino-Laryngologicum. Salzburg. Austria. September. A.W. Blayney. G. McAvoy. H. Rice. K.R. Williams. "Assessment of External Ear Canal Geometry by Magnetic Resonance Imaging". Irish Otorhinolaryngological Society. October. P. Lacy. J. Stack. G. McAvoy. H. Rice. A.W. Blayney. "Determination of Middle Ear Impedance: A new Experimental Technique". Irish Otorhinolaryngological Society. October. AW. Blayney. G.McAvoy. H. Rice. K.R. Williams. "Hearing Loss in the Pseudoexfoliation Syndrome" Glaucoma Society of U.K. and Ireland. Moorfields Eye Hospital. London. November. A Early. P. Eustace. S. Stack. A.W. Blayney. MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 E I "Recalcitrant Psoriasis: When is Tonsillectomy indicated?" (Poster) 9th British Academic Conference in Otolaryngology, Manchester, July, M,J. Donnelly, A,W Blayney, S.W. Hone, F. Powell. "Quantifying Healthy Ear Canal Geometry using Magnetic Resonance Imaging". (Poster Presentation). 9th British Academic Conference in Otolaryngology, Manchester, July. A.W. Blayney, J. Stack, G. McAvoy, H. Rice. "Tympanoplasty". 3rd International Symposium on Transplants and Implants in Otology, Bordeaux, June 1995. Chairman: c.H. Martin, A.W. Blayney (by invitation). "Surgery for Bone Anchored Hearing Aids". Irish Society of Audiology Seminar on Bone Anchored Hearing Aids, October. Co-Chairman: A.W. Blayney (by invitation). PUBLICATIONS Cordectomy: A solution to teflon granuloma of the vocal fold. The Journal of Laryngology and Otology, 1995, 109:53-55. ]. Russell, A Perry, AD. Cheeseman. TeflonGranuloma of the Vocal Cord. Accepted for inclusion in book on Phonosurgery, May, 1995. Eds: Isshili, Schutte & Mahew. J. Russell, A Perry, AD. Cheeseman. Thyroid Function following treatment for Layrngeal Cancer. Clinical Otolaryngology, 1995.20:254-257. MJ. Donnelly, IP. O'Dwyer, N. O'Meara. Is deep insertion of the cochlear electrode array necessary and possible? The Australian Journal of Otolaryngology, 1995 2: 79-81. MJ. Donnelly, L Cohen, G.M Oarke. ENT and General Practice: A study of Paediatric ENT problems seen in General Practice and Recommendations for General Practitioner Training in ENT in Ireland. The Irish Journal of Medical Science, 1995 164: 209-91 I. MJ. Donnelly, M.S. Qurashi, D.P. McShane. Nasopharyngeal Carcinoma: A disease increasing with ethnic diversity? The Australian Journal of Otolaryngology, 19952:147-149. G. Boag. MJ. Donnelly. Investigation of the efficacy and biosafety of hyaluronate (healon) as an aid to electrode array insertion. Annals of Otology, Rhinology & Laryngology, 1995 104(Suppl. 166):45-48. MJ. Donnelly, L Cohen, G.M. Clark. Investigation on a curved intracochlear array. Annals of Otology, Rhinology & Larynology, 1995 104(Suppl. 166) 409-412. MJ. Donnelly, L Cohen, G.M. Oark. Chronic Middle Ear Disease and Cochlear Implantation. Annals of Otology, Rhinology & Larynology, 1995 104(Suppl. 166) 406-408. MJ. Donnelly, B.P. Pyman, G.M. Oark. Three Dimensional enhancement of Radiographic changes in the inner ear: Examples of new bone formation and the common cavity deformity. Annals of Otology, Rhinology & Larynology, 1995 (Suppl. 166): 79-83. B.C. Pyman, H.L Seldon, R. O'Sullivan, WD. Tillner, M.]. Donnelly, M. Scott Migrating foreign body: A new casue of trismus. The Journal of Laryngology and Otology, 1995, 109: 990-991. P. Lacy, C.I. TImon, C.D. Ryan, MJ. Donnelly, D.P. McShane. Temporal Bone Fractures. (Abstract) The Irish Journal of Medical Science, 1995. MJ. Donnelly, S. Moodley, M. Walsh. _109_ MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 Dysphonia and inhaled steroid: A Prospective Study. (Abstract). The Irish journal of Medical Science 1995, 164, Suppl. 14:38. MJ. Donnelly, S. Hone, j. Robertson, S. O'Neill, M. Walsh. Clinical Teaching 01 Otoscopy. (Abstract). British journal 01 Surgery 1995,82 Suppl. 1:60-61. MJ. Donnelly, S. Hone, P. O'Sullivan, D. Smyth, M. Walsh. Chrondoradiomnecrosis of the Larynx - Still a Diagnostic Dilemma! March, 1995, JLO, Volume 109,218-221. H. Rowley, M. Walsh, D. McShane, I. Fraser, T.P. O'Dwyer. The G Syndrome/apia Oculo - gentiallaryngeal Syndrome/apia BBB/G Syndrome/apia Frias Syndrome. March, 1995,jLO Volume 109:244-247. BJ. Conlon, T.P. O'Dwyer. Lymphoma and Hashitomo's Thyroiditis. August. 1995, jLO Volume 109:781-784. jE Fenton,j. Stack, P. Kelly, T.P. O'Dwyer. Cancer of the Pyriform Fossa - The use of Hyperfractionated Radiotherapy as a Treatment. Proceedings of the lOS, Volume 25, 26-28. BJ. Conlon, T.P. O'Dwyer, M. Walsh, D. McShane, N. Corcoran, M. Moriarty, I. Fraser,j.B. Healy. Invasion 01 the Mandible by Squamous Cell Carcinomas 01 the Oral Cavity and Oro-pharynx. Proceedings 01 the lOS, Volume 25, 46. D.A. Smith, T.P. O'Dwyer. A Mathematical Approach to Thyroplasty. (Type I). Proceedings of the lOS, Volume 25, 45. J.P. Hughes, j.D. Russell, T.P. O'Dwyer. Adjuctive Chemoradiotherapy in Head and Neck Squamous Cell Carcinoma - The Valve 01 and In-Vitro Predictive Assay. (Abstract). Sylvester O'Halioran Surgical Meeting. Page 16. P. Lacey, M. Sheridan, C. Mothersill, C. Seymour, I. Fraser, T.P. O'Dwyer. The Use 01 Hyperbaric Oxygen lor the Surgical Patient. Irish journal of Medical Science, Volume 1064, Suppl. 16, 15. J. O'Donnell, E. McCarthy, T.P. O'Dwyer, N. Flynn. Bismuth Subgallate - Its role in Tonsillectomy. journal 01 Laryngology and Otology 1995, 109: 203-206. J. Fenton, A W Blayney, T.P. O'Dwyer. A 3-D finite element analysis of the natural frequencies of vibration of a stapes prosthesis replacement reconstruction of the middle ear. Clin. Otolaryngology, 1995, 20:36-44. KR. Williams,A. W Blayney, T.H. J. Lesser. Langerhan's Cell Histiocytosis: Head and Neck Manifestations in Children. Head and Neck, 1995, May/june, 226-23 I. M.S. Quraishi, A W Blayney, D. Walker, F. Breatnach, PJ. Bradley. Quantifying healthy ear canal geometry using magnetic resonance imaging. Proceedings of the 3rd International Symposium on Transplants and Implants in Otology. Bordeaux, France. Ed. M. Portmann, Kugler Publications 1995, 1-7. AW Blayney,j. Stack, G. McAvoy, H. Rice. Recalcitrant Psoriasis: When is tonsillectomy indicated? Irish journal of Medical Science, Vol. 164, Suppl. 14, P.2. S. W Hone, M. Donnelly, F. Powell, A W Blayney. A 3-D finite element ~nalysis of the natural frequencies of vibration following stapedotomy. Proceedings of the OKS., Clinical Otolaryngology, 1995. A W Blayney, KR. Williams, T.HJ. Lesser. Ultrasonography for the preoperative evolution of paediatric neck abscesses. Proceedings of the Irish Paediatric Association Scientific Meeting. Irish Medical Journal. 1995. M.S. Quraishi, D. Q'Ha/pin, A W Blayney. MATER MISERICORDIAE HOSPITAL ANNUAL REpORT 1995 ..... Hearing Loss in the Pseudoexfoliation Syndrome. Proceedings of the Irish College of Ophthalmologists Irish Journal of Medical Science, Vol. 167, No.4, 332-333. A. Early, A. W. Blayney,). Stack, P. Eustace. A 3-D Finite Element Analysis of Middle Ear Biomechanics and Acoustics. Proceedings of the Irish Otolaryngological Society 1995, 30-33. A. W. Blayney, KR. Williams, G.McAvoy, H.Rice. Recalcitrant Psoriasis: When is tonSillectomy indicated? Proceedings of the Irish Otolaryngology Society, 1995, 34-35. 5. W. Hone, MJ. Donnelly, F. Powell, A. W. Blayney. Mesure de la Geometrie du condiut auditif sur un sujet vivant grace a I'imagerie par resonance magnetique. Resumes des Seances, 92e Congres Francais d'ORL, Paris, October, 1995. Ed. Freche, Arnette, Paris, P. 259. A.w. Blayney,). Stack, G.McAvoy, H. Rice. IN PRESS Inhaled steriods and dysphonia. Journal of Laryngology and Otology, 1994. j. Robertson,). Russell, A. Curran, R. Coakley,S. O'Neill, N. Atkins, M. Walsh. _111_ MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 -- DEPARTMENT OF ORTHOPAEDIC SURGERY Introduction Orthopaedic Surgery continues to be one of the busiest departments in the Hospital. The primary focus is on the management of acute musculoskeletal trauma. The Spinal Injuries Unit. designated as the National Referral Centre in 1988. is becoming increasingly busy. Originally planned to deal with 60 cases per year. the Unit dealt with almost 200 patients in 1995. Scope of Service Fracture clinics are held every morning in a dedicated suite which includes a plaster & cast application area. A physiotherapy service is available in the 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. 8y the end of 19950 Spinal. Foot & Ankle. & Hip Knee. Upper limb and Sports Injuries clinics were established. Mr. DarraglJ lIynes, Con.mllan, Orthopaedic Surgeon. wilh a speciol inlerest in Upper Limb In close co-operation with the National ~ehabilitation Hospital at Rochestown Surgery. Avenue. the National Spinal Injuries Unit provides investigation. treatment and management of patients with these potentially devastating injuries. New Developments The appointment of Mr. Darragh Hynes in September 1995 to the Mater Hospital and Cappagh Orthopaedic Hospital. strengthens the speciality interest in Upper Limb Surgery. After completion of orthopaedic training in Dublin on the Irish Senior Registrar scheme. he went to Norwich. England and Buffalo. New York for further training in Upper Limb Surgery. In combination with the Department of Plastic Surgery. he provides cover for acute hand trauma. He has established speciality clinics in the Mater Hospital and Cappagh Orthopaedic Hospital. Medical Education Undergraduates in University Coliege Dublin are given lectures and tutorials by the staff. Students attend the out patients department, ward rounds and operating sessions to familiarise themselves with all aspects of Orthopaedic Surgery. Postgraduate trainees are taken at the Basic Surgical Trainee or SHO grade and at the Senior Registrar levels. The Consultant staff act as trainers and examiners at undergraduate and postgraduate level including the Fellowship and the Intercollegiate Examination in Orthopaedic Surgery. Research Projects Cervical Trauma - How good are lateral x-ray views? - lOA. Cork. May 1995. Pedobarographic scoring and Hallux Valgus - lOA. Cork. May 1995 . 1• __ 11=-2 _----'I. MATER MISERICORDIAE HOSPITAL ANNUAL REpORT 1995 •• Normal Pedobarograph Footspring - European Society of Foot & Ankle Surgeons - Davos, SWitzerland, June 1995. Pedobarograph Scoring System - Ist Combined Meeting of the American, British & European Foot & Ankle Surgeons - Dublin. August 1995. Bicycle Spoke Injury - lOA. October 1995. A new screw fixation technique for Ankle Arthrodesis - lOA. October 1995. Foot Deformities in Children with Cerebral Palsy - lOA. October 1995. Dynamics of venous blood flow during surgery for fracture of the proximal femur - Cappagh Resident's Prize. November 1995. Orthopaedic Foot problems in Diabetes Mellitus - Course on diabetes care. Mater Hospital. November 1995. Gait Analysis in Children who toe walk - European Federation of Orthopaedic & Trauma Societies. Munich. July 1995. A new screw fixation technique for Ankle Arthrodesis - BOFSS. Glasgow 1995. Economic Impact of Spinal Injuries with no Neurological Deficic : Operative vs Non-operative Treatment. lOA May 1995. A review of Spinal Injuries sustained in Sports Activities: The high level of equestrian related injury and Recommendations. lOA May 1995. Compensatory Mechanisms in the knee in Hip Osteoarthritis. lOA 1995. Dorsal Capsulodesis for Scapholunate Dissociation. Hand Association. Buffalo. June 1995. On-going Research Neurological Improvement following Spinal Fracture The Health Care Cost of Hip Fractures Long term responses to Disease injection The use of Venous Foot Pump in Spinal Injuries The Variable Angle DHS plate in Hip Fractures The effect of Traction on Femoral Vein Blood Flow assessed by Duplex Scanning Publications Tibialis Posterior Tendon Injuries. Letter - J.B.J.S. Jan 1995. Gait Analysis in Children who toe walk. J.B.J.S. 1995. Organising a malor meeting. The Consultant. Oct 1995. Tendon Shift in Hallux Valgus - Observations at MR Imaging. Skeletal Radiology. Nov 1995. _113_ MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 .... Conferences attended Irish Orthopaedic Association Meeting. May 1995. Irish Orthopaedic Association Meeting. October 1995. Spinal Research Society. Ashville. N.C. July 1995. Sports Medicine Association. Orlando. FL October 1995. Knee Arthroplasty Research Society. Hosp for Special Surgery. New York. Dec 1995. Academy for American Orthopaedic Surgeons. Orlando. FL 1995 The Future The Department of Orthopaedic Surgery has grown beyond it's current resources. The National Spinal Injuries Unit requires extra staffing to sustain the correct level of patient care. Increased use of short stay beds will increase the efficient utilisation of the beds and hospital staff. The expansion of upper limb surgical services must be reflected by increased physiotherapy and occupational therapy staffing. The long waiting list for out-patient appointments can only be addressed by increasing the Consultant staffing levels in the Department. MATER MISERICORDIAE HOSPITAL ANNuAL REpORT 1995 .. I DEPARTMENT OF PATHOLOGY HISTOPATHOLOGY DEPARTMENT Scope of Service Workload for 1995 Surgicals 8742 Blocks 20904 Frozen Section 378 Immunohistochemistry 5989 Cytology 2724 Autopsies 381 (959 histology blocks) Workload increased slightly in 1995. Also, there was a marked increase in requests for frozen sections and for post mortems. The department provides a comprehensive service. Diagnostic immunohistochemistry. enzyme histochemistry and electron microscopy are available on site. There are facilities for in situ nucleic acid hybridization. The UCD Academic Department of Pathology is located in the Mater Hospital and Earlsfort Terrace. Medical students also attend autopsies and surgical pathology demonstrations during term. Medical students also attend tutorials and clinicopathological conferences in the hospital. Doctors O'Keane and Kelly participate in undergraduate training through lectures. tutorials and demonstrations. The Department participates fully in postgraduate training. A programme of Quality Assurance has been instituted. The Department is recognised for higher training by the Royal College of Pathologists. Histology UJborolory Histopathology work is managed by the Telepath computer system. All Histopathology reports are SNOWMED-coded. The Department is 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 medicallaboracory students is provided. Departmental Conferences: I. Oncology/Pathology/Radiology. 2. Postgraduate Surgical Pathology. 3. Dermatopathology/Dermatology. 4. Ophthalmology/Pathology. 5. General Medicine. 6. General Surgery. 7. Radiology/Gastroenterology/Surgery/Pathology. 8. Radiology/Respiratory Medicine/Pathology. ~.115=- MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 9. Interhospital Soft Tissue Tumour Review Panel. 10. Urology/Pathology. I I. ENT /Pathology. 12. Hepatitis C/Hepatology/Pathology. CommitteestOffices Held: P. Dervan: Chainnan, Grants Review Committee, Mater College for Postgraduate Education and Research, November 1995. Grants Review Committee, Cancer Research·Advancement Board, May 1995. Health Research Board, Pathology and Immunology Committee, May 1995. EC Biomedial and Health Research Programme Fellowships. Evaluator. Irish Representative on European Prototype Reference Standard Slides Project. External Examiner, University of Dublin, Trinity College. EC Working Group on Breast Pathology. Editorial Board: Irish Journal of Medical Science, (Speciality Editor, Pathology/Laboratory Medicine). International Journal of Surgical Pathology, Editorial Board. American Journal of Surgical Pathology, Editorial Board. Scientific Advisory Board, Electronic Journal of Pathology and Histology. P. Kelly Chairman and Administrator of Department. Board of Faculty of Pathology, RCPI. Education Committee, Faculty of Pathology, RCPI. Regional Advisor for Republic of Ireland, Royal College of Pathologists. Irish Representative, UEMS Board of Pathology. Pathology Group, National Hepatitis C/Ant-D Programme. C,O'Keane Visiting Professor, Mallory Institute of Pathology, Boston University School of Medicine, May 1994. Inspector, Laboratory Accreditation Programme, College of American Pathologists. Pathology Group, National Hepatitis C/Anti-D Programme. Papers Published: Dr. Peter Kelly, Chairman and Prognostic Significance of Microvessel density in lymph node negative breast carcinoma. AdminislTtJloroJlhe Pathology Human Pathol 1995; 26: 1181-1184. Costello P. McCann A, Carney ON, Dervan PA. Department Evaluation of Ki-67 Reactivity in Neuroblastoma Using Paraffin Embedded Tissue. Path Res Pract 1995; 191 :87-91. Graham 0, Magee H, Kieree B, Ball R. Dervan p. O'Meara A. Chromosome I Aneusomy, identified by interphase cytogenetics, in mammographically detected ductal carcinoma in situ of the breast. J Pathol 1995; 175:303-309. Harrison M, Magee HM, Oloughlin}, Gorey TF, Dervan PA. Prospective evaluation of a composite s~oring system for mammographicaUy detected cytologically assessed impalpable breast abnormalities. . Eur J Surg Oncol 1995: 21 :360-363. Kerin M}, Murray J, Mulligan E. Kent p. Ennis J, Dowling M, Dervan PA, FlIZPatrick JM, Gorey TF. L-__-C 11::6 __---I MATER MISERlCORDIAE HOSPITAL ANNuAL REpORT 1995 E I Amplification of the MDM2 gene in human breast cancer and its association with MDM2 and p53 protein status. Br J Cancer 1995; 71 :98 1-985. McCann AH, Kirley A, Carney ON, Corbally N, Magee HM, Keating G, Oervan PA Vascular Malformations presenting as spinal cord neoplasms; Case report. Montine Tj, O'Keane jC, Eskin TA, Giangaspero F. Gray L., Friedman AH, Burger Pc. Practice Guidelines for Autopsy Pathology. Autopsy procedures for brain, spinal cord and neuromuscular system. Arch Pathol Lab Med. September 1995; 119:777-783. PowersjM. Autopsy Committee of the College of American Pathologists. Practice guidelines for autopsy pathology. Autopsy Reporting. Arch Pathol Lab Med. 1995; I 19: 123-130. Hutchins GM. Bartonella Henselae Endocarditis in an Immunocompetent Adult. Clinical Infectious Diseases 1995;21: I 004-7. Holmes AH, Greenough TC, Balacly Gj, Regnery RL., Anderson BE, O'KeanejC, Fonger jO, McCrone EL Imaging of small cell carcinoma of the oesophagus. Clinical Radiology (in press). Fenlon HM, O'Keane C, Carney ON, Brearnach E. Abstracts and Papers Presented: Progressive fibrosis in chronic Hepatitis C is related to the severity of periportal, not lobular inflammation. Ir J Med Sci 165 (Suppl 1):20. O'Keane JC, Crowe J. Pathology of Chronic Hepatitis C (CHC): 17 year follow up of a unique uniform cohort with a low rate of progression to cirrhosis. Mod Pathol 1995; 8: 132A. O'Keane JC, Kelly PMA, MacMathuna P. Crowe J. Presentation of Hepatitis C in a unique uniform cohort 17 years from inoculation. Gastroenterology 1995; I 08:A I 054. Crowe J, Doyle C, Fielding JF, Holloway H, Keegan M, Kelleher 0, Kelly P. Leader M, littie M, McDonald G, McCarthy CF, McWeeney H, O'Keane C, Rajan E, Kenny Walsh L, Weir DG, Whelton M. Apoptosis and bcl-2 expression in colorectal ademonas. Irish Association for Cancer Research, Annual Meeting, Derry 1995. Annual Meeting, Irish Association of Cancer Research, Derry April 1995. Pathology and Pathogenesis of Hepatitis. Update on Infection. Faculty of Pathology, RCPI, October 1995. O'Keane Jc. Case Reports. Irish Association of Dermatology AGM 1995. O'Keane Jc. Genomic Alterations in Non-Hodgkin's Lymphomas. Irish Association for Cancer Research, Derry 1995. Butler M, Corbally N, Dervan PA, Carney ON. FI5H for Pathologists. Symposium on Recent Advances in Laboratory Medicine. faculty of Pathology, RCPI, March 1995. Dervan PA. Telepathology in Telemedicine. "The delivery of acute health care in the Information Age". Symposium, Mater Hospital, October 1995. Dervan P. Interphase Cytogenetic Study of Chromosomes I and 17 in Ductal Carcinoma in situ (DClS) if the Breast. US/Canadian Academy of Pathology. Toronto 1995. Harrison M, Magee H, O'Loughlin J, Gorey T, Dervan P. Correlation between Chromosome I Aneusomy and DNA Ploidy in Breast Carcinoma. US/Canadian Academy of Pathology. Toronto 1995. Harrison M, Magee H, O'Loughlin J, Gorey T, Dervan P. _117_ MATER MISERICORDIAE HOSPITAL ANNUAL REpORT 1995 Comparison of Chromosome I Aneusomy detected by Interphase Cytogenetics and DNA Ploidy in Breast Carcinoma. Irish Association for Cancer Research. Derry 1995. Harrison M, Magee H, O'Loughlin J, Gorey T, Dervan P. Chromosomes I and 17 in mammographically detected Ductal Carcinoma In-Situ (DClS) - An Interphase Cytogenetic Study. Irish Association for Cancer Research, Derry 1995. Harrison M, Magee H, O'Loughlin J, Gorey T, Dervan P. Genomic Imprinting of the IGF2 Gene in Childhood Cancers. MMH Student Research Symposium 1995; Abstract. Keogh K, McCann A, Miller N, O'Meara A, Dervan P. Cell Proliferation with S-phase fraction detected by histone H3 mRNA in ductal carcinoma in situ of the breast. MMH Student Research Symposium 1995. Lim HY, Harrison H, Magee H, Keating G, Gorey T, Dervan P. Analysis of IGF2 Genomic Imprinting in Human Breast and Eilm's Tumours. Irish Association for Cancer Research, Derry 1995. Miller M, McCann AH, O'Meara A, Croke DT, Dervan PA. Suitable DNA from Archival Clinical Material for POP-PCR and CGH. Irish Association for Cancer Research. Derry 1995. Moore E, Magee H, Lemass H, Dervan PA. ''The gender of genes. Implications in Tumourgenesis". St. Vincent's Hospital Seminar, June 1995. McCann A. "Genomic Imprinting and Cancer". Royal Academy of Medicine in Ireland, December 1995. McCann A. c-erbB-2 Amplification in Ductal Carcinoma In-Situ (DClS) of the Breast: Detection by In-Situ Hybridization. Irish Association for Cancer Research, Derry 1995. O'Loughlin J, Harrison M, Magee H, Dervan P. Proliferative growth fraction in common pigmented skin lesions. MMH Student Research Symposium 1995. Rajasegaran K, Tobin B, Harrison M, Keating G, Dervan P. Total Genomic Amplification by DOP-PCR on selected tumour cells. MMH Student Research Symposium 1995. Ryan D, Moore E, Dervan P. ConferencesiWorkshops Attended: P. Dervan USCAP Conference, Toronto, March 1995. Irish Association For Cancer Research, Annual Meeting, Derry, April 1995. EU Breast Workshop, Turin, May 1995. Course for Advanced Technology and Image Analysis (CATAI), Genoa, June 1995. Session Chairman. The Challenge of Breast Cancer Symposium, St. Vincent's Hospital, September 1995. "New Therapies derived from Biotechnology" Europe Blanche XVII, October 1995. The Uses of New Technologies in Education and Training. Workshop, UNIV Centre, UCD 1995. Dublin Soft Tissue Sarcoma Panel (monthly meetings). M. Harrison Irish Association for Cancer Research, Derry, April 1995. USCAP, Toronto, March 1995. j.c. O'Keane US/Canadian Academy of Pathology, Toronto, March 1995. Irish Society of Gastroenterology, Dublin, November 1995. Irish Association for Cancer Research, Derry, April 1995. MATER MISERICORDJAE HOSPITAL ANNUAL REpORT 1995 gr. Irish Association of Dermatology, Killarney, April 1995. P. Kelly European Society of Pathology, Biennial Congress, Copenhagen, September 1995. Irish Society of Gastroenterology, Dublin, November 1995. MICROBIOLOGY DEPARTMENT Scope of Service 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 tests are carried out to a large number of antibacterial agents. Laboratory control of antibiotic 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 treaunent of \ patients is provided by the consultant microbiologist at ward level. Microbiology UWoraJory Special Interests Rapid diagnostic techniques for identification and senSitivity testing of Mycobacterium Tuberculosis are being developed. Mr. V. Shaw is undertaking a study of culture or Mycobacterium and their identification using a radiometric technique. Dr. N. Corbally and Mr. A. Murray are working on direct identification of Myobacterium in clinical specimens using 'PCR' techniques. Identification of other micro-organisms by this technique have also been perfected. Fungal infections in immunosuppressed patients have been encountered with increasing 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 particular interest for many years. Dr. C. O'Sullivan devised a number of educational strategies which target specific problem areas and encourage best practice, whilst promoting economic use of antibiotics. Dr. R. Hone in her capacity as 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 ail the doctors in the Hospital. It will be revised annually in association with the Chief Pharmacist. __ 119~ MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 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. Member Department of Health and Comhairle na nOspideal Advisory Body on Virology Services in Ireland. Advisor North Eastern Health Board Infection Control Working Group. Member Medical Council of Ireland. Conferences/Meetings attended Challenging Clinical Infections. Academy of Medical Laboratory Science. Dublin, March 1995. A. Murray, V. Shaw, L. Dyke. Hospital Infection Society Meeting. London, April 1995. R. Ruddy, R. Hone. Microbiology Symposium. Association of Clinical Pathologists. London, April 1995. C. O'Sullivan. Use of 'PCR' Technology. Royal Irish Academy. Dublin, May 1995. A. Murray, N. Corbally. New Applications of Emerging Molecular Diagnosis for Infections Diseases. London, June 1995. A. Murray. 'NEQAS' Diagnostic Parasitology. Dublin, July 1995. T. O'Sullivan. Western Tuberculosis Review Group. Galway, 1995. B. Boyle, A. Murray. Bact Alert Users Group. Warwick, England, November 1995. B. Boyle, A. Murray. Bactec User Group. Belfast. November 1995. A. Murray, V. Shaw, J. Collier. Presentations/Lectures Clinical Significance and Management of 'MRSA' Infections. Northside Inter Hospital Education Group. Dublin, February 1995. R. Hone. Antibiotic Audit in an Acute General Hospital. National Scientific Medical Meeting. Royal College of PhYSicians, Dublin. March 1995. C. O'Sullivan, R. Hone. European Nosocomial Infection Survey: Analysis of Irish Data. National Scientific Medical Meeting. Royal College of Physicians, Dublin. March 1995. C. McCrory, B. Marsh, R. Hone, D. Phelan, M. White, J. Fabry. Promotion of Economic Use of Antimicrobial Agents in an Acute General Hospital. Pan celtic Microbiology Meeting, Kilkenny. June 1995. C. O'Sullivan, R. Hone. Pan European MRSA Conference. Paris, June 1995. R. Hone Incidence and Control of Nosocomial Infections. Seminar. European Union Directives on Sterile Supplies. Trinity College Dublin. August 1995. R. Hone. Incidence and Significance of MRSA Infection. Community Care Study Programme, Eastern Health Board. Dublin, August 1995. R. Hone. MATER MISERlCORDlAE HOSPITAL ANNUAL REPORT 1995 Molecular Mycobacteriology - A Review. Academy of Medical Laboratory Science. Limerick. November, 1995. A. Murray. Publications Adherence of Bacteria to Intraoccular Lens. British Journal of Ophthalmology 1995. 79,374-379. A. Doyle, B. Beigi, A. Early, A. Blake, P. Eustace, R. Hone. Nosocomial Pneumonia in Intensive Care: A Review. Irish Journal of Medical Science 1995. 164,215-218. F. Chambers, R. Hone, D. Phelan. European Nosocomiallnfeetion Survey; Analysis of Irish Data. Irish Medical Journal 1995. In Press. B. Marsh, R. Hone, M. White, D. Phelan,). Fabry. Patterns of Colonising and Pneumonic Organisms in Intubated Intensive Care Patients - A Prospective Analysis. Journal of Clinical Intensive Care 1995. F. Chambers, M. White, R. Hone, R. Ruddy, D. Phelan. Staphylococcus Aureus Sensitivity to various Antibiotics - A National Survey in Ireland 1993. Irish Journal of Medical Science. 165,40-44. E Moorhouse, L Fenelon, R. Hone, E Smyth,). McGahon, M. Dillon. Antibiotic Audit in an Acute General Hospital. Irish Journal of Medical Science 1995. Vol. 164. Supplement 14,31. C. O'Sullivan, R. Hone. BIOCHEMISTRY DEPARTMENT Scope of Service The Biochemistry Laboratory carried out 975,000 tests in 1995, continuing the very large increases on previous years, as shown below. Yet staffing levels have remained static in that time interval. Year Number oftests performed 1970 98,000 1980 405,000 1985 594,000 1990 625,000 1994 884,000 1995 975,000 In addition to the routine service. the laboratory continued to provide a twenty-four hour emergency service. Primary sampling continues successfully on the 2 major analyzers in the laboratory, the Synchron CX7s, so that samples go direcdy for analysis immediately after centrifugation. 1995 saw an increase in the range and number of tests carried out on Stat machines in the Intensive Care Unit and the High Dependency Unit. The Stat Profile 9, Nova 8 and ABL520 machines offer 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 playa very active rol. in the Maintenance and Quality Control of these machines. Mr. John Collier and Dr. Sean Maguire have also investigated the clinical use of ionized calcium and magnesium in cardiopulmonary bypass patients and post cardiac transplant patients in conjunction with medical staff of the Intensive Care Units. MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 The worldwide interest in the prostate cancer marker PSA has been reflected by increased demand (or this test in the Mater Hospital which was met by the introduction ofa twice weekly service on the IMx. The computerisation of the Biochemistry Laboratory has been complete for some time. The increasing use of the Order Communications system from the wards, and it's extension to the Accident and Emergency Department. made a significant difference to the time spent in Request Entry and in responding to telephone enquiries in the Biochemistry Laboratory. The new pneumatic chute system means that samples from Intensive Care. AlE, Coronary Care, etc. can be delivered quickly to the laboratory. The staff of the Laboratory, in particular Mr. Edwin Wright. Chief Technologist. were actively involved in the training of students studying for their degrees in Biomedical Sciences. For the third year of the B.Se. in Biomedical Sciences, students rotate between the various pathology departments including biochemistry. Dr. Peadar McGing lectured to the final year students on tumour markers. • Biochemists in the Republic of Ireland are now eligible to join the Continuing Medical Education scheme run by Royal College of Physicians of Ireland. Special Interests I. Computing. 2. Cyclosporine Monitoring in Transplant Patients (Reference Centre for HPLC analysis). J. Ionized Magnesium 4. Investigation of Creatine Kinase Isoenzyme variants. S. Lipoprotein analyses. 6. Tumour Markers. 7. "Stone" analysis. 8. Alkaline Phosphatase Isoenzyme profiling. Special Equipment and Techniques The principal analytical eqUipment are 2 Beckman Synchron CX7s. In addition the laboratory uses the IL·1302 and AVL blood gas analysers. the TDx fluorescence polarisation analyser and the IMX immunoassay automated analyser. Flame photometry, osmometry. electrophoresis of proteins, isoenzymes and lipoproteins are other techniques used. A modern flame photometer using caesium as internal standard is used to measure lithium. Osmolality is measured by freezing point depression on a Fiske Osmometer. Fractionation of the isoenzymes of alkaline phosphatase and creatinine kinase are other specialist techniques used. The Cary Spectrophotometer is used for manual assays and for reagent evaluation and trouble-shooting. The laboratory is'actively involved in making up reagents as a cost-saving device and many commercial reagents have been replaced. One lab aide is employed for this reason. The laboratory continues to provide many tumour marker assays such as CA·125, AFP. B2M and PSA. The use of the Abbott IMx System has reduced turnaround time for these assays. The demand for tumour marker analyses continued to grow in 1995 and a weekly service was continued for all assays except for PSA for which a twice weekly service is now routinely provided. The laboratory was recently featured in Beckman's quarterly Diagnostic Update Magazine, showing how the 2 Beckman Synchrons and ward order communications are integrated into the laboratory data management system. Research Activities John Collier and Dr. Sean Maguire are currently undertaking a number of studies in the Intensive Therapy Unit with Dr. D. Phelan and 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. Mr. Frank Kyne and Dr. Sean Maguire continued research on cyclosporine, the anti-rejection drug used in transplant patients. New techniques to speed up the assay were investigated. The laboratory now provides a reference service for the cyclosporine assay to many major hospitals in Ireland covering all transplant types, including the Blackrock Clinic, Beaumont. and St. Vincent's Hospital. It is hoped to establish an assay for FKS06, an immunosuppressant which has been used in clinical trials in humans in the U.S.A. and which is now being tested in heart transplant patients in Europe. MATER MISERICORDIAE HOSPITAL ANNUAL REpORT 1995 I I During 1995 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 laboratory concluded its large study to determine reference ranges for cholesterol in the Irish population, based on a study of 1000 blood donors. Mr. John Collier, Dr. Mary Codd and Dr. Sean Maguire co-operated on this Mater Hospital Screening Survey, which is due for publication shortly. Arising from this study, data on calcium and albumin changes with age which will be published in July 1996 as the Mater Hospital Cholesterol Survey. Mr. Edwin Wright attended a workshop on Protein Electrophoresis in Dublin in November 1995. COMMITTEES D, UaConaill: Secretary, Mater Hospital Computer Committee, Chairman, Pathology Computerisation Project Group, Member, Mater Hospital Costing Committee, Member, Pathology Committee. F, Kyne: Member, Conference Committee of the Association of Clinical Biochemists (Ae.B.I). Member, Mater College Scientific Committee Member, Professions Supplementary to Medicine liaison Group. 5, Maguire: Member, Conference Committee of the Ae.B.1. Editor, Clinical Biochemistry News (ACBI/ACB Newsletter) P. McGing: Chairman, Ae.B.I. Conference Committee Member, A.e.B.I. Council Treasurer, Meetings Secretary and Regional Tutor, Republic of Ireland Region of A.e.B. Member, Mater Hospital T.P.N. Committee. E, Wright: Member, Kevin St. College of Technology Fellowship Examination Committee. K_ Halton: Member, Conference Committee of Ae.B.I. Poster and Podium Presentations were made at the following meetings: The Annual Conference of Association of Clinical Biochemists of Ireland, Davenport Hotel, October 1995. Annual Conference of Academy of Medical Laboratory Sciences. limerick, November 1995. Association of Clinical Biochemists (UK), National Meeting. Annual Conference May 1995. _123_ MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 -- Papers: Pattern of Ionized versus total magnesium levels in peri operative cardiac surgery patients- the influence of preoperative diuretic therapy. Proceedings of the 18th Annual Conference. Association of Clinical Biochemists. Dublin. 20-21 October. 1995. S. Maguire. j. Collier, F. Kyne, D. Phelan, j. Fiugerald, B. Harte. I. Leonard. Pattern of Ionized versus Total Magnesium in Perioperative Cardiac Surgery Patients - a Prospective Controlled Study of the Influence of Perioperative Diuretic Therapy. National Winner of the International Federation of Clinical Chemistry - AVL Award for Significant Advances in Critical Care Testing December 1995. I. Leonard, J. Collier, S. Maguire. B. Harte. D. Phelan. Enzyme Profiles for Myocardial Infarction Diagnosis Submitted to the Irish journal of Medical Science. P. F. Lai, D. UaConaill, D. Sugrue, F. Kyne, D. N. Carney Elevated total serum Enolase levels in patients with cancer. Proceedings of the Annual Conference of the American Society of Clinical Oncologists 1995: Abstract 1095. K.j. O'Byrne. D.Egan. P.McGing. DN. Carney. Rapid Ultrafiltration Method for detecting myoglobinuria Submitted to Clinical Chemistry. E. Wright, O. McCormack, D. Kennedy, P. McGing. Cholesterol levels in normal Irish subjects Irish journal of Medical Science (for publication july 1996). J. Collier, S. Maguire. F. Kyne, P. McGing, E. Wright, D. Sugrue, M. Codd. MATER MISERJCORDIAE HOSPITAL ANNuAL REpORT 1995 PHARMACY DEPARTMENT Scope of Service The Pharmacy Department in 1995 had a drug budget of £2,600,000. Drug expenditure was under budget due to policies of generic purchasing and prescribing. contract purchasing, price negotiation, stock rotation and control. Supply and Distribution of Drugs The Ward Pharmacist and Pharmaceutical Technician top up services were firmly bedded down in the hospital in 1995. The flexibility of the system has meant alterations and amendments to drugs stocked and required on each ward can be addressed immediately. Each ward pharmacist carries a pager to ensure constant availability has accommodated direct contact between medical, nursing and pharmaceutical staff. The pneumatic air tube system was also extended to the Pharmacy Department in 1995. Compounding Centralised compounding of cytotoxic chemotherapy in the Pharmacy Department for all hospital in-patients commenced in May 1995. This service complements the out-patient service which was already in place. To accentuate the comprehensive nature of the compounding service. a new cytotoxic prescription sheet was simultaneously introduced. This Cytotoxic Prescription was consensually agreed by medical, nursing and pharmacy staff and was introduced to further enhance the level of patient care and safety in the hospital. Formulary Development The Drug Formulary was completed in 1995 and sent for printing. The Formulary is a comprehensive list of drugs, agreed by the Hospital Consultants, available for prescription by junior hospital doctors. It is hoped to introduce the Drug Formulary in April 1996. DrugCardex Much developmental work has gone into the production of a new hospital drug cardex. This work has been done as a result of the Mater Hospital Management Training Programme and involved Sr. E. Freeman, Sr. M. Bluett. Sr. M. Fitzgibbon, Ms. E. Burke, and Mr. C. Meegan. The aim of the new format is to consolidate prescribing and administration of drugs on the same card ex. Drug Information (01) With access to an extensive library, on-line access to Medline and a comprehensive CD ROM based Drug Information package, the DI service is being utilised with increasing frequency by medical and nursing staff. Patient Counselling It is intrinsic to patient care that those patients on complex drug regimes be counselled by a pharmacist on discharge. The Pharmacy Department has introduced this service in a limited manner for transplant patients. psychiatric patients and HIV patients. The patients will be informed in lay-man's language of the pharmacological properties and side-effects of each medicine, as well as the dosage schedules and the dos and don'ts associated with their drug therapy. The Pharmacy Department is also involved in patient counselling in each Cardiac Rehabilitation Session. Computerisation Stand alone systems for purchasing, labelling and drug utilisation review exist in the Pharmacy Department. A comprehensive integrated hospital pharmacy system was assessed and deemed unsuitable for the needs of this hospital. It was decided that with the knowledge base in existence in the hospital, that comprehensive in-house system would be _ 125 __ MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 designed and implemented. This work is being done by Ms. P. O'Leary of the Pharmacy Department and Ms. A. Prendergast of the Computer Department. Lectures A number of lectures to the hospital medical and nursing staff were conducted on a variety of topicS including: • Drugs used in Psychiatry • The Pharmacology of Opiate Analgesics • Drugs used in Electro-Convulsive Therapy • Nefazodone and its clinical applications • The Misuse of Drugs Act and its application in the Hospital Environment • Intravenous Drug Administration • Pharmaceutical Calculations. A number of lectures for outside groups have also been conducted. These include: • Risk Management in the HoSpital Pharmacy Environment • Cost Containment in the Health Sector - The Pharmacist's Role • Drugs used in Cardiac Transplantation • Novel agents used in the treatment of HIV • The treatment of Parkinson's Disease • The inauguration of Ward Pharmacy Services. Posters At the Hospital Pharmacists Association, Ireland Annual Educational weekend in April 1995, the following posters were presented: ,,,., - .' - • Patient Information Leaflets for NSAID's, Ms. J. Strawbridge • Clinical Audit - The Way Forward. Ms. P. O'Leary • Cardiac Rehabilitation - The Patient Perspective, Ms. M. Keane. Student Training One student pharmaceutical technician completed her training year in the Pharmacy in 1995. M_ Sc Degree in Hospital Pharmacy One candidate from the Mater Hospital Pharmacy Department, Ms. J. Strawbridge, succeeded in gaining one of the five Department of Health funded posts in this new degree programme. The Mater is one of five centres in which this degree can be completed and Ms. Strawbridge will be based here. The degree involves eighteen months of lectures, study and direct involvement at ward level as well as administrative and management components. The final six months of the two year degree will be dedicated to thesis work. Transition Year Programme The Pharmacy Department participated again in this stimulating exercise in 1995. It is very much felt to be an exchange of ideas rather than a purely didactic programme. Parenteral Drug Administration Sheets Many hours have been dedicated by the Pharmacy Department to the compilation of these information sheets. The sheets include data specific to each drug including dosage regimens, methods of administration and dosage adjustments in hepatic and renal impairment. These sheets will be available in the wards for consultation by medical and nursing staff. MATER MISERICORDIAE HOSPITAL ANNuAL REPORT 1995 I ! Staff Dispensing The Pharmacy Department dispenses prescriptions for all staff members. A small but comprehensive range of non prescription medicines such as anti-histamines. cough bottles etc. is also stocked. The only drugs available from the Pharmacy Department are those routinely held to meet the requirements of hospital in-patients. There will, therefore, be occasions when we cannot dispense various prescriptions. Staff are generally requested to drop their prescriptions into the Pharmacy in the morning and collect them later in the day. Intra and Extra Mural Activities President. Hospital Pharmacist's Association, Ireland - Mr. C. Meegan. Hon. Secretary, Hospital Pharmacist's Association, Ireland - Ms. P. O'Leary. Council member of the Pharmaceutical Society, Ireland - Mr. C. Meegan. Member of the Pharmacy Bill Working Party of the Pharmaceutical Society, Ireland - Mr. C. Meegan. Executive Committee member of the Hospital Pharmacist's Association, Ireland - Mr. G. Goggins. Member of the Mater Hospital Infection Control Committee - Mr. C. Meegan. Member of the Hospital Computer Committee - Mr. C. Meegan. Member of the Drugs and Therapeutics Committee - Mr. C. Meegan. Members olthe T.P.N. Committee - Ms. C. Nugent. Mr. C. Meegan. Member of the Cardiopulmonary Resuscitation Committee - Ms. P. O'Leary. Member of the Professions Complimentary to Medicine Uaison Group - Mr. C. Meegan. Meetings Participants in the Hospital Pharmacists Association, Ireland Educational Meeting, Killiney, Co. Dublin. April 1995 - all pharmacists. Participant in the American Society of Hospital Pharmacists Mid-Year Meeting, Las Vegas, Nevada. December 1995 - Mr. C. Meegan. Participant in the 2nd Isolator Conference of the Environmental Isolator Association, Leeds, U.K. September 1995 - Ms. P. O'Leary. MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 PHYSIOTHERAPY DEPARTMENT Scope of Service The Physiotherapy Department provides patient care services to a wide range of specialities: Cardiac Surgery; General Medicine: Respiratory: Cardiology: Oncology: Gynaecology: Endocrinology: Rheumatology: Orthopaedics: Accident & Emergency; Dermatology. General Surgery; Geriatrics and Infectious Diseases. The demand for the service is ever increasing. and because of the big 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.CD. Physiotherapy Students. There can be up to twenty during college term time, between the 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. workshops etc. These are organised by the Specific Interest Groups within the Chartered Society of Physiotherapists. Certain longer post graduate courses are also participated in. Neurological/Rehabilitation All in-patients in this category are treated daily. There is also an out-patient service when this is indicated for certain patients. Of the staff complement of this section, four full time and one part time. the Senior Physiotherapist is involved on a regular basis as an instructor for the Hosp~tal's Manual Handling and Patient lifting Programme. During 1995 the staff upgraded their skills by attending relevant courses. This included one staff member successfully completing the Advanced Bobath Course on the Treatment of Adult Stroke Patients, and another commenced a two year Diploma Course in U.CD. on Health, Safety and Welfare at Work (Physiotherapy). Hydrotherapy This year the senior in Hydrotherapy, Ms. Colette O'Flynn, successfully completed the Bath Hydrotherapy. Course in ~~ . This six month course involved intensive course work in the Royal National Hospital for Rheumatic Diseases in Bath as well as written assignments and project work. This academic year also saw the beginning of the clinical placements in Hydrotherapy for Final Year Physiotherapy Students from University College Dublin. Research Activities Ms. Fiona Curran, Staff Physiotherapist, presented results of research undertaken as part of a Master of Medical Science (U.C.D.) and in conjunction with the Endocrine Department, at the 2nd International Diabetic Foot Symposium (Holland, May 1995), and at the Irish Society of Chartered Physiotherapists 12th Annual Scientific Conference (October 1995). This research found that physiotherapy techniques can significantly reduce plantar pressures in Diabetic patients at risk of Plantar Ulceration, by improving the range of motion and strength at the foot and ankle. Ms. Anne Horgan, Staff Physiotherapist carried out a research project towards post graduate MSc, in Sports Medicine with Trinity College Dublin (1992 - 1994). MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 The study evaluated the assessment of knee joint muscle torque values in different [est positions. using an isokinetic dynamometer. Standardised joint positioning is essential in obtaining reliable. reproducible and maximal torque values. A poster presentation was made (and abstract publication at the opening of the new Trinity Centre for Health and Sciences 1994, and also at the Chartered Society of Physiotherapy 12th Annual Conference/Scientific Meeting, Dublin, October 1995. _ 129_ MATER MISERICORDlAE HOSPITAL.ANNUAL REPORT 1995 RADIOLOGY DEPARTMENT Introduction The Radiology Department underwent many important changes during 1995 which improved the range and quality of the services offered. The introduction of new equipment and the remodelling of the existing sections within the department were central to the progress made. Employing some of the latest computer technology, the Radiology Department is one of the most advanced of its kind in Irish Hospitals. The department is the first to employ the Kodak integrated imaging system which was developed jointly with Shared Medical Systems (SMS) in the Intensive Care Unit. C. T. Scanner Plans to introduce a new imaging system dedicated to use in Casualty work are advancing and it is scheduled to be operational this year. The system to be used is the FUJI Computed Imaging System, which will feature a laser imager. Both systems are evidence of the Department's advancement in the field of imaging technology. Also they are part of a significant initiative towards the achievement of film-less radiology. The installation of new computer technology enable the completion of the change over from conventional radiography to digital radiography. Following the introduction of the new system. once radiology examinations are completed in the ITU instant reports may be obtained. The reports are transferred simultaneously to the computer system. Special Interests New Appointment: Dr. John Murray has been appointed as Consultant Radiologist with a special interest to Cardiovascular Radiology. He replaced Dr. Paddy McCann who has retired. Dr. Murray received his initial training in Radiology in our Department. Currently he is a fellow of Thoracic Radiology in Duke University. North Carolina. Training Programme: Important changes to the Irish Radiology Training Programme have been introduced. The current three and a half year training period is being extended to five years, bringing trainees to consultant standard. The trainees will be required to spend time on rotation in other hospitals in the programme. This will have benefit of broadening their experience and their skills. During the past year, radiographers at the Mater Hospital have renewed links with their counterparts at the Kingston University Hospital in Jamaica. The links with the Kingston Hospital are a result of the Third World Aid Programme. A plea for assistance was received from the hospital's director due to a critical staffing crisis. In response, the three-month staff exchange programme, first introduced in 1989, recommenced in June 1995. The programme has proved successful. helping to alleviate the difficulties faced by staff at the Kingston Hospital. The continued operation of it's Radiology Deparunent has been made possible and the bonds between the two hospitals have been strengthened. '--___130-'- __-' MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 ... New Developments/New Equipment/Ongoing Research Projects: In CT Services a new ART Siemens scanner was introduced. The equipment is located in the basement area adjacent to the entrance to the Radiology Department. The system replaced the existing 14 year old second generation scanner. The new equipment is intended for ambulatory. both out-patients and in-patients. The equipment complements the service provided by the Soma tom PlUS-S Spiral CT Scanner which carries out spiral scanning and 3D reconstruction. These functions are routinely utilised by Orthopaedic and the Maxillofacial surgical teams. The combination of the ART Scanner and the Soma tom PlUS-S Spiral CT have enabled the Department to provide a much enhanced service to patients. Screening facilities have also advanced. The installation of a screening room with a Siemens Siereskop SAS Configuration with Exploration ML allows GI investigations. Due to the new equipment and facilities, some special examinations, including Myelography and limited angiographic work may be carried out using Digital Subtraction techniques. Computerisation: During the past year the change over to digital radiography from conventional radiography was also completed. Under the new system all portable chest radiographs in the Unit are stored and displayed on a computer monitor. This dispenses with the need for the use of film. The new system acquires and integrates digital images transferred across the hospital nerwork_ It utilises computer radiology based on phosphor plate technology supplied by Kodak ltd. The facility allows for instant reporting on radiology examinations once they are preformed in the ITU. The reports are transferred simultaneously to the hospital computer system. In another development, one Agfa laser Camera was part-exchanged for a larger and faster speed processor, the lR Imager. It provides laser hard copy from the following departments: Nuclear Medicine Department, CT, Ultrasound, and Fluoroscopy. The Cardiovascular Department was equipped with a Super VHS tape recording facility. Still images of selected frames can be recorded on hard copy laser film. A "Hot Reporting" room equipped with a computer terminal for direct dictation has been set up adjacent to the chest unit. This expedites the reporting of urgent in-patient investigations. Terminals for the reporting of digital images have also been installed in this room. The remodelling of the Nuclear Medicine Department has been completed. The laboratory has been relocated so that the entire facility is self-contained. A separate waiting room with a toilet has been placed between the injection and scanning rooms. The changes ensure that the operation of this area conforms with the radiation safety requirements and improves patient safety and comfort. Staff Publications: "Ileal loop Conduit Volvulus: A Rare but Reversible Cause of Bilateral Ureteric Obstruction". Clinical Radiology 1995: 50: 177-179. F. Flanagan, H.M. Fenlon, E. Breatnach. "Imaging of Small Cell Carcinoma of the Oesophagus". Clinical Radiology 1995: 50: 634-638. H.M. Fenlon, C. O'Keane, D.N. Carney, E. Breatnach. "Three Dimensional CT Imaging in Complex Craniofacial Pathology". Postgraduate Radiology April, 1995: 9S-112. H.M. Fenlon, E. Breatnach. MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 .1 .. "3DCT Aids Planning of Craniofacial Surgery". Diagnostic Imaging Europe, June 1995,23-30. H.M. Fenlon, E. Breatnach. "3DCT Aids Planning of Craniofacial Surgery". Diagnostic Imaging International. August 1995. 12-17. H.M. Fenlon. E. Breatnach. "High Resolution Chest CT in Systematic Lupus Erythematosus". American Journal of Roentgenology 1996; 166; 301-308. H.M. Fenlon, M. Doran, S.M. Sant, E. Breatnach. "Bilateral Tension Pneumothorax Complicating Combination Chemotherapy for Soft Tissue Sarcoma. Clinical Radiology (Accepted for publication, July 1994). H.M. Fenlon,D.N. Carney, E. Breatnach. MRI in Acute Hemiplegia of Childhood". Department of Radiology, Mater Misericordiae HoSpital, Dublin. J-Comput-Assist-Tomography 1995, May-Jun 19(3); 492-4. B. Connolly, M.D. King, J. Stack. "Cauda Equina Syndrome in Ankylosing Spondylitis: A Case Report and Review of the Literature." Department of Rheumatology, Mater Hospital, Dublin. Clin-Rheumatology, March 1995, 14(2); 224-6. S.M. Sant, D. O'Connell. "Symptomatic Enlarged Iliopsoas Bursae in the Presence of A Normal Plain Hip Radiograph." Department of Diagnostic Radiology and Rheumatology. Mater Hospital, Dublin. BR-J. Rheumatol. 1995 Apr; 34(4) 365-9. F. Flanagan. S. Sant, R.J. Coughlan, D. O'Connell. "A Magnetic Resonance Imaging Study of Centric Maxillomandibular Relations'-'. International Journal of Prosthodontics: Vol 8, No.4 1995;377-392. W. McDevitt, A. Brady, J. Stack, M. Hobdell. "MRI Diagnosis of Haemorrhagic Cystic Renal Cell Carcinoma". Journal of Computer Assisted Tomography; 18( I); 68-7 1994. J. Murray, S. Eustace, J. Stack. "Hallux Valgus First Metatarsal Pronation and Collapse of the Medial Longitude Arch; A Radiological Correlation". Skeletal Radiology 1994; 23; 191-194. S. Eustace, J. Byrne, O. Beausang, M. Codd, J. Stack, M. Stephens. "IH-Magnetic Resonance Spectroscopy of the Left Temporal and Frontal Loves in Schizophrenia; Clinical, Neurodevelopmental. and Cognitive Correlates." St. John of God Psychiatric Service, Stillorgan, Dublin. Bioi-Psychiatry, December 15, 1994; 36( 12); 792-800. P.F. Buckley, C. Moore, H. Long, C. Larkin, P. Thompson, F. Mulvany, O. Redmond, J. Stack, J.T. Ennis, J.L. Waddington. "Magnetic Resonance Imaging of Haemochromatosis Arthrophaty." Department of Radiology Deaconess Hospital, Boston, MA 021 15. Skeletal-Radiology October 1994; 23(7): 547-9. S. Eustace, B. Buff, C. MacCarthy, P. MacMathuna, P. Gilligan, J.T. Ennis. "Ultrasonographic Diagnosis and Surgical Enucleation of an Epidermoid Cyst of the Testis." Mater Misericordiae Hospital, Dublin. Br-J-Urol. October 1994; 74(4); 518-9. S. Eustace, D. Graham, M. Behan, J.M. Smith. "Pleural Thickening Caused by Leukaemic Infiltration; Pleural Findings [letter]." American Journal of Roentgenology, December 1994; 1527-8. M.J. Lee, E. Breatnach. "Imaging of Abdominal Complications following Cardiac Surgery." Department of Radiology, Mater Hospital, Dublin. Abdominal Imaging Sept. - Oct. 1994; 19(5): 405-9. S. Eustace, B. Connolly, C. Eggleston, D. O'Connell. "Magnetic Resonance Demonstration of Haemorrhagic Acoustic Neuroma." Clinical Radiology 1994; 49: 61-3. A. Brady, J. Stack. "MR Diagnosis of Haemorrhagic Cystic Renal Cell Carcinoma." Com put Assist Tomogr. Vol 18, No. I (1994). J. Murray, S. Eustace, E. Breatnach, J. Stack. MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 .... "Magnetic Resonance Imaging in Pigmented Villonodular Synovitis." C.n.di.n Assoc. Radiology Journ.1 Vol 45 No 4, August 1994. 5. Eustace, M. H.rrison, U. 5riniv.sen, J. Stack. "Prolonged Unil.teral Lower Limb P.resis following Abdomin.1 Surgery with Epidural .nd General An.esthesi .... M.ter Hospital Dublin. Anaesth Intens Care 1995; 23: 507-509. B. Lyons, D. Phelan, M. McCarroll,J. Stack, S. Murphy, B. O'Moore, T. Gorey. "Digital Subtraction in Gd-DTPA Enhances Imaging of the Breast." The Institute of Radiological Sciences, M.ter Hospital, Dublin. Clinical Radiology (1995) 50; 848-854. F. Flanagan, J. Murray, P. Gilligan,J. Stack,J.T. Ennis. "Atypical Chest Pain." British Journal of Radiology, 1995; 68: 1261-2. 5. Eustace, J. Murray, E. Breatnach. 'The American Thoracic Society Lymph Node Mass, A CT Demonstration." European Journ.1 of R.diology 1994; 17:61-68. J. Murray, E. Bre.tn.ch. Presentations: The Role of the Radiographer in C.su.lty - Mrs. C.rmel Eggleston, UCD School of Di.gnostic Im.ging. Equipment requirements in the Casu.lty Department - Ms. Joy Riordan, UCD School of Di.gnostic Imaging. The New Look of Mobile Im.ging - Mr. John Heeney/Ms. Jeanne Donoghue, UCD School of Diagnostic Im.ging. Spiral CT Im.ging .nd it's .pplications - Ms. Mary Shortt, Phase I A Conference Room. The Role of Three Dimensional CT in the Pre-operative Evaluation of Congenital and Traumatic Craniofacial Anomalies - H.M Fenlon, V. Donoghue, J.P. Stack, E. Breatnach. Annual Scientific Meeting, Faculty of Radiology, Royal College of Surgeons in Ireland, September 1995. Endometrial Response to Tamoxifen - Evaluation with Transvaginal Ultrasound - H.M. Fenlon, A.M. Cahill, D.M. Campbell, C. O'Herlihy, E. Breatnach. Annual Scientific Meeting, Faculty of Radiology, Royal College of Surgeons in Ireland, September 1995. High Resolution Computerised Tomography as a Predictor of Pulmonary Involvement in Systemic Lupus Erythematosus - H.M. Fenlon, V. Donoghue, J.P. Stack. E. Breatnach. Roentgen Centenary Congress, Birmingham, June 1995. 3D Computerised Tomography in Congenital and Traumatic Craniofacial Defects - H.M. Fenlon, V. Donoghue, J.P. Stack, E. Breatnach. Roentgen Centenary Congress, BIR Birmingham, June 1995. Early Experience of Craniofacial 3DCT - Techniques and Pitfalls -H.M. Fenlon. Workshop in 3D Imaging. Mater Misericordiae Hospital, May 1995. Computerised Tomography and it's Applications in Maxillofacial Surgery. Invited Lecture. Department of Oral Surgery, Western Health Board, July 1995. Pulmonary Involvement in Systemic Lupus Erythematosus - Evaluation with HRCT, Chest Radiography and Pulmonary Function Testing - H.M. Fenlon, M. Doran, S.M. Sant, E. Breatnach. Annual Scientific Meeting, Faculty of Radiology, Royal College of Surgeons in Ireland, September 1995. Alterations in Femoral Vein Duplex Sonography with Intra Operative Orthopaedic Traction - AM Cahill. December 13, 1995. Registrar's Prize, Sylvester Boland Medal. Alterations in Femoral Vein Duplex Sonography with Intra Operative Orthopaedic Traction - H.M. Fenlon, A. Devitt, M. Behan. British Medical Ultrasound Society. Poster Presentation, December 8, 1995. Imaging Artifacts in Helical Thoracic CT - T. Toma,_'133_ E. Breatnach. Spring Meeting, Imaging Meeting, Faculty of Radiology, MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 I • Royal College of Surgeons in Ireland, Dublin, February I, 1995. The Influence of Different Protocols on Artifacts in Helical Thoracic CT - T. Tarna. E. Breatnach. Association of Chest Radiologists, Royal College of Radiologists, london, March 15 1995. Evaluation of Pitch I and Pitch II in Helical Thoracic CT - T. Toma, S. Blake, E. Breatnach. Roentgen Centenary Congress, Birmingham, June 1995. Comparison of Three Different Contrast Media used in Helical Thoracic CT - T. Tarna, M. Morrin. E. Breatnach. Annual Scientific Meeting, Faculty of Radiologists, Royal College of Surgeons in Ireland, Dublin 1995. Pitch I and Pitch II Protocols in Helical Thoracic CT - S. Blake, T. Toma, E. Breatnach. Annual Scientific Meeting, Faculty of RadiologiSts, Royal College of Surgeons in Ireland, Dublin 1995. Artifacts in Helical Thoracic CT: The Effect of Pitch I and Pitch II Protocols - T. Toma, E. Breatnach. Radiological Society of North America, November 1995, Chicago. Mammographic Measurement of Breast Tumour Size - F. Flanagan, P. Barton, M. McDermott, T. Pilgram, B. Monsees. RSNA Radiology 1995. No. 261: Page 171. MR Imaging in Reflex Sympathetic Dystrophy Syndrome: Improved Diagnostic Efficacy with Digital Image Subtraction and MR Spectroscopy - P. Kavanagh, P. Gilligan, P. Kelly, S. Sant, D. Mcinerney, M. Behan. RSNA Radiology 1995, No. 1436 page 361. Dose-Reduction Advantages of Computed Radiology in Abdominal Imaging - P. Kavanagh, P. Kenny, A.M. Cahill, J. MacEnri, J.T. Ennis. RSNA Radiology 1995, Space 06PH, page 450. Anal Sphincter Endosonography with Use of a 120 Degree Sector Scanner - D. Campbell, V.S. Donnolly, C. O'Herlihy, R. O'Connell, M. Behan. Radiology RSNA 1995: 335. Three Dimensional Computerised Tomography in the Pre-Operative Evaluation of Children with Complex Craniofacial Anomalies - H.M. Fenlon, E. Breatnach, V. Donoghue. Maughan Gold Medal for Best Original Research in Paediatrics 1995. Monitoring Endometrial Response to Tamoxifen in Women with Breast Cancer - G. Connolly, H.M. Fenlon, T. Gorey, E. Breatnach, C. O'Herlihy. Registrar's Prize in Obstetrics and Gynaecology, Feb. 1995. The Radiology of Non-Small lung Cancer - J. Murray, E. Breatnach. In 'lung Cancer', Editor: Desmond Carney. Arnold Publications, 1995:43-47. HRCT of lungs - E. Breatnach. Refresher Course, Royal College of Surgeons in Ireland, Faculty of Radiologists, 1995. Computed Tomography During Arterial Portography: A Comparison of Spiral and Non-Spiral Techniques - P. Kavanagh, A. Brannigan, G. McEntee, E. Breatnach. Department of Radiology, Mater Misericordiae Hospital, S2 Eccles Street, Dublin 7. Roentgen Centenary Congress 1995; 104. Effects of Sedation During Interventional Radiological Procedures - P. O'Sullivan, E. Breatnach. Department of Radiology, Institute of Radiological Sciences, University College Dublin, Mater Misericordiae Hospital. 52 Eccles Street, Dublin. Roentegen Centenary Congress, Birmingham 1995; 353. Abdominal Aortic Aneurysms: Criteria for Elective Surgical Intervention Determined by Spiral CT - P. Kavanagh, P. O'Sullivan, B. Egan, K. O'Malley, E. Breatnach. Department of Radiology and Vascular Surgery, Mater Misericordiae Hospital, 52 Eccles Street, Dublin. Roentgen Centenary Congress, Birmingham 1995; 356. Comparison of TRUS-Guided Biopsies from Specialist and Non-SpeCialist Referrals - P. O'SUllivan, E. Breatnach. Department of Radiology, Institute of Radiological Sciences, Mater Misericordiae Hospital, University College Dublin, 52 Eccles Street, Dublin. Roentgen Centenary Congress, Birmingham 1995; 446. Endoscopic Balloon Dilatation of the Sphincter of Oddi (SO Sphincteroplasty): Assessment by Quantitative Biliary MATER MISERICORDIAE HOSPITAL ANNUAL REpORT 1995 !III! • Scintigraphy - P. Kavanagh, R, Merriman, N. Phelan, M. Behan, J. Crowe, J.T. Ennis. Department of Radiological Sciences, Mater Misericordiae Hospital, University College Dublin, 52 Eccles Street, Dublin. Roentgen Centenary Congress, Birmingham 1995; 39. Radiological Audit Control of Emergency CT Requests by a Peer Review Method - P. Kavanagh, M. Morrin, M. Behan. Department of Radiology, Mater Misericordiae Hospital, 52 Eccles Street, Dublin. Roentgen Centenary Congress, Birmingham 1995; 316. Assessment of Cerebral Abnormalities in Discordant Twins with Schizophrenia Using MR Imaging - P. Gilligan, J. Stack, J. Waddington, J.T. Ennis. Institute of Radiological Sciences, University College Dublin, Mater Misericordiae Hospital, 52 Eccles Street, Dublin. Roentgen Centenary Congress, Birmingham 1995; 330. An Audit of the Impact of CR in the Electronic Patient Reco on ICU Radiology - P. O'Sullivan, K. Peters, J. MacEnri, J.T. Ennis. Department of Radiology, Institute of Radiological Sciences, Mater Misericordiae Hospital, University College Dublin, 52 Eccles Street, Dublin. Roentgen Centenary Congress, Birmingham 1995; 98. Hybrid Magnetic Resonance Fat Suppression Sequences - M. Banks, P. Gilligan, J.T. Ennis. Institute of Radiological Sciences, Medical Division Siemens Ltd.. University College Dublin, Mater Private Hospital, 52 Eccles Street, Dublin. Roentgen Centenary Congress, Birmingham 1995; 468. Work In Progress Thoracic HRCT Findings in Ankylosing Spondylitis. Acute and Longterm Pulmonary Effects of Chest Radiotherapy Evaluation with Plain Chest Radiology, Thoracic HRCT and Pulmonary Function Testing. Myocardial Reinnervation Following Cardiac Transplantation - Evaluation with Planar and SPECT MIBG Scintigraphy. Comparison of Plain Film Mammography, Ultrasound, Scintimammography and MR Mammography in Benign and Malignant Breast Disease with Histopathological Correlation. Technetium-99m-Tetrofosin: Unity in the Investigation of Parathyroid Pathology. Success of Wire Localisation and Biopsy in Second-Round Screening Breast Carcinomas. Evaluation of 99m Tc MIBI Uptake in Prostatic Tumour. Breast Parenchymal Changes in Patients on HRT. 3DCT Scan of the Upper Airway Pathology. Transvaginal Ultrasound Future for Pelvic Sonography. MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 .... SCHOOL OF NURSING Staffing Mrs. laserina O'Connor moved to the Post.Registration Education Centre as Nurse Tutor. and we wish her success and happiness in her new post. We welcome Nurse Teachers Ms. Regina Browne and Mrs. Maureen Corbet who joined the staff of the School of Nursing last year. For the year ending 31 st December 1995 a total of 94 student nurses were successful in the Registration Examinations of An Bard Altranais. All first year student nurses successfully completed Intermediate Assessments and 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; the Natl,onal 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 Nurses were presented with their Certificates on 26th July 1995 and on 28th February 1996 following their Registration Examinations. The Annual Presentation of Nursing Certificates and Awards was held in the Freeman Auditorium on 28th February 1996 following a special "Graduation Class November 1995, Mass of Congratulations" offered in the Hospital Chapel by Chaplains Rev. T. Smith, O.S. Cam .. Rev. Fr. B. Conway and Rev. Fr. Brennan. The student nur:ses, their parents and friends were welcomed to the Freeman Auditorium by Sr. ,M. of the Incarnation. Director of Nursing following the distribution of prizes and nursing certificates. The Annual Awards and Prizes Ceremony was attended by Sr. M. Margherita, Executive Chairman, Board of Management: Sr. M. Gerard Majella, Sr. Superior: Dr. R.G. Firth: Consultant Physician and Chairman of the Nurse Education Committee; Sr. M. of the Incarnation and Nursing Administration Staff; Ms. P. O'Sullivan and Nurse Teaching Staff. Ms. Patrice O'Sullivan addressed the audience, firstly congratulating the newly qualified nurses on their achievements and secondly speaking on twO very important aspects:- a The proposed changes in Nurse. Education from Certificate to Diploma/Degree qualification. b The impact of current industrial disputes on the nursing workforce. A buffet function was held in the afternoon in the Hospital Restaurant. Nursing Awards Margaret Harold Memorial Prize 1995 Mrs. Patricia O'Leary, Unit Nursing Officer of Intensive Care Units. Mother Catherine McAuley Prize 1995 Prize for Operating Theatre Nurses Ms. Marie Hayes Gold Medal Award 1995 Ms. Nuala Meehan Silver Medal Award 1995 Ms. Aoife Reynolds MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 Gold Badge 1995 Ms. Margaret Dowling Prize for 2nd Place in Registration Examinations 1995 Ms. Susie Cunningham Student Nurse Prizes for 1995 to Ms. Ruth Browne Ms. Brigid Wall Ms. Melissa O'Reilly Mr. Desmond Corbett. A special word of thanks to Ms. Aine Monaghan of 3M Company for awards given annually to student nurses. Student Nurses and Teachers attended the Irish Guild of Catholic Nurses Annual mass and Blessing of Hands in the Carmelite Church, Whitefriar Street on 9th May 1995, the Chief Concelebrant being Rev. Fr. Fiachra O'Cealiaigh who was assisted by many hospital chaplains. Nurse Teachers and students were involved in many of the Research Evenings of Irish Nursing Research Interest Group (I.N.R.I.G.) throughout the year and attended the A.G.M. and Annual Conference in the Trinity Centre for Health Sciences on the 8th September 1995. Second Year Student Nurse Melissa O'Reilly presented an excellent case study at the Research Evening on 23rd October 1995. This case study designed on a model of nursing, highlighted the decision making process involved in clinical nursing practice and she is to be congratulated for this. Lectures I. 23rd November 1995 at I.N.O. Student Nurse Conference, lecture given by Ms. Regina Browne, Nurse Teacher on "Managing Your Stress". 2. 13th November 1995, Research Seminar on Oncology Care at the F.N.R.C.S.I., given by Ms. Catherine Guihen, Nurse Teacher on "Behaviour Demonstrated by Nurses when caring for the Dying Person". 3. 17th April 1995, Diploma in Management for Nurses at F.N.R.C.S.I., lecture given by Ms. Patrice O'Sullivan on "The Impact of the E.u. on Nursing in Ireland". Ms. Catherine Guihen, Nurse Teacher continues to study for the M.Sc. in Education and Training Management at Dublin City University, a two year taught programme for people working in the management of education and training in educational institutions. Nurse Teacher's Committees In the past year Nurse Teachers have been involved full time in association with Ward Staff on the Clinical Objectives Committee. This work aims to ensure the beds clinical placements for Nurse Students for the future Diploma in Nurse Training and is closely linked to the Research Study on Patient/Nurse Dependence Ratios being carried out by Sr. R. Murnane in the Computer Centre . • Ms. P. O'Sullivan is a member of the "Libraries for Nursing" R.C.N. Committee and attended their Annual Conference in London in Summer 1995 . • Ms. P. O'Sullivan attended three meetings of the Nurse Advisory Committee in Brussels in the past year. being a member of the Committee examining nursing specialisations. This continuing work is very challenging and the questionnaires Basic Nursing Specialisations V Post-Basic Specialisation have been completed for 15 member states. Ireland being one ofthe only countries still retaining Basic Specialisation Training Programmes leading to Registration in An Bard Altranais. _ 137_ MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 In-Service Nurse Education Nurse Teachers have co-operated with Nursing Administration in providing Lectures and Seminars for Hospital Sisters and Staff Nurses on a continuous basis Le. • 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 WardslDepartmental Sisters. • Study Days for the Assessment of Student Nurses to become proficient 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. • LV. Policy, Drug Therapy Training and Certification. • Information Technology and Computer Training. U,C_D_/Mater School of Nursing In the past year Nurse Teachers have been preparing themselves for the new Diploma in Nursing by taking Interpersonal Skills Courses and are now involved in the preparation to teach in courses for clinical nursing staff on "Teaching and Assessing in the Clinical Areas for Student Nurses", We have been very closely linked to U.C.D. NurSing Studies through our Core Curriculum Committee of Nursing Administration, Chief Executive Officer, Nurse Teachers, Dr. Pearl Treacy and her U.C.D staff. Since 1994 we have given all our time and energies meeting with Nursing Studies. U.C.D. in planning our desired new curriculum, in planning our needed educational facilities and in costing the whole programme. Conferences/Seminars attended by staff from the School of Nursing "Psychiatric Nursing" Day Seminar in Faculty of Nursing, Royal College of Surgeons (F.N.R.C.S.I.), 27th January 1995. "Research for Practice" Annual Conference in F.N.R.C.S.I., 29th February, I st March, 1995. "Spirituality and Health Care", All Hallows College, Drumcondra, 7th March 1995/ "Advanced Clinical Practice" Department of Nursing Studies, U.C.D.. University Industry Centre, 9th March 1995. Irish Association for Nurses in Oncology, A.G.M., St. Vincent's Hospital, Elm Park, I I th March 1995. Quality Assurance in Nursing Association, Update, Department of Nursing Studies, U.C.D.. 22nd March 1995. "Alliance for Mental Health", School of Nursing, St. Brendan's Hospital, nnd March 1995. Irish Primary Nursing Network "Developing Nursing for the 21 st Century", National Conference. Royal Marine Hotel. Dun laoghaire, 30th March 1995. "National Symposium", Burlington Hotel, Lederle Labs., 3rd April 1995. MATER MISERlCORDlAE HOSPITAL ANNUAL REPORT 1995 "Change and Challenge in Nurse Education", A Workshop for Nurse Teachers in F.N.R.C.S.I., 28th April and 9th june 1995. "Breast Cancer Support and Healing", Irish Cancer Society and Reach for Recovery, Gresham Hotel, I st May 1995. Staff Performance Appraisal at I.B.E.C., 19th May to 8th june 1995. North/South Orthopaedic Conference, Cappagh Hospital, 20th May 1995. "Living with AI.D.S.lH.I.Y.", Annual Clinical Information Update, F.N.R.C.S.I .. 27th May 1995. "Academic Changes", Association of Nurse Teachers Conference, All Hallows College, Drumcondra, 22nd and 23rd june 1995. "Soul Pain, Death and Healing", Dr. Michael Kearney at the Irish Hospice Foundation, 4th September 1995. "Career Pathways for Nursing", Milton, Pillar Room, Rotunda Hospital, 20th September 1995. "Nursing Practice: Quantity and Quality", Department of Nursing Research Unit, Beaumont Hospital. 14th September 1995. "Eating Disorders: Gender and Cultural Issues", SL john of God Conference Centre, 20th September 1995. European Week of Information on Cancer, jean Monnet, E.U. Centre, 6th to 12th October 1995. Professional Connections, Irish Nurse Education Specialists, "The Developing Field of Stoma Care", Conference Centre, SL Vincent's Hospital, Elm Park, 10th October 1995. "Pharmacology and Toxicology" Symposium, Royal Irish Academy, 27th October 1995. "Nursing Management of the Tracheostomy Patient, Sr. Agatha Fleming, Conference Room, Phase I A, Mater Misericordiae Hospital, 31 st October 1995. Intensive Care Society of Ireland, Seminar by Glaxo, Waterford, 4th November 1995. Quality Assurance in Nursing Association (Q.AN.A.) - "Quality Improvement and Change" Annual Conference at Industry Centre, UC.D., 9th November 1995. National Conference, An Bord Altranais, jury's Hotel, 23rd November 1995. H.I.V. Study Day, Conference Room, Phase I A, Mater Misericordiae Hospital, I st December 1995. "Advances in Breast Cancer, Clinical and Biological Lessons from Screening" at Royal College of Physicians, Mr. T. Gorey, M.C.H., F.R.C.S.I., Mater Hospital, 6th December 1995. _139_ MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 PHOTOGRAPHS MAY 1995 FINALISTS Fronl Row: Sr. M. Eugelle Nolall; Martina Quirke; Orla McNamara; Nuala Doyle; (L 10 R.) Ms. P. O'Sul/iI'an; Cetitle Kelly; Sioblwn Kelly: Clara l..ong; Susan Cmming"am: Marie Plood. 2nd Row: Nualo Meehan; Caroline Griffith: Kim Healy; Mario Brellnan; Orw /leelJ'; Sioh"an Beirne; Tanya 8)'r/le: Tracey Eagar: DearbIJlo McGarry; An/oineUe Cos/ello. 3rd ROK-': Cioru Mf.'Carthy: Deirdre Broderick: lie/en O'/Jeo: Maria Browne; Filma Fil::;gerald; Elmo tynch; Noreen Earley; Ms. Margaret Kilken"y: Maria lIealy: Caroline I/ickey. 41h Row: Gwen Coburn; Nora O'Brien: Margaret Cofeman: Siamh Flynn: Clilire Hand: Brid McGee; Ann "'arie Murphy; Coillin McCarthy; Caroline l..olligon. 51h Rolf.': Moe~'e Hennessy; Elisa Bridgeman: Claire Stafford: Saral! McSK-'ceney: Anne/te Kin."ella; Sillead Moloney; Sr, Nora McCanh)"; Sillead Moriarty; A~'rill..ordon, 6lhRolf.': Ms, Phil nolshe: Paul Troy; Bre/filli O'Rourke: Aisting Sprillg; Caitrilma Doyle; Kalhry'n Reid; JenniJer Hea:.le: tWce Lucey; M.", Catherine Guihell: Deirdre Henllessy: Ann Marie De"lill, NOVEMBER 1995 F/NAUSTS Pro", Row: Ai.ding While; A.ngeia o 'Riordan: Fionnula I.ynalll; Cathy O'I..oughlin; Ann nalsh; ,Hne naish, Le/IIO Righi 2nd Rolf.': Miss Nora O'Callaghan; ,\"" Margaret Hogan: Fimla Kehoe; Elllllla nard: Sheila Coogan; Joanne Coolley; CI,ri.uine Cusack, 3rd Row: Miss Rose McCabe; Fimmuala Keane: Aisling Carolan: Ann Foley: Miriam Taaffe; MargareIIJoK-'ling; Triona Co,~/i"; ,\Jarie Henry'. 4tll Ro .... : ,'Hiss Po O'Sullil'an; Palricia Fit:gerald: AoiJe Reynolds; Majella O'Sulli"an; Jennifer Deane; Deirdre l.inrrick; Catherine O'c'mlwr; Emer Saunderson, 5,11 Row: Niunrh Treacy; H'onne Pield: Calherine IJont,lwe: Collette Gal'in: Julie Couglllall; l..nois Byrne: Fiona Coyle; Danraras lIug/res: Margaret Cunningham, fith Row: Carol Mulqueen: \"emllicn SteM!art: Elller Kill,,,ella; Atlife Maguire; Taro Shield."; Jacqllelinr Maddell; Patricia McGee; A"" Marie na£o"',; Nessa McCormack: BIi:.abelh Connolly. -=:140-=- MATER MISERICORDIAE HOSPITAL ANN[JALREPORT 1995 • .I PRIZEGIVING 1995 Bock Row (Llo R) Sr, Nora McCarthy: Sr. M. Gerard Majello: Mrs. A. Carrigy; Dr. R.G. Firth .. Sr. M. oJ/h'e Incarnation; Ms. M.P. O'Sulli.'on; Sr. M. Margherito Front Row (1.;10 R) Als: Nuala Meehan; Mrs. Patricia O'Leary; M,\,,'!t1ann Hayes. Back !low (I~ to R) Ms. Brigid Widl: Mrs. It. Carrigy; Dr. R.G. Firth; Mr. Desmond Corbell; Ms. Melissa O;Reilly; Ms. Ru.lh Browne. Front Row-(Llo R) Ms,-M.P. O·Sulli~'all;_Ms. Margaret Dowling; S7.Nora McCarthy. 1_'-----_141'---_1. MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 UNIVERSITY COLLEGE, DUBLIN. AND MATER MISERICORDIAE HOSPITAL SCHOOL OF PHYSIOTHERAPY Report on Examinations for the Bachelor of Physiotherapy, N~tional University of Ireland June and August 1995 1st Year: Thirty six students _entered for the summer examination. Eight gained first class honours grade I; eight gained second class honours grade I; eight gained second class honours grade I I; six students passed; six students failed. Five students repeated in the autumn and all passed. One student withdrew. . 2nd Year: Thirty eight students entered for the examination. Ten gained first class honours grade I; seventeen gained second class honours grade I; ten passed ~nd one failed. One student repeated in the autumn and failed. . . 3rd Year: Thirty seven students entered for·me"examination. Two students obtained first'class honours grade-I; eight obtained second class honours grade I; twenty obtained second Ciass honours grade I I; four passed and three failed .• Three students repeated in the autumn and failed. 4th' Year: Thirty two students entered for the examination. Fifteen students obtained second class honour grade I; fifteen obtained second class honours grade I I and two passed. .overseas Students Three overseas students were admitted from Botswana at undergraduate level. The School also had three undergraduate students entering second year, one undergraduate entering third year,and one undergraduate entering fourth year from Botswana. Report on Postgraduate Studies One student graduated with the degree MMedSc. Six students were registered for the M.Med. Science degree. one of whom is from Saudi Arabia and one from Qatar. Involvement with European C?mmunity '. I. CAMARC I I Computer Aided Movement Analysis in a Rehabilitation ·Context. Project sponsored by the Council of the European Community (CEq DGX III. Telecommunications. Information Industries. and Innovation. Programme commenced January 1992. 2. CAMARN Computer Aided Movement Analysis in a Rehabilitation Network: . 3. Vice Chairperson and Executive Board member of the European Network of Physiotherapy in Higher Education. . . Examining Dr. Mary Garrett visited Queen's College Glasgow and UniversitY, of Manchester as extern examiner in 199~. Dr. Mary McAteer acted as Extern Examiner for the University of Ulster at Coleraine. . . Involvement in Professional Activities, Physiotherapy and University Teaching Dr. Mary Garrett served as member of Education Committee for the Irish Society of Chartered Physiotherapists. Member of Academic Council. U.CD. Member of Medical Faculty. U.CD. Member of U.CD. Medical Faculty Heads of Department 5 Year Development Plan Committee. MATER MISERlCORDlAE HOSPITAL ANNUAL REPORT 1995 ! • Served on UCD Disciplinary Committee. Appointed to Heads of Department Committee, UCD. Appointed to Faculty of Medicine Sub-Committee on Marks and Standards, Semesterisation, FTE's. Committee member Biological Section, Royal Academy of Medicine in Ireland. Dr. Mary McAteer was President of the Irish Society of Chartered Physiotherapists. Dr. M. Hanly served as 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, Phoenix Park, Dublin. Conferences Organised - Dr, Mary Garrett Hosted CAMARC II Final Workshop at University College Dublin, 24-26 February 1995. Invited Lectures - Dr, Mary Garrett Sweden, National Institute of Occupational Health, Umea. Invited to give two lectures. 16-18 November. Courses and Conferences Attended - Dr, Mary Garrett • Dublin, Royal Academy of Medicine in Ireland, winter meeting at RCSI, 6 January 1995. • Ancona, CAMARC II meeting, 14/15 January 1995. • Dublin, Finance for Heads of Departments, meeting in DCU, 26/27 January 1995. • Wicklow, Bioengineering in Ireland, 28/29 January 1995. • Leuven, European Network of Physiotherapists in Higher Education, I 1/12 January 1995. • Barcelona, European Network of Physiotherapists in Higher Education, 26129 May 1995. • Dublin, Irish Association of Rehabilitation Medicine, Scientific Meeting, Beaumont Hospital, 29 September 1995 .. Washington, World Congress of Physical Therapists, 21-28 June 1995. • Dublin, Management Services Conference, Mater Hospital, 13 October 1995. • Amsterdam, Meeting for the Constitution of the ELDERLY Consortium and Definition of ELDERLY proposal, 24 November 1995. • Milan, Meeting for the constitution of the SHINSE (Social Health Information Networking System for Elderly) consortium and definition of SHINSE proposal, 14/15 December 1995 Publications Classification of Walking Handicap in the Stroke Population, Stroke. 26; 982-989, June 1995. Perry, j., Garrett, M., Gronley, . j., Mulroy, S., Presented as Oral Communication Evaluation of Impairment, Disability and Handicap as Treatment Outcome in Chronic Low Back Pain. Presented at a conference "Moving in on Pain", Sponsored by Physiotherapy Research Association. Adelaide: 18-21 April 1995. Blake, c., Garrett, M. Effects of a Multidisciplinary Pain Management Programme on the Functional Status of patients with Chronic Low Back Pain. Presented at 12th World Congress of the International Federation of Physical Medicine and Rehabilitation in conjunction with the Annual Scientific meetings of the Australasian Faculty of Rehabilitation Medicine, the Australian Pain Society, the New Zealand Pain Society. Sydney 27-31 March, 1995. Blake, c., Garrett, M. Physiotherapy; A novel intervention in diabetic ulceration. MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 Presented at 2nd International Symposium on The Diabetic Foot. at Leeuwenhorst Congress Centre. Noordwijkerhout, Netherlands, 10-12 May 1995. Curran, F., Nikookam, K, O'Meara, N., Firth, R. A novel intervention in diabetic ulceration. Poster presentation to the Royal College of Surgeons in Ireland for the National Scientific Meeting in Dublin 30-31 March 1995. Curran, F., Garre~ M. Enhancing communication in Physical Therapy Education: An International perspective. International meeting of Physiotherapy educators. Presented at 1995 Symposium for Physiotherapy Educators. Shenandoah University, Winchester, Virginia, 21-24 June, 1995. Garre~ M. A need for greater communication among Physical Therapists to facilitate excellence in the provision of physical therapy services. Presented at World Congress in Physical Therapy, Washington DC, 25-30 June, 1995.d Walsh, MB., Garre~ M. MATER MISERICORDIAE HOSPITAL ANNUAL REpORT 1995 • DEPARTMENT OF SPEECH AND LANGUAGE THERAPY Scope of Service The 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 Mater Hospital Consultants. A service is provided to the following assigned groups: (a) Patients with communication/swallowing difficulties following acute care or progressive neurological impairment. - .. _, (b) Patients with swallowing/speech difficulties following resections for head and neck cancer. Ms. Fiona Delaney, (c) Patients with disorders of the voice. Speech and lmrguage Therapisl (d) Patients with communication difficulties associated with tracheostomy of ventilator dependence. A 30% increase in referrals to Speech and Language Therapy was noted between 1994 and 1995. In particular. the Intensive Care Unit had increased referrals for tracheostomised and ventilator dependent patients. The Department is still awaiting sanction for a fourth Speech and Language Therapy post. This would allow a lesser waiting period for both in-patients and out-patients and a provision of more intensive therapy for clients with communication difficulties. Ms. Celine Lenihan. Senior Speech and Language Therapist. returned from a years leave of absence in August 1995. Ms. Fiona Delaney. Speech and Language Therapist, was made permanent in March 1995. Lectures Given: (I) Communication Issues for the Tracheostomised and Ventilator Dependent Patient, In-service talk to Department of Physiotherapy. (2) Communication Issues in the Elderly. St. Mary's Hospital. Phoenix Park. (3) Management of the Laryngectomy Patient, St. Luke's Hospital. Rathgar. (4) Management of Dysphagia. School of Nursing. Mater Hospital. (5) Developments in Voice Therapy. Eye and Ear Hospital. Courses Attended: (a) First World Voice Conference. Apeurto. Portugal. April 1995. (b) Two day forum in Clinical Supervision of Students. organised by T.C.D. (c) Two Day Advanced Dysphagia Course. Jerilyn Logemann. London. (d) Voice Symposium. Royal Infirmary. Edinburgh. (e) One Day Voice Conference. London. The Department is accredited for T.C.D. students and students in Northern Ireland and the U.K. Students attend for clinical supervision and examinations throughout the year. 145 MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 'I! • DEPARTMENT OF SURGERY Scope of Service The unit consists of nineteen beds and a full range of general surgical and urological conditions is managed. There is a special interest in the management of urinary calculi and the lithotriptor unit has meant an increased experience and throughput of this condition. Management of urinary incontinence has been helped considerably by the urodynamics service which facilitates the diagnosis. Reconstructive procedures are also carried out in this unit. speCialiSing in the formation of new bladders and continent urinary diversion. Gastro-oesophageal surgery and restorative procto~ colectomy are becoming increasingly part of the workload; new techniques for measuring oesophageal motility on an ambulatory basi.s are available. Medical Education Undergraduate surgical education includes courses of lectures. clinical demonstrations and clinical attachments which are conducted by the Professor and Lecturers .. Projects are organised for students who wish to do an elective period in research. The research of the work is presented at a meeting in the hospital and the surgical project judged to be the best. is awarded the Henderson Prize. Postgraduate surgical teaching is arranged in association with the Dublin Postgraduate Training Committee for doctors studying for the fellowship examination of the Royal College of Surgeons in Ireland. Research Activity Research activity continues in the experimental and clinical fields. Studies in partial ureteric obstruction and renal artery stenosis are showing that there is marked evidence of microvascular disease in these conditions. Further studies are being carried out in the effect on the microvascular chair of acute pancreatitis and of extra pancreatic disease in this condition. Clinical studies into urodynamic evaluation of the bladder in urinary incontinence and the effect of lithotripsy on kidney function are also being performed. Further clinical studies are being carried out with the Pathology and Nuclear Medicine Departments. PAPERS John M. Fitzpatrick, Professor of Surgery Prostate disease: management options for the primary healthcare team. Postgrad. Med.J. 71:136. G.D. Chisholm, SJ. Carne,).M. Fitzpatrick, NJ.R George,).e. Gingell.).W Keen, RS. Kirby, D./(jrk, E.P.N. Donoghue, WB. Peeling. R). Shearer, G.B. Williams. Anatomy of the prostate and distribution of early prostate cancer. Semin. Surg. Oncol. II :9. D.R Greene,j.M. Fitzpatrick, P.T. Scardino. Regional renal blood flow in normal and disease states. Urological Research 23;1 .. M.e. Regan, LS. Young.). Geraghty,j.M. Fitzpatrick. Phytotherapy in benign prostatic hyperplasia. Urol. C1in. North Amer. 22:407. ).M. Fitzpatrick, T. Lynch. Prospective evaluation of a composite scoring system for mammographically detected cytologically assessed impalpable breast abnormalities. Eur. J. Surg. On col. 21: 135. MJ. Kerin,). Murray, E. Mulligan, P. Ken~). E.nnis, M. Dowling. P. Dervan,).M. Fitzpatrick, T.F. Gorey. MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 i'l Acute urethral trauma. Eur. Ural. Updates 4: 122. T.H. Lynch,J.M. Fitzpatrick. Cardiorespiratory effects of laparascopy with and without gas insufflation. Arch. Surg. 130:984. J.P. McDermott, M.e. Regan, R. Page, M.A. Slokes, M.K. Barry, D. Moriarty, P.E. Coushaj,J.M. Fitzpatrick. T.F. Gorey. Kontinente Vesikostomie Mittels Submukos versenktem Boari-Rohr: Tierexperimentelle Studie in Schweinmodelle. Akt. Ural. 26: I 06. J. Fichtner, M. Fisch, GE Voges, }.M. Fitzpatrick. R. Hohenfellner. ABSTRACTS Prognosis of patients with vibration-induced white finger after cessation of occupation vibration exposure. Brit. J. Surg. 82:549. P. Ken!,J. McNamara, E. Mooney, T. Gorey.).M. Fitzpatrick. Determination of testicular function using flow cytometry following testicular torsion. j. Ural. 153:427A. T. Carrall, D. Greene, M. Regan, B. Curran, M. Leader.).M. Fitzpatrick. TUNA therapy for symptomatic BPH. A collaborative European trial. J. Ural. 153:533A. I. Eardley.).M. Fitzpatrick. J. Frick. B. Goldwasser, P. Wicklund. Arginine induces pancreatitis by a nitric oxide independent mechanism. Ir. J. Med. Sci. 164:253. M.K. Barry, E.D. Mulligan, M.A. Stokes, M.G. O'Riordain, T.F. Gorey, K.F. McGeeney,J.M. Fitzpatrick. Prostate Cancer; an update. Irish Med. J. J.M. Fitzpatrick. CHAPTERS Enuresis. In, Clinical Applications of Uradynamics. Edited by CAL d'Ancona and N.R. Netto, Published by Cartgraf Editora Limitada, pp 195-20 I. D.R. Greene, j.M. Fitzpatrick. Non-continent urinary diversion. In, Reconstructive Surgery of the Lower Urinary Tract in Adults. Edited by S. Colleen and W. Mansson. Published by Isis Medical Media. Oxford. pp 73-91. T.H. Lynch, J.M. Fitzpatrick. New Medical and technological methods of managing benign prostatic hyperplasia. In, Forum; Trends in Experimental and Clinical Medicine. Edited by M. Pavone-Macaluso and P.H. Smith, Published by S.I.O.M.S., Genova. pp 23-32. j.M. Fitzpatrick. Vesical Fistulae. In, The Bladder. Edited by J.M. Fitzpatrick, R.J. Krane. Published by Churchill Livingstone, Edinburgh, London, Melbourne, New York, Tokyo, pp 189-193. TA Creagh,J.M. Fitzpatrick. Epodyl. In, The Bladder. Edited by j.M. Fitzpatrick, R.J. Krane. Published by Churchill Livingstone, Edinburgh, London, Melbourne, New York, Tokyo, pp 307-316. j.M. Fitzpatrick, TA Creagh. Partial Cystectomy. In, The Bladder. Edited by J.M. Fitzpatrick, R.J. Krane. Published by Churchill Livingstone, Edinburgh, London, Melbourne, New York, Tokyo, pp 413-416. T.A. Creagh, J.M. Fitzpatrick. Impact of new technologies on the natural history of benign prostatic hyperplasis. In, Epidemiology of Prostate Disease, Edited by M. Garraway; Published by Springer. Berlin etc.. pp 177-183. J.M. Fitzpatrick. _147_ MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 --- BOOKS The Bladder. Published by Churchill Livingstone. Edited by j.M. Fitzpatrick and R.j. Krane. PUBLICATIONS Thomas F. Gorey Cardiorespiratory effects of laparoscopy with and without gas insufflation. Arch. Surg. 1995, 130:984-8.j.P McDermott, M.e. Regan, R. Page, K. Barry, D.e. Moriarty, PF. Cassidy,j.M. Fitzpatrick, IF. Gorey. The introduction of Laparoscopic Cholecystectomy - Audit of Transition Period with Late Follow-Up. Irish J. Med. Sci. 1995, 165: 1-5. P. Kent, e.A Bannon, O. Beausang, P.R. O'Connell,. IP. Corrigan, IF. Gorey. The short bowel syndrome: a review. Int. J. Surg. Sci., 1995,2: MA Stokes, IF. Gorey Prognostic Significance of Retinblastoma Gene Product Expressions in Colorectal Cancer. Irish j. Med. Sci. 1995,164:220. E Ryan, A Kitching, P. MacMathuna, E Mulligan, R. Merriman, P. Dervan, P. Kelly, IF. Garey, j.R. Lennon,). Crowe. Superoxide radical and xanthine oxidoreductase activity in the human heart during cardiac operations. Ann. Thorac. Surg. 1995,60: 1289-93. S. W MacGowan, M.e. Regan, e. Malone, O. Sharkey, L Young, IF. Gorey, AE Wood. Update on breast cancer treatment benign disease. Forum 1995, I 1(9): 38-40. IF. Gorey. Chromosome I aneusomy identified by interphase cytogenetics in mammographically detected ductal carcinoma in situ of the breast. journal of Pathology, 1995, 175:303-9. M. Harrison, H.M. Magee,j. O'Laughlin, IF. Gorey, PA Dervan. Arginine Induces Pancreatitis by a Nitric Oxide Independent Mechanism. Ir. j. Med. 5ci. 1995, 164:253. M.K. Barry, ED. Mulligan, M.A. Stakes, M.G. O'Riordain, IF. Garey, K.F. MeGeeney, }.M. Fitzpatrick. General Practice management of breast disease: Cancer. Forum 1995, II (10) 36-8. IF. Gorey. Prospective evaluation of MRI mammography in patients with suspected breast carcinoma. Ir. j. Med. Sci. 1995, 164: (16):9. M.P. O'Sullivan, M.G. O'Riondain,j.P. Stack, M.K. Barry,j.I Ennis,j.M. Fitzpatrick, IF. Garey. Prospective evaluation of a composite scoring system for mammographically detected cytologically assessed impalpable breast abnormalities. Eur. j. Surg. Oncol. 1995;21 :360-3. MJ. Kerin, j. Murray, E Mulligan, P Kent, j. Ennis, M. Dowling, P. Dervan, j.M. Fitzpatrick, IF. Gorey. CONFERENCES/PRESENTATIONS 1995 JANUARY II: Visiting Lecturer Surgical Fellowship Course King Abdulaziz University, jeddah, Saudi Arabia. FEBRUARY 10: Chairman Charter Day Research Symposium. Royal College of Surgeons in Ireland, Dublin. MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 E • FEBRUARY 18: Chairman Sylvester O'Halioran Research Symposium University of Umerick. MARCH II: Lecture "Screen detected breast cancer surgery" joint meeting RCSI & Arabian Gulf University, Bahrain. MAY2S: International Hepato-Pancreato-Bilary Association Athens, Greece Guest speaker "Bile duct injuries in Japaroscopic surgery". JUNE 12: Extern Examiner Surgical Fellowship Royal College of Surgeons in Edinburgh JUNE 17: Irish Oesophageal Association St. james' Hospital, Dublin. SEPTEM BER 18: Chairman and presentations Irish Society of Gastroenterology Elected member of Executive Committee Mater Hospital, Dublin. SEPTEMBER 22: "Issues in screen detected breast cancer" International symposium St. Vincent's Hospital, Dublin. OCTOBER 18: George Dunlop Visiting Professor of Surgery MCCM U. Mass Boston, U.S.A. OCTOBER 23: American College of Surgeons annual conference Presentation on "hand assist laparoscopic surgery" attended meeting of editors of journals of surgery. NOVEMBER 13: Attended course on "Laparoscopic Fundoplication" Paris, France. NOVEMBER 2S: Conference on Reflux. Barcelona, Spain. DECEMBER I: Workshop on "benign breast disease". GP Study Day, Mater Hospital. DECEMBER 6: Delivered the 21 st Annual St. Luke's Cancer Lecture. Royal Academy of Medicine in Ireland. _149_ MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 1 , GENERAL/COLORECTAL SURGERY UNIT Scope of Service/Special Interests The General/Colorectal Unit performed 720 surgical procedures during the year ended December 1995 of which 212 were major or complex major procedures. Approximately 70% of the workload involved colorectal surgical cases. This increase in colorectal cases has followed with the establishment of the Anorectal Physiology Laboratory. New Developments/New Equipment The major development during the year was the funding by the Department of Health of a full-time Stoma Therapist to the Mater Misericordiae Hospital. The appointment will be made in early 1996. The second promising development has been the purchase of a new en do-anal ultrasound equipment in foot of special and the. allocation of £50,000 from the Department of Health. This new equipment allows detailed assessment of patients with continence and defecatory problems. Ongoing Research Projects Dr. Valerie Donnelly has completed her studies of The Effect of Postpartum on the Pelvic Floor at the National Maternity Hospital. This work has been presented both nationally and internationally. Dr. Donnelly was awarded both the Registrar's Prize of the Royal Academy of Medicine in Ireland (Section of Obstetrics and Gynaecology) and the British Journal of Surgery Prize at the Association of Coloproctology of Great Britain and Ireland. As a result of Dr. Donnelly's research, the Health Research Board have awarded a research grant to allow the appointment of Dr. Michelle Fynes as Research Fellow to continue these studies at the National Maternity and Mater Misericordiae Hospitals. Ms. Maeve Duffy continues her PhD research investigating the metabolic changes in large and small bowel mucosa in patients with inflammatory bowel disease. This was has been accepted for presentation at the American ~astroenterology Association. Departmental Presentations and Publications Mr. Mark Regan, Senior Registrar and Dr. Brian Flavin, Senior House Officer are engaged in a study of The Activity of Fibroblasts in Crohn's disease. This work has been presented at the O'Halloran Meeting in limerick, where it received the prize for best poster and also to the Royal Academy Medicine in Ireland (Surgical Section) where Dr. Flavin was awarded the Registrar'S Prize. Publications Anal Sphincter endosonography using a 120 sector scanner. Ir J Med Sci, 1995; 164; 189. Campbell, D.M., Donnelly, V.S., O'Connell, D., Behan, M., O'Herlihy, C Reproducible Assay for Colonic Mucosal Metabolic Flux. Ir J Med Sci, 1995; 164. Duffy, M., Regan, M., Harrington, M.G., O'Connell, P.R. Constipation not Anal Sphincter Hypertonia Predisposes to Postpartum Anal Fissure. Ir J Med Sci, 1995, 164: 250. Corby, H., Donnelly, v., O'Herlihy, C, O'Connell, P.R. Anal Sphincter Repair in Treaunent of Faecal Incontinence. Ir J Med Sci, 1995, 164: S 16, 13. Egan, B., O'Connell, P.R. MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 •• The Introduction of Laparoscopic Cholecystectomy - Audit of Transition Period with Late Follow-Up. Ir J Med Sci, 1995; 164: 1-4. Ken~ P., Bannon, C.A., 8eousong, 0., O'Connell, P.R., Corrigan, T.P., Gorey, T.F. Morphology, Histochemistry and Crypt Cell Kinetics of Ileal Pouch Mucosa: An Experimental Model. Int J Colorettal Dis, 1996; I I: 52-55. 0'8yrne, }.M., O'Connell, P.R., Nolan, N., Hourihan, 008, Keane, F.8., Tanner, W.A. Presentations to Learned Societies, 1995 Constipation not Anal Sphincter Hypertonia Predisposes to Postpartum Anal Fissure. Irish Society of Gastroenterology, Galway, May 1995. Reproducible Assay for Colonic Mucosal Metabolic Flux. Irish Society of Gastroenterology, Galway, May 1995. Obstetric Factors Associated with Anal Sphincter Damage during First Delivery. Royal Academy of Medicine in Ireland - Section of Obstetrics. (Awarded the Registrar's Prize). Postpartum Continence Symptoms are more common in Women with Irritable Bowel Syndrome (IBS). 5th Congress of the European Council for Coloproctology, Barcelona, June, 1995. Anal Sphincter Endosonography using a 120 Sector Scanner. 5th Congress ofthe European Council for Coloproctology, Barcelona, June, 1995. Obstetric Factors Associated with Anal 5phincter Damage during First Delivery. Association of Coloproctology of Great Britain and Ireland, Cork, July, 1995. (Awarded British Journal of Surgery Prize). Anal Canal Pressures are Low in Women with Postpartum Anal Fissure. Association of Coloproctology of Great Britain and Ireland, Cork, July, 1995. Anal Sphincter Repair in Treatment of Faecal Incontinence. Sir Peter Freyer Surgical Symposium, Galway, September, 1995. _151_ MATER MISERICORDlAE HOSPITAL ANNUAL REPORT 1995 • r GYNAECOLOGY Scope of Services Routine gynaecological services. Fertility - endocrinology. Cytology and colposcopy. Laser surgery. Urodynamics. Gynae-urology. Gynaecological Oncology. Endominimal invasive surgery. Special Equipment Laparoscopyand Hysteroscopy for investigations and minimal invasive surgery. Cervical colposcopy. Urodynamics. C02 Laser. LH-RH Infusion Pump. Female S.T.D. Clinic. Special Interests Fertilicy and gynaecological endocrinology. Radical Surgery for genital cancer. Gynaecological urology assessment for surgery. Colposcopy LLETZ Laser. Minimal Invasive Surgery - Endometrial Resection. Ongoing Research Projects I. Prospective Assessment of Current Treatment Modalities for Ovarian Cancer. 2. The Prevalence of Genital Condylomata in a Teenage Population anending an S.T.D. Clinic. 3. Pelvic Pain in Adolescent Girls. Presentations/Publications Audit in a Gynaecological Unit. Irish Journal of Medical Science 1995. G. Connolly, B.M. Coughlan, P. McKenna, C. O'Herlihy. Tamoxifen and Postmenopausal Endometrial Stimulation. Presented to Obstetrical Section of Royal Academy of Medicine in Ireland 1995. G. Connolly, B.M. Coughlan, P. McKenna, C. O'Herlihy. Hysterectomy in an Irish Population. Presented to Obstetrical Section of Royal Academy of Medicine in Ireland. January 1996. 5. Ong. M. Codd, B.M. Coughlan, C. O'Herlihy. MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 • Gynaecological Surgical Emergencies (Book Chapter in Press). K. Hickey, P. McKenna, B.M. Coughlan. STATISTICS for 1995 Dr. McKenna New Patients 236 Return Patients 793 Total 1,029 Mr. Coughlan New Patients 506 Return Patients 1,129 Total 1,635 Infertility New Patients 141 Return Patients 422 Total 563 Female S. T.D. Clinic New Patients 384 Return Patients 1,157 Total 1,541 _153_ MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 nIT DEPARTMENT OF PLASTIC AND RECONSTRUCTIVE SURGERY Introduction In 1995. the plastic surgery service continued to both consolidate and expand. A new consultant, Mr. James Small was appointed and is to become part of the team in mid 1996. Mr. James Small, already a consultant in the Regional Unit in Dundonald. Northern Ireland. has an interest i~ hand and lower limb trauma which will complement the service provided by Mr. Darragh Hynes. Orthopaedic Surgeon. In this way. the Mater is consolidating its role as a major trauma centre with an active plastic and reconstructive unit. Activity increased dramatically when compared to that of 1994. The total number of out-patients seen increased by 30% to reach 340 I. Of these, there were 1093 new referrals. In-patient discharges increased by over 30% to 354. This was in part facilitated by the increase in 5 day ward admissions which demonstrated the importance of this facility in the plastic surgical service. There were also 892 day cases carried out. We have continued a policy of accepting trauma only from the Accident & Emergency Department and from in·house referrals. In the future. it is hoped to provide a more regional service. However. even within these limitations. there were 123 emergency admissions in 1995 which makes a stark contrast to the 6 admissions of 1994. This increased trauma workload has had the effect of reducing waiting list admissions by approximately 10% and it is this problem which we hope to address in the future. Training There are now three N.C.H.D.s in plastic surgical training between the Mater Hospital and the Children's Hospital. Temple Street. The registrars rotate to St. James' Hospital as part of a S.A.C. approved higher surgical training scheme. The 'career' S.H.O. is post-Fellowship and sufficiently experienced to participate in emergency cover. A three month inter rotator completes the team. In 1995, we hosted the InterCOllegiate Fellowship in Plastic Surgery Examination. This is only the second time it has ever been held in Dublin and this has raised the profile of the unit considerable as the majority of both examiners and candidates had to travel from overseas to attend the Examination. The Future The Plastic and Reconstructive Surgical Service has now become a significant development in the Mater Hospital. In 1996, there will be three consultants with three full operating days, three half-day local anaesthetic lists and three out patient sessions. The Children's Hospital. Temple Street is an integral part of the unit with over 1,000 operative treatments in 1995. This workload will have to be considered with the planned move to The Mater Site takes place. Future links with Beaumont and James Connolly Memorial Hospitals are planned and together will form part of a North Dublin Plastic Surgical Service with the Mater Hospital as its centre. MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 i I DEPARTMENT OF VASCULAR SURGERY The Department of Vascular Surgery provides a full range of service for both arterial and venous disease. They recently developed the Vascular Laboratory which provides a comprehensive non-invasive imaging for both arterial and venous disease. This has resulted in a large increase in the amount of out-patient investigations performed and a subsequent decrease in the number of patients in hospital investigations. The Vascular Laboratory currently performs approximately 60 examinations per week and is available to both in hospital and outside referrals. It is likely that in the very near future the developing area of Endo-Vascular Surgery will be expanded within the Department of Vascular Surgery at the Mater Hospital. !lis Sharon Dundon, ''tzscular Technologist. aJ work in the Vascllior Laboratory __ 155 __ MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 HOSPITAL STAFFING CONSULTANT MEDICAL STAFF Mr. R. Acheson Ophthalmology Doctor M. Behan Radiology Mr. A.W. Blayney E.NT Surgery Doctor W. Blunnie Anaesthesiology Mr. R. Bowell Ophthalmology Doctor M. Bowen ~n~esthesiology Doctor E. Breamach Radiology Doctor C. Breslin Anaesthesiology Doctor C. Burke Respiratory Physician Doctor N. Byrne Child Psychiatry Doctor D.N. Carney Oncology Doctor E. Carton Anaesthesiology Professor P. Casey Professor of Psychiatry Doctor F. Chambers Anaesthesiology Doctor L. Claffey Anaesthesiology Mr. T.P. Corrigan GeneralNascular Surgery Mr. M. Coughlan Gynaecology Doctor J. Crowe Gastroenterology Doctor Mark 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 DiabetidEndocrinology Doctor J.M. Fitzpatrick Professor of Surgery Doctor M. Floyd Anaesthesiology Doctor I. Fraser Radiotherapy Doctor J. Gardiner Anaesthesiology Mr. T. Gorey Consultant Surgeon Mr. W. Grant EN.T. Surgery 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 Doctor J. Lennon Gastroenterology Ms. P. Logan Ophthalmology Mr. D. Luke Cardia-Thoracic Surgery Doctor H.A. McCann Cardiology Docror P. McCann Radiology MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 f I Doctor M. McCarroll Anaesthesiology Doctor C. McCarthy Cardiac Physiology Mr. G.P. McEntee General Surgery/Hepatobiliary Ms. E. McGovern Cardio-ThoracidCardiac Surgery Doctor R. MacSullivan Anaesthesiology Doctor P. McKenna Gynaecology Mr. F. McManus Orthopaedics Doctor P. MacMathuna Physician/Gastroenterologist Doctor P. McQuaid Child Psychiatry Doctor J. Magner Anaesthesiology Doctor A. Mohan Consultant Psychiatrist Doctor D. Moriarty Anaesthesiology Doctor D. Mulherin Locum Consultant Rheumatologist Mr. N. Mulvihill Orthopaedic Surgery Doctor G. Murphy Dermatology Doctor S. Murphy Neurology 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 E.N.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. Phelan Anaesthesiology Professor D. Powell Endocrinology/Acting Professor of Medicine Doctor F. Powell Dermatology Mr. D. Ryan Oral & Maxillo Facial Surgery Doctor G. Sheehan Infectious Diseases Doctor J. Sheehan Adult Psychiatry Doctor E.M.P. Siung Child Psychiatry Mr.J. Smith Urology Doctor J. Stack Radiology Mr. M. Stephens Orthopaedic Surgery Doctor D. Sugrue Cardiology Doctor D. Tyrrell Anaesthesiology Mr. M.G. Walsh Orthopaedic Surgery Mr. A.E. Wood Cardio-Thoracic Surgery Doctor M. Wrigley Psychiatry _157_ MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 -~- MANAGEMENT STAFFING EXECUTIVE CHAIRPERSON Sr. Margherita Rock CHIEF EXECUTIVE Mr. M. Cowley ACCOUNTS: FINANCIAL CONTROLLER Mr. B. Conlan SYSTEMS ACCOUNTANT Mr. R. McCutcheon FINANCIAL ACCOUNTANT Mr. P. Martin MANAGEMENT ACCOUNTANTMs. K.Hamili CHAPLAINCY SERVICES: ... CHAPLAINS Rev. T. Smith, O.S. Cam Rev. P. O'Brien, O.S. Cam Rev. B. Conway, O.S. Cam GENERAL SERVICES: GENERAL SERVICES OFFICER Mr. M.lgoe CATERING SUPERINTENDENT Mr. O. Sheedy HOUSEKEEPING SERVICES Mrs. A. Dillon Mr. C. Farmer PORTERING SERVICES OFFICER Mr. D. O'Neill HOSPITAL DEVELOPMENT: ACTING PROJECT ADMINISTRATOR Mr. M.lgoe 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 ASSISTANT DIRECTOR OF NURSING Sr. M.Joan Sr. Nora Ms. N. Keane PRINCIPAL TUTOR Miss P. O'Sullivan MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 .... MANAGEMENT STAFFING PATIENT SERVICES: PATIENT SERVICES OFFICER Mr. T. Kehoe MEDICAL RECORDS OFFICER Ms. F. Fahy ADMISSIONS 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. JA Sadlier MAINTENANCE SUPERVISOR Mr. S. Maher ASSISTANT TECHNICAL SERVICES MANAGER Mr. B. Pierce _159_ MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 1 T DEVELOPMENT OF HOSPITAL The phased development of the hospital is summarised in the following section and the Reverend Mother who was in office during each development term, is indicated:- 1861-1882 East wing completed Sr. M. Patrick Kickham 1882-1912 West wing completed Sr. M. Berchmans Barry 1912-1918 Development of private hospital Sr. M. Scinislaus Kostka Farrell 1918-1924 Additions to private hospital. First Nurses Home built. Sr. M. Callistus Sheedy 1924-1930 A modern X-Ray Department replaced the 'medical electrical department', Sr. M. Carmel Grennel 1930-1936 Work commenced on the new chapel. Sr. M. Madeleine McCormack 1936-1942 New chapel completed. Sr. M. Brigid Brennan 1942-1948 Operating Theatres rebuilt. Sr. M. Reginald McHugh 1948-1945 New Nurses' Home, North Circular Road. Sr. M. Magdalene Fane 1954-1960 Development of Cardiac Unit. Establishment of School of Physiotherapy. Establishment of Department of Physical Medicine and Rehabilitation. Sr.·M. Gabriel O'Leary 1960-1966 Building of new Department of Child Psychiatry. Planning of new Operating Theatres. Education and other facilities completed. Sr. M. josephine Bourke 1966-1972 Building of new cafeteria, kitchen, non,-consultant hospital doctors' accommodation, the Freeman Auditorium and a new Accident and Emergency" Department. Opening of new open heart surgery theatres. administrative offices and central stores. Formation of the Board of Management and the adoption of a new constitution for the Mater Misericordiae Hospital. Sr. Teresa joseph Moylan 1972-1975 New Cardia-Vascular Diagostic Unit. Establishment of Endocrine Laboratory. Sr. Gemma Galgani Byrne 1975-1980 Establishment of additional temporary Out Patient accommodation, Computer Unit, Day Centre for diabetic patients. Enlargement of the Ophthalmic Department. Erection of new Gastro-intestinal Unit. Provision of accommodation for full-time Professors of Medicine and Surgery. Sr. Marian joseph Keogan MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 ••• 1981 Opening of new Department of Radiology. Commissioning of computerised axil tomographic scanner. Work commenced on the ward block of the new Mater Hospital. A new Ophthalmic Professorial Unit was completed in Nelson Street. Extension to Intensive Treatment Unit. Second Cardiovascular X-Ray Unit opened. Establishment of Oncology Laboratory. Commissioning of electron microscope unit. Foundation of Institute of Radiological Science. Sr. Rose Philippine Campbell 1989 Opening of Phase I A of the hospital's development programme consisting of eleven 3 I-bedded wards, twelve Intensive Coronary Care beds, Rehabilitation Department, Pharmacy, Hospital's Communication Centre, Switchboard, three temporary Operating Theatres, Ophthalmic Professorial Unit and Out Patient Clinic, Oratory and Prayer Room and Concourse Reception. Sr. M. Gerard 1991 The Centre for Cardiovascular Science was founded in late 1991. The activities of the Centre are conducted in newly renovated laboratory space in the Clinical Sciences building. 1992 The new Medical Records Department opened with expansive new library facilites. This has resulted in improved working conditions and an enhanced service to the various specialties in the hospital. 1993 The new Laboratory was formally opened by the Minister for Health on 21 st June 1993. 1993 The Infectious Diseases Unit was commissioned in July 1993 when Dr. Gerard Sheehan commenced work at the Mater. The Out Patient Unit was opened during the year and the dedicated ward unit opened on Ist January 1994. 1993 St. Agnes' Orthopaedic Ward was renovated and re-opened in September 1993. The unit contains the National Spinal Injuries Centre. Sr. M. Bernarde 1993 A new day theatre unit was opened in December 1993 to cater for day case procedures. The unit is situated in the former St Monica's Theatre and has been completed to the highest standard. 1994 The new Cardiac Surgery development including Intensive Care and High Dependency Units was opened by the Minister of Health on 10th November 1994. The refurbished top floor of the old hospital now includes 43 Cardiac Maintenance Beds St. Aloysius' Psychiatric Ward on the ground floor of the old hospital was refurbished to accommodate 15 beds. The new unit opened in October _161_1994. MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 HOSPITALS OF THE SISTERS OF MERCY THROUGHOUTTHEVVORLD 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: Edgeworthstown 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 EI Dorado Warner Brown Hospital 1920 130 Fort Smith St. Edward's Mercy Hospital 1905 339 Fort Smith Mercy villa-convalescent & chronic 25 Hot Springs St. Joseph's Hospital 1888 .317 Waldron Mercy Hospital 1,00 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 CALIFORNIA 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 MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 'I I State and City Name of Institution Year Beds CO LARA DO 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 Servo 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 1903 333 Council Bluffs St. Bernard's Hospital 1887 208 Cresco St. joseph's Mercy Hospital 1911 35 Davenport Mercy Hospital 1869 265 Des Moines Mercy Hospital 1894 500 Des Moines Bishop Drumm Home for Aged-Chronic 1939 90 Duduque St. joseph's Mercy Hospital 1879 348 IOWA Dubuque St. joseph's Sanitarium 1887 155 Fort Dodge St. joseph's Mercy Hospital 1908 175 Iowa City Mercy Hospital 1878 240 Marshalltown Mercy Hospital 1902 84 Mason City St. joseph's Mercy HOSpital 1916 318 Olewein Mercy HOSpital 1926 58 Sioux City St. joseph's Mercy Hospital 1890 425 Waverly St. joseph's Mercy Hospital_163_ 1904 46 MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 State and City Name of Institution Year Beds KANSAS Fort Scott Mercy Hospital 1887 165 Fredonia St. Margaret's Mercy Hospital 1950 42 Hutchinson St. Elizabeth'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 5t. Mary's Hospital 370 Grant Grant Hospital 32 jackson Mercy Hospital 1915 125 lansing St. Lawrence's Hospital 1920 450 Manistee 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 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 ~16~ MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 •• State and City Name of Institution Year Beds 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 JERSEY Sea Isle City Mercy Hospital 1953 25 NEW YORK Albany 5t. Peter's Hospital 1869 437 Batavia 5t. jerome Hospital 1917 110 Buffalo Mercy Hospital 1904 383 Gabriels Sanitauiurn 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 Port jervis 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 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 _165_ MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 State and City Name of Institution Year Beds OKLAHOMA Oklahoma City Mercy HoSpital Oklahoma City General 1916 150 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 SL 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 SL Mary's Hospital 1916 70 Wilkes-Barre Mercy Hospital 1898 300 SOUGH 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 WISCONSIN Janesville Mercy Hospital 1907 200 New Richmond Holy Family Hospital 60 I J MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 i r REST OF THE WORLD Country Name and Institution Year Beds NEWFOUNDLAND St. John's St. Clare's Mercy Hospital 1922 140 ENGLAND- DERBYSHIRE Ednascon, Brailsford St. Mary's Nursing Home 1948 20 ESSEX Clacton-on-Sea Sc. 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's Hospital 925 68 Forbes Mater Misericordiae Hospital 1951 II 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 VICTORIA Melbourne Mercy Hospital 1935 173 WESTERN AUSTRALIA Perth St. Anne's Hospital 1937 141 _167_ MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1995 ... Country Name and Institution Year Beds SOUTH AMERICA- BRITISH GUIANA Mahaica Leprosarium 1935 360 George[own 5~ Joseph's Mercy Hospital 1945 124 INDIA Jameshedpur Dalal Memorial Hospital 1952 80 AFRICA- EA5T AFRICA Nairobi Mater Misericordiae Hospital 1963