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HERMITAGE MEDICAL CLINIC

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ISSUE 3

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BUILDING FOR THE FUTURE: NEW TECHNOLOGIES

CYBERKNIFE: CUTTING EDGE TECHNOLOGY

OVERVIEW OF THE HERMITAGE MEDICAL CLINIC

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PROUDLY

ASSOCIATED WITH

THE INSTALLATION OF THE CYBERKNIFE.

PROUDLY

ASSOCIATED WITH

THE INSTALLATION OF THE CYBERKNIFE.

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Editorial

CONTENTS

EDITOR

Mary Connaughton HMC EDITOR

Karen Walsh

EDITORIAL ASSISTANT

Aoife Loy

EDITORIAL CONTRIBUTORS

Design CREATIVE DIRECTOR

Jane Matthews

DESIGN AND LAYOUT

Antoinette Sinclair ADVERT DESIGN

04 HMC CEO EAMONN FITZGERALD Improving Patient Outcomes

07 MEDICAL DIRECTOR DR GEORGE DUFFY Forward Thinking

08 OVERVIEW OF THE HMC Leaders in Private Healthcare

Colm McDermott, Jennifer Reid PHOTOGRAPHY

Mary Connaughton

PRODUCTION EXECUTIVE

Prof Brendan McAdam and Dr Tora Leong on modern cardiac imaging modalities

Advertising SALES DIRECTOR

00353 1 432 2200 info@ashville. com www.ashville.com MANAGING DIRECTOR

Diarmaid Lennon

Prof Ciaran Bolger on investing, developing and delivering a wider range of treatments

28 CARDIAC MRI

Nicole Ennis

Group Old Stone Building Blackhall Green Dublin 7

24 NEUROSURGERY: BUILDING THE BEST

A fully comprehensive service for coronary heart disease

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PUBLISHED BY Ashville Media

Mr Danny Rawluk and Dr Clare Faul on the cutting edge technology offering a painless, non-invasive treatment

26 CARDIOLOGY

Thinkstock, HMC

Paul Clemenson

20 CYBERKNIFE

08 10 HIGH DEPENDENCY UNIT The HMC have invested in a HDU to ensure the highest standard of care according to Dr Stephen Frohlich

12 CHAMPIONING PATIENT SAFETY Prof Oscar Traynor brings his Clinical Governance expertise to the HMC

29 HEART SAFETY Dr Deirdre Ward on testing and sudden cardiac death in the young

30 ORTHOPAEDICS Mr Fergal McGoldrick discusses the scope and development of the orthopaedics department

32 ORTHOPAEDICS TREATMENTS Mr Joe Sparkes discusses developments in orthopaedic treatments and techniques

13 CERTIFIED QUALITY OF CARE Mary Shore discusses the importance of JCI accreditation for staff and patients All articles ÂŠ2015/2016. No part of this may be reproduced, stored in a retrieval system or transmitted in any form or by any means without written permission from the publisher. Opinions and comments expressed herein are not necessarily those of Ashville Media Group. Readers should make their own independent evaluation of the information contained within this publication and make such other investigations as they consider necessary (including obtaining independent financial advice) before acting in reliance on this information.

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15 ICT DEPARTMENT Building for the Future

17 INFECTION PREVENTION & CONTROL The HMC promote and adhere to the highest standards of infection control

19 EMERGENCY MEDICINE Dr David Foley explains the significance of operating a top level emergency services at the HMC

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CONTENTS 34 JOINT REPLACEMENT Mr David Cogley explains how minimally invasive techniques have revolutionised joint replacements

36 PAEDIATRIC CARE Neurology, respiratory and general medicine for paediatric patients

40 RADIOLOGY DIAGNOSTICS Dr David O’Donnell, outlines the quality interventional services available at HMC

43 UROLOGY

Mr Barry Jones on the benefits of green light laser treatment for BHP

44 BREAST CLINIC Consultant Surgeon, Mr Michael Allen and Consultant Radiologist, Dr Gavin Briggs discuss the significant benefits of HMC's ‘one-stop’ clinic

46 CANCER CARE: RADIATION Radiation oncology in HMC provides an international standard of cancer treatment

48 CANCER CARE: MEDICAL Medical oncology at the HMC provides timely, quality care from the point of diagnosis and throughout the treatment process

50 OPHTHALMOLOGY Dr Andra Bobart-Hone looks at the development of ophthalmology at the HMC

52 SLEEP THERAPY Dr Liam Cormican on the treatments offered for sleep and respiratory disorders at the HMC

53 ENT Mr John Kinsella gives an overview of the services offered by the sizeable ENT department

54 PHARMACY Justin O'Sullivan manages the quality assured pharmacy department to ensure suitable medication is provided at the correct time

55 PAIN MANAGEMENT Effective pain management is an important part of treatment for patients at the HMC

56 DAYCARE Day Care at HMC provides services such as direct access endoscopy and minor surgical procedures

57 NURSING & CLINICAL SERVICES Clinical Services provide a range of supports for both patients and clinicians at the HMC

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59 EDUCATION AND SOCIAL ENGAGEMENT 60 CONSULTANT DIRECTORY 64 PATIENT INFORMATION

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CEO INTERVIEW

Improving Patient Outcomes DESPITE THE CHALLENGES RESULTING FROM THE ECONOMIC DOWNTURN, HMC HAS CONTINUED TO GROW AND IS AT THE FOREFRONT OF INNOVATIVE PATIENT CARE. WITH AN EXTENSIVE BACKGROUND IN IRISH HEALTHCARE, CEO EAMONN FITZGERALD HAS BEEN LEADING THE CLINIC'S SUCCESS SINCE ITS ESTABLISHMENT ALMOST TEN YEARS AGO.

ermitage Medical Clinic (HMC) has distinguished itself as a high-tech, stateof-the-art organisation with a strong focus on patient outcomes. It has continued to grow despite the challenges presented by the economic downturn. CEO Eamonn Fitzgerald has been at the forefront of the hospital's success since its inception almost a decade ago, and has seen well over 200,000 people treated on an in-patient basis and many hundreds of thousands on an out-patient basis. “We really want to be able to make a difference in people's lives,” he says and attributes the success of the hospital almost exclusively to the competency and compassion of its staff. From induction onwards, HMC promotes a culture of patient safety amongst its

employees and encourages the mentality that risk management is everybody's job – not just the job of any one individual. “I think that it's only appropriate that we would strive to provide the very best clinical and ethically-focused services to patients and families.” In addition to compassion and competence, all HMC staff members – whether they be clinical, engineering, HR or finance staff – are recruited for their team-spirited approach. “They're all links in a chain and if there's any break in that link for whatever reason, it is going to impact on the quality of the services and potentially on the safety of the services,” says Fitzgerald. “That is in part why we have, from the inception of the hospital, committed to undergoing internationally

accredited surveys through Joint Commission International.” The hospital has now been successfully accredited three times. For Fitzgerald, developing the right ethos is a continuous progression. “We see this as a journey,” he says. “A journey of learning, a journey of committment, a journey of putting the patient first and developing a culture of safety. That culture of safety is something that has to be grown from the ground up and not just delivered by way of sermon. It's very much about the little things – that you never pass something or someone where you could avoid an event or a near-miss by making a simple intervention,” he says. In further developing this, the hospital is making significant strides in their clincal

CEO INTERVIEW

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governance framework and has recently appointed a Director of Clinical Governance in Professor Oscar Traynor.

CONTINUED GROWTH With the economic downturn taking its toll on the country at large, the last few years have been challenging – not least of all for the health sector. There has also been the challenge of joining up the thinking at a policy level between public and private healthcare. “At the moment we still have a situation where there are different services that develop at different levels in different ways, which does not provide optimisation in terms of scarce use of resources – be they capital resources, or clinical resources and expertise,” Fitzgerald says. “That being said, the independent sector, of which the Hermitage Medical Clinic is an intrical part, is working very closely with the Department of Health and the HSE and other relevant third parties to try and continue to engender that vision of working together in the most cohesive and interactive way in order to be able to provide access, quality and affordability to patients. That is what it should look like – that access is on the basis of clinical need rather than on the basis of ability to pay at the point of service delivery.” HMC has continued to expand and will see its staff numbers increase throughout 2015 as they bring on new services. The Clinic's close rapport and collaboration with general practitioners in its surrounding area has been significant in its development. “We continue to see growth in our Emergency Department activity,” Fitzgerald says. “Not least of all because it's a consultantdelivered service and because it's very accessible and responsive to the needs of general practitioners on behalf of meeting the needs of their patients.”

WORLD-CLASS FACILITIES HMC distinguishes itself as a leader in top-class facilities and treatments for patients which are among some of the best in the country. At the end of November 2013, the hospital clinically commissed CyberKnife – a form of stereotactic radiosurgery, which despite the name, is a non-invasive alternative to surgery. HMC is the only hospital on the island of Ireland that has this cutting-edge technology. “It has proven to be a wonderful benefit to patients whose clinical care would otherwise have to had been met outside of

the country,” Fitzgerald says. He outlines the ways in which the Clinic is making use of the technology: “At the moment we're treating people not only with cranial pathologies but also with prostrate cancer, and we're developing treatment options in other areas such as lung. We're also doing some clinical research in the area of cardiac care and the application of CyberKnife in terms of people with certain types of cardiac or heart conditions.” Furthermore, HMC has also seen developments in its orthopaedic services. “We now have certain consultants involved in minimally invasive joint replacement activity and that affords patients an opportunity to have joint replacements with less invasive impact on their muscles,” Fitzgerald explains. While it lowers the risk of infection and the risk of delays in recuperation, it also speeds up the process of rehabilitation. HMC is continuing to develop a wider spectrum of activity with its services, including elective as well as trauma orthopaedics and a significant amount of extremity orthopaedics – such as shoulder and foot and ankle. “Paedriatric orthopaedics is also an area that we are doing more of and we see a need to continue to develop the widest spectrum of activity in these areas,” Fitzgerald says. Fitzgerald is keen to further develop the hospital's services to an excellence of care which is capable of being benchmarked and seen to perform against the best national and international centres in the world. “We have a significant programme that we've developed with a group of very eminent neurosurgeons and to that end we've just completed a new neurosurgical theatre, which will furnish these consultants with the opportunity of doing a significant amount of complex neurosurgical activity, for which there are significant waiting lists in the public system, in this hospital,” he explains. “We're developing the hospital along the lines of institutes for subspeciality areas – so institute for neurosciences, where we'll have neurosurgery, neurology, neurophysiology, neuropsychology and neuroradiology working within a multi-disciplinary team to provide excellence of care.”

THE FUTURE Fitzgerald sees HMC going from strength to strength and looks towards leaving a long-term legacy. “My vision would be to make a significant contribution to the

From induction onwards, HMC promotes a culture of patient safety amongst its employees and encourages the mentality that risk management is everybody's job – not just the job of any one individual.

PICTURED: Eamonn Fitzgerald, CEO, HMC. provision of healthcare both primary and secondary, as in community-based and hospital-based,” he says. “We're working closely with general practitioners in our outreach clinics – of which we have six currently around the country – to bring consultants and diagnostics to the practitioners in these outreach clinics so that patients don't have to travel unnecessarily to receive initial consultation.” According to Fitzgerald, HMC will continue to be at the forefront in creating better patient outcomes. The Clinic has an involvement with i360 Medical, a research and innovation company which supports new healthcare ideas and medical technologies, and has developed a HMC iPhone App. As part of their strategic focus, they have developed the H.E.A.R.T programme – an acronym for Hearing, Emphasising, Apologising, Responding and Thanking – which addresses customer service and communication within the organisation. This programme was initiated in 2002 by the Cleveland Clinic. HMC is also involved in research into personalised medicine and the area referred to as genomics, which looks at a person's DNA sequencing and the individuality of each person. “We're now at a point – in terms of technology and clinical expertise – where people can anticipate in the not too distant future, as the norm rather than the exception, that the individuality of the person will be taken on board in terms of tailoring specific treatments for patients,” Fitzgerald explains. “We believe that the more we can tailor and target and specify the diagnostic work-up and the therapeutic interventions to the unique and particular and specific needs of the patient, the more likely that's going to lead to better outcomes.” With it's innovational and hightech focus to all aspects of healthcare, there can be no doubt that HMC will continue to distinguish itself as a hub of patient safety and quality of care.

CEO INTERVIEW

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MEDICAL DIRECTOR INTERVIEW

Forward THINKING AS MEDICAL DIRECTOR OF HMC, DR GEORGE DUFFY'S VISION FROM THE START WAS TO RELIEVE THE PRESSURE ON PUBLIC HOSPITALS AND TO MAXIMISE THE BEST POSSIBLE OUTCOMES FOR PATIENTS THOUGH THE PROVISION OF STATE-OF-THE ART MEDICAL SERVICES.

PICTURED: Dr. George Duffy, Medical Director, HMC.

MC is led by some of the foremost medical professionals in the country. Among them is Dr George Duffy whose trail blazing career has been characterised by endeavours to improve the quality of healthcare in Ireland. Along with three other medical consultants, he was involved in setting up Blackrock Clinic over 25 years ago. Subsequently, Dr Duffy was approached by Sean Mulryan with the idea of setting up a private hospital in the west Dublin area where there was a growing population and an increasing need for hospital services and he agreed to apply his expertise in helping to bring this idea to fruition.

service which is provided 16 hours per day for patients, including weekends. When the Clinic was first established, the provision of an Emergency Department (ED) was a bold move for a private hospital. An emergency service places a broad-based demand on many hospital services to meet both the needs of patients referred by GPs and of those who present directly to the ED. Dr Duffy explains: “In addition to the specialised staff in the ED, you must have the back-up services available in the Imaging Department, the Pathology and Laboratory Departments and the inhouse services of, at least, a consultant general surgeon, a consultant general physician, and a consultant cardiologist.”

HIGH-QUALITY SERVICES

Dr Duffy sees the ED service at HMC as a valuable medical resource for the community – in particular, for the primary care physicians. "Our biggest contribution is to the many primary care physicians who want answers quickly,” he says. The Clinic strives to maintain this relationship by making prompt exemplary medical services readily available.

The principal concept was to alleviate the pressure on the public hospital systems and to reduce the amount of time patients spent waiting for services. In particular, he wanted to improve access to high-quality diagnostic imaging services including PET-CT, and to introduce up-to-date Radiotherapy such as IMRT and hopefully, innovative CyberKnife. The intention was to concentrate, in particular, on services related to Oncology. These areas have been successfully built up over the years. “We have a very comprehensive diagnostic imaging department with a very active interventional radiology service provided by six diagnostic and interventional radiologists who, under image guidance, do biopsies, injections and draining procedures,” Dr Duffy says. “Our interventional radiology service is highly regarded and consequently, many patients are sent to HMC specifically for these services.” The Clinic has also seen huge demand for its MRI scanning

A PROGRESSIVE ETHOS Looking forward, Dr Duffy sees a greater degree of transparency developing around the standards of patient care in hospitals – including HCL. “The patient will be able to log into the hospital website to see what the up-to-date measurable results and outcomes are for that hospital,” he says. “Such as the time from presentation, to ED, to being seen by an ED consultant; incidence of MRSA infections on presentation at the hospital and acquired while there; frequency of post-op wound infections; falls in hospital;

patient satisfaction rates regarding medical services catering service, etc.” This is just some of the information which will be available online in the future to compare with other national and international hospitals. Dr Duffy indicates that patient safety at all times is a priority for HMC, and developing a hospital-wide culture of safety and quality of care is an overriding, guiding principle. Dr. Duffy also notes that HMC increased its services by building a new dedicated neurosurgical theatre which opened in January, thus adding intracranial procedures to the existing neurosurgical procedures carried out at HMC. In addition, the Clinic has installed the only CyberKnife in Ireland - north or south, which means that patients will no longer have to travel to England or Germany to receive this treatment Dr Duffy would like to see the Department of Health and the HSE again purchasing more services from private hospitals, thereby reducing waiting times that are once more increasing for many elective procedures. He is convinced that many medical services can be provided by private hospitals at a reduced cost to the taxpayer. This is the result of underutilisation or closure of many facilities within public hospitals due, for example, to staff shortages. Dr Duffy is optimistic that the grouping of hospitals into Trusts within the country will lead to competition in the provision of services between the Trust hospitals and that the private hospitals will be given an opportunity to compete and bid to provide services from within these Trusts – for all patients, not simply those with private health insurance. Time will tell whether this too will come to fruition.

Medical Director Interview

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LEADERS in private HEALTHCARE SINCE ITS INCEPTION IN 2006, HMC HAS EVOLVED INTO ONE OF IRELAND’S LEADING PRIVATE HOSPITALS, OFFERING ADVANCED MEDICAL CARE, STATE-OF-THE-ART FACILITIES AND TECHNOLOGY TO A GROWING PATIENT BASE FROM AROUND THE COUNTRY.

MC is a 101-bed hospital in west Dublin, providing a full range of medical and surgical care across a broad spectrum of specialities. It also has 25 day-beds and eight operating theatres. HMC offers top quality healthcare with access to over 240 leading consultants. The service provided by the Clinic has achieved international recognition based on its modern, technologically advanced facilities and its team of specialists and experienced staff who are committed to providing excellent care to the community. At HMC, we define that community not only geographically but also in terms of the demographics of the population and what the population needs, from paediatrics right up to caring for the elderly. We have a very broad spectrum of surgical and medical activity to reflect that. HMC views the relationship between GPs and primary care as fundamental to the successful provision of timely access for patients to its clinical facilities. In keeping with its ethos of providing access for all, agreement has been secured for the broadest range of patient cover with Vhi Healthcare, Layahealthcare, Aviva Health and Glo Health. Wide-ranging cover is also provided for members of the ESB, An Garda Síochána, the Defence Forces and the Prison Officers’ Association Schemes.

THE HEART OF HMC HMC has an extensive, patient-centred cardiology service, providing both diagnostic and interventional services, led by a dedicated team of consultants and staff. The Cardiology Department is a GPdirect access, non-invasive service and includes ECG, stress ECG, ambulatory BP and cardiac monitoring, pacemaker and defibrillator clinics and

echocardiography including 3D and transoesophageal echocardiograms. The advanced cardiac imaging programme includes cardiac MRI, nuclear perfusion scans and cardiac/coronary CT. The state-of-the-art cardiac catheterisation laboratory (cath lab) at HMC performs a comprehensive list of diagnostic and interventional procedures including coronary angiograms using intracoronary pressure and intravascular ultrasound studies; percutaneous coronary stenting for the treatment of coronary narrowings or blockages; device implantation i.e. pacemakers, defibrillators including heart failure therapies and electrophysiology studies and ablation therapy for cardiac rhythm disturbances. We also have a Chest Pain Clinic for patients with multiple risk factors and palpitations

FORERUNNERS IN ORTHOPAEDICS Orthopaedics is a major area of expertise at HMC and we have a vibrant orthopaedic practice. One of the significant developments in orthopaedics today has been the move from larger incisions to minimally invasive surgery. Some of our orthopaedic consultants specialise in minimally invasive joint, hip and knee replacement. We also carry out ankle and shoulder procedures and foot surgery. At HMC, we have a multidisciplinary approach to care including clinical nurse specialists, a physiotherapy team and other allied health professionals. We have a comprehensive diagnostic imaging department where we provide a service across a range of modalities including MRI, CT and digital X-ray. We also have an interventional radiology service for patients who require such investigations and treatment.

NEUROSURGERY SPECIALISTS Spinal neurosurgery is also performed at HMC with a view to helping pain in relation

to spinal disorders, alleviating neurological problems and stabilising the spine. GPs refer patients to a spinal neurosurgeon if they have ongoing pain in the spine and pain radiating down the arms and legs. Following consultation, usually an MRI scan of the spine is obtained. One may also need plain X-rays/CT scans, all of which are provided for at HMC. The neurosurgeon may suggest conservative management, spinal injection or spinal surgery. In addition, a neurosurgeon will also treat spinal fractures, tumours, infections and

OVERVIEW

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SERVICES AND SPECIALITIES • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •

PICTURED: State-of the art Neurosurgical Theatre some complex abnormalities of the cervical spine including rheumatoid arthritis. They will also investigate and treat intracranial pathology.

ADDITIONAL SERVICES HMC has first-class consultant expertise in the areas of medical, surgical and radiation oncology. The Radiotherapy Department at HMC has two state-of-the-art identically matched linear accelerators. The HMC offers Cyberknife, a painless, non invasive treatment for cancerous and non-cancerous tumours. This is the first treatment of its kind in Ireland. CyberKnife is the world’s only radiosurgery system that

used advanced robotics to treat tumours anywhere in the body. Our ED is a rapid access service provided by consultants in emergency medicine. Patients presenting with a broad range of conditions including cardiology, general surgery, orthopaedic and urology will be seen in the first instance by a consultant in emergency medicine. HMC also provides training placements to the Royal College of Surgeons (RCSI), UCD and TCD medical students and is a partner with the Dundalk Institute of Technology nursing degree and Dublin City University (DCU).

Audiology Allergy Breast Clinic Cardiology Daycare Diagnostic Imaging Dentistry Dermatology Dietetics and Nutrition Emergency Department Endocrinology and Diabetes ENT Gastroenterology Gynaecology Haematology Nasal Plastic Surgery Nephrology Neurology/Neurosurgery/ Neuropsychology/Neurophysiology Nuclear Medicine/PET Centre Nursing Oncology Department Ophthalmology Orthopaedic Surgery Paediatrics (General and Respiratory) Pain Medicine Pathology Pharmacy Phlebotomy Services Plastic Surgery Physiotherapy Psychiatry Radiology Radiotherapy Respiratory Department Rheumatology Speech and Language Therapy Surgery (Breast, Colorectal, General, GI and Vascular) Urology Vascular Medicine

MISSION STATEMENT Our mission is to provide excellence in care to all patients. The philosophy of HMC is one of service and an acknowledgement of the holistic needs of patients not just from a clinical perspective for their presenting illness but also from a psychological, emotional and spiritual perspective. The values that underpin our mission and philosophy include dignity, compassion, advocacy, quality and respect. There is a strong ethos of teamwork and the patient is at the forefront of everything that we do and strive for at HMC.

OVERVIEW

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COMPLEX CONDITIONS DEMAND

COMPLEX CARE

THE HIGH DEPENDENCY UNIT, PROVIDES CONSULTANT DELIVERED CRITICAL CARE TO PATIENTS WHO’S CONDITIONS REQUIRE IT, WRITES DR STEPHEN FRÖHLICH, CONSULTANT IN ANAESTHESIA AND INTENSIVE CARE MEDICINE.

High Dependency Unit (HDU) has been present in the Hermitage Medical Clinic since 2006. It provides high level monitoring and management for patients who’s condition necessitate it. Given the increasing complexity of surgical patients, the recent opening and expansion of the emergency department and a higher acuity of medical patient there has been a need to expand the clinical capability offered by the Hermitage Clinic’s HDU service.

The High Dependency Unit has been upgraded to a specially staffed and equipped eight bed unit able to provide care to patients at an intermediate clinical level with expert nursing care and monitoring facilities. As a result the HDU is now equipped to deal with complex postoperative patients, including neurosurgical cases and support medical patients requiring single organ support (such as non-invasive ventilation, inotropic support or haemodialysis). In the unlikely event of a patient requiring more prolonged multiple organ supports (e.g. prolonged mechanical ventilation) a service level agreement is in place with the Blackrock Clinic to transfer patients for specialist critical care support to their new 12-bedded state of the art Intensive Care Unit. Over the last three months transfer protocols and HDU staff training have been undertaken to ensure rapid and seamless transfer should such a clinical need arise. To support the delivery of expert clinical care to the Hermitage Medical Clinic ICU two intensive care consultants have recently commenced practice at the

To further enhance patient safety and ensure a rapid out of hours response to any medical emergency that might arise a resident on-call anaesthetic registrar is now present on site.

Hermitage Medical Clinic. Dr Stephen Fröhlich, Consultant in Anaesthesia and Intensive Care Medicine has recently returned from the John Radcliffe Hospital, Oxford, and together with Dr Noelle Murphy (Kings College Hospital, London) will now be providing a consultant delivered critical care service to the Hermitage Medical Clinic. To further enhance patient safety and ensure a rapid out of hours response to any medical emergency that might arise a resident anaesthetic registrar is now present on site. An Intensive Care foundation course commenced in January 2015 which will support the ongoing professional development of our nursing staff. Run in conjunction with the Dundalk Insitute of Technology four nurses are anticipated to graduate from this programme in June 2015. The upgrading of the Hermitage Medical Clinics critical care facility ensures our patients have access to the highest standards of clinical care, regardless of the complexity of their condition. Moreover, referrers to the hospital can be confident that the needs of any patient can be met, regardless of the acuity of their illness.

HDU

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KONV 2252

Agents

Tablet

OLMESARTAN

AMLODIPINE

HYDROCHLOROTHIAZIDE

20mg

5mg

12.5mg

40mg

5mg

12.5mg

40mg

10mg

12.5mg

40mg

5mg

25mg

40mg

10mg

25mg

Konverge Plus 20 mg/5 mg/12.5 mg, 40 mg/5 mg/12.5 mg, 40 mg/10 mg/12.5 mg, 40 mg/5 mg/25 mg and 40 mg/10 mg/25 mg film-coated tablets (olmesartan medoxomil/ amlodipine [as amlodipine besilate]/hydrochlorothiazide). Prescribing information: Please consult the Summary of Product Characteristics (SmPC) for full prescribing information. Presentation: Film-coated tablets containing: 20 mg olmesartan medoxomil, 5 mg amlodipine, 12.5 mg hydrochlorothiazide or 40 mg olmesartan medoxomil, 5 mg amlodipine, 12.5 mg hydrochlorothiazide or 40 mg olmesartan medoxomil, 10 mg amlodipine, 12.5 mg hydrochlorothiazide or 40 mg olmesartan medoxomil, 5 mg amlodipine, 25 mg hydrochlorothiazide or 40 mg olmesartan medoxomil, 10 mg amlodipine, 25 mg hydrochlorothiazide. Uses: Treatment of essential hypertension. Indicated as add-on therapy in adult patients whose blood pressure is not adequately controlled on the combination of olmesartan medoxomil and amlodipine taken as dual-component formulation. Also as substitution therapy in adult patients whose blood pressure is adequately controlled on the combination of olmesartan medoxomil, amlodipine and hydrochlorothiazide, taken as a dual-component (olmesartan medoxomil and amlodipine or olmesartan medoxomil and hydrochlorothiazide) and a single-component formulation (hydrochlorothiazide or amlodipine). Dosage: Oral administration. Adults (18-65 years): Recommended dose is 1 tablet daily. Add –on therapy: administer in patients whose blood pressure is not adequately controlled on olmesartan medoxomil and amlodipine taken as dual-component combination. Step-wise titration of the dosage of the individual components recommended before changing to the triple-component combination. When clinically appropriate, direct change from dual-component combination to triple-component combination may be considered. Substitution therapy: dose to be based on the doses of the individual components of combination at time of switching. Maximum daily dose of 40 mg/10 mg/25 mg. Elderly: Caution, monitor blood pressure frequently especially at maximum dose. Extreme caution, including more frequent monitoring of blood pressure, recommended in patients aged 75 or older. Patients with mild to moderate renal impairment: Maximum dose 20 mg/5 mg/12.5 mg and monitor potassium and creatinine levels. Caution in patients with mild to moderate hepatic impairment; maximum daily dose 20 mg/5 mg/12.5 mg; monitor blood pressure and renal function closely. Children and adolescents under 18 years: Not recommended. Contra-indications: Hypersensitivity to any component, to dihydropyridine derivates or to sulfonamide-derived substances. Severe renal impairment. Refractory hypokalaemia, hypercalcaemia, hyponatraemia and symptomatic hyperuricaemia. Severe hepatic insufficiency, cholestasis or biliary obstruction. Second or third trimesters of pregnancy. Severe hypotension, shock (including cardiogenic shock), obstruction of the outflow tract of the left ventricle, haemodynamically unstable heart failure after acute myocardial infarction. Warnings and Precautions: Correct intravascular volume depletion before administering Konverge Plus or maintain close medical supervision. In patients with other conditions associated with stimulation of renin-angiotensin-aldosterone system, possible side effects include acute hypotension, azotaemia, oliguria or, rarely, acute renal failure. Increased risk of severe hypotension and renal insufficiency in patients with bilateral renal artery stenosis or stenosis of the artery to a single functioning kidney. Periodic monitoring of serum and potassium levels is recommended in patients with impaired renal function and kidney transplantation. Special caution in patients with aortic or mitral stenosis, or obstructive hypertrophic cardiomyopathy. Not recommended in patients with primary aldosteronism. May impair glucose tolerance. In diabetic patients dosage adjustments of insulin or oral hypoglycaemic agents may be required. Increases in cholesterol and triglyceride levels. Thiazides may precipitate hyperuricaemia or frank gout. Periodic determination of serum electrolytes should be performed. Can cause fluid or electrolyte imbalance (including hypokalaemia, hyponatraemia and hypochloraemic alkalosis). Risk of hypokalaemia with cirrhosis of the liver, brisk diuresis, inadequate oral intake of electrolytes, concomitant therapy with corticosteroids or ACTH. Hyperkalaemia, risk factors include renal impairment, and/or heart failure. Monitoring of serum potassium in patients at risk of hyperkalaemia is recommended. Concomitant use of potassium containing and sparing products should be undertaken with caution and potassium levels monitored frequently. May cause intermittent and slight elevation of serum calcium. Discontinue before carrying out tests for parathyroid function. May increase urinary excretion of magnesium. Dilutional hyponatraemia may occur in oedematous patients in hot weather. Not recommended for combination use with lithium. Changes in renal function in susceptible individuals with heart failure. Amlodipine associated with increased reports of pulmonary oedema. Do not initiate during pregnancy. Discontinue as soon as possible if pregnancy occurs. Photosensitivity reactions have been reported with thiazide diuretics. Excessive blood pressure decrease in patients with ischaemic heart disease or ischaemic cerebrovascular disease could result in a myocardial infarction or stroke. Hypersensitivity reactions to hydrochlorothiazide may occur in patients with or without a history of allergy or bronchial asthma. Exacerbation or activation of systemic lupus erythematosus with the use of thiazides. The blood pressure lowering effect of olmesartan medoxomil is somewhat less in black patients than non-black patients. Interactions: Not recommended for concomitant use with lithium, drugs affecting potassium levels, caution with baclofen, NSAIDs, amifostine, other hypertensive agents, alcohol, barbiturates, narcotics, antidepressants CYP3A4 inhibitors, CYP3A4 inducers, calcium salts, cholestyramine and colestipol, digitalis glycosides, non-depolarizing skeletal muscle relaxants, anticholinergic agents, antidiabetic medicinal products, beta-blockers and diazoxide, pressor amines, medicinal products used in the treatment of gout, amantadine, cytotoxic agents, salicylates, methyldopa, ciclosporin, tetracyclines. Pregnancy and Lactation: Do not use in the first trimester and discontinue as soon as possible if pregnancy occurs. Contraindicated in second and third trimesters of pregnancy. Not recommended during lactation. Side Effects: Konverge Plus: Common (≥ 1/100 <1/10): upper respiratory tract infection, nasopharyngitis, urinary tract infection, dizziness, headache, palpitations, hypotension, diarrhoea, nausea, constipation, muscle spasm, joint swelling, pollakiuria, asthenia, peripheral oedema, fatigue, blood creatinine increased, blood urea increased, blood uric acid increased. Olmesartan: Common: urinary tract infection, hypertriglyceridaemia, hyperuricaemia, dizziness, headache, cough, bronchitis, pharyngitis, rhinitis, diarrhoea, nausea, abdominal pain, dyspepsia, gastroenteritis, arthritis, back pain, skeletal pain, haematuria, peripheral oedema, fatigue, chest pain, influenza-like symptoms, pain, blood urea increased, hepatic enzymes increased, blood creatine phosphokinase increased. Amlodipine: Common: dizziness, headache, somnolence, flushing, nausea, abdominal pain, ankle swelling, fatigue, oedema. Hydrochlorothiazide: Very common (≥1/10): hypertriglyceridaemia, hypercolesterinaemia, hyperuricaemia. Common: hypokalaemia, glycosuria, hypercalcaemia, hyperglycaemia, hypomagnesaemia, hyponatriaemia, hypochloraemia, hyperamylasaemia, confusional state, dizziness, diarrhoea, nausea, constipation, abdominal pain, meteorism, gastric irritation, vomiting, blood creatinine increased, blood urea increased. For less frequent side effects see SmPC. Pack Sizes: Blister containing 28 film-coated tablets. Legal Category: POM. Product Authorisation Numbers: PA 865/19/1-5. Product Authorisation Holder: Menarini International Operations Luxembourg S.A, 1 Avenue de la Gare, L-1611 Luxembourg. Marketed by: A. Menarini Pharmaceuticals Ireland. Further information is available on request from A. Menarini Pharmaceuticals Ireland Ltd, 2nd Floor, Castlecourt, Monkstown Farm, Monkstown, Co. Dublin or may be found in the SmPC. Date of Preparation: May 2012. Co-promoter: DAIICHI SANKYO IRELAND LTD., Riverside One, Sir John Rogerson Quay, Dublin 2, Ireland. Date of item: January 2013. 13Kon001

A. MENARINI

PHARMACEUTICALS IRELAND LTD

Healthcare for Life

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Information and Communication Technology

BUILDING for the future IT IS AN EXCITING TIME FOR THE HERMITAGE MEDICAL CLINIC WITH MUCH CHANGE WITHIN ICT AND SIGNIFICANT INVESTMENT IN NEW TECHNOLOGIES FOR 2015. THIS WILL CREATE A STATE OF THE ART ENVIRONMENT AND GREATLY IMPROVE PERFORMANCE, EFFICIENCY AND SCALABILITY OVER THE NEXT FIVE YEARS, ACCORDING TO CHIEF INFORMATION OFFICER, JOSEPH RYAN.

he ICT department at the HMC has a strategy to create a solid infrastructural foundation that will help us focus on implementing and enhancing new and existing systems over the coming years. As part of this we are currently in the process of replacing all the servers, storage and fibre infrastructure that supports the hospital's applications and systems. This will increase the performance of the network and benefit hospital users.

with workstations. Four new email servers with the latest functionality have also been commissioned and they will be accessible from anywhere in the hospital.

ENHANCED SECURITY

The hospital has recently purchased a new Picture Archiving and Communication System (PACS) and Radiology Information System (RIS).

To ensure we provide the highest levels of security when communicating sensitive information internally and externally we have commissioned and purchased two enterprise standard firewalls. These will provide a substantially enhanced level of protection against modern day threats than older firewalls. A modern virtual environment using virtual servers and clients has also been commissioned which will bring additional flexibility and dramatically reduce service desk turnaround time for problem solving

A new phone system will replace the current one. This will be complimented by a new disaster recovery room which will be a mirror of the current server room and in the event of a hardware problem all systems and applications will be available.

IMAGE INFORMATION AND ARCHIVING

This new system has generated more efficient work flows and users of the system can make more accurate and precise decisions, while the patientâ&#x20AC;&#x2122;s journey through Radiology has become a better experience.

SMART TECHNOLOGY The HMC launched it new Hospital App for iPhone which gives patients a

Users of the system will be able to make more accurate and precise decisions, while the patientâ&#x20AC;&#x2122;s journey through Radiology will be a better experience mobile perspective of hospital life and its services. There has been positive feedback from users on the quality of the information and the ease of use of our new mobile application. This is part of the HMC's digital media strategy which will increase its virtual footprint on the web and social media. There is a bright outlook for innovation and cutting edge technologies in the HMC for 2015. Along with the significant investment in the infrastructure, there are a number of new technologies on the horizon which will make the HMC technology leaders in Ireland and we are laying the blocks for building for the future.

ICT. Information and communication technology

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ACCREDITED Quality Of Care HMC WORKS HARD TO COMPLY WITH THE HIGHEST NATIONAL AND INTERNATIONAL STANDARDS OF HEALTHCARE , QUALITY AND SAFETY. WITH THREE SUCCESSFUL JCI ACCREDITATION SURVEYS ALREADY UNDER ITS BELT, MARY SHORE, DIRECTOR OF NURSING AND CLINICAL SERVICES OUTLINES THE PROCESSES INVOLVED. its compliance with international standards. “There is a theme of culture of safety that permeates all the standards,” explains Mary Shore, Director of Nursing and Clinical Services at HMC. “The surveyors come and they review all our documentation, all of our policies and procedures, guidelines, and protocols. Then they carry out what are called tracer audits where they follow a patient's care within the hospital. They look for evidence that care is provided in compliance with the JCI standards.” HMC works hard to ensure that we are compliant with the standards at all times – not just for survey. PICTURED: Mary Shore

n just 18 months of first opening, HMC was successful in achieving Joint Commission International (JCI) accreditation. With a mantra of 'continuous improvement', JCI has a tried and tested accreditation scheme which surveys patient safety and quality of care in healthcare organisations against the highest international benchmarks. 662 organisations in 90 countries worldwide have achieved accreditation. HMC has achieved accreditation on three occassions, the most recent in November 2014. JCI accreditation is a three-year process, where a triennial survey is carried out usually by three surveyors over a four-day period. During this time, the hospital demonstrates

The hospital was recently surveyed under the new, JCI fifth edition standards. “One of the focus areas in the fifth edition standards is developing various elements of a culture of safety – from incident reporting to safety walkrounds, to tracer audits to a myriad of elements. We would plan to grow those constantly and expand them,” Shore says. “The other area we've had a particular focus on is quality monitors, localising them to individual departments, but again we'd like to expand that and continuously grow that area.”

With its successful track Accreditation not only sets the hospital standards to maintain. It is, in fact, essential. Shore explains: “It's a requirement for us to have contracts with private health insurers, because they need to be able to demonstrate that their customers are receiving care in accredited hospitals. It benefits us in that we have independent validation of our standards of care, and also it gives us a standard to achieve across a myriad of areas – from staff qualifications and education, through facilities management, through anaesthetic and surgical care to patient and family rights"”

CONTINOUS GROWTH With its successful track record, HMC will undoubtedly continue to impress with its high standards of patient care. “We have recently been awarded our third successful accreditation.”

record, HMC will undoubtedly continue to impress with its high standards of patient care. Looking forward, HMC will continuously strive to benchmark against national and international standards. The Clinic is continuing to collaborate with Galway and Blackrock Clinics in sharing information and successes around compliance with accreditation standards, which we have found to be a positive relationship. Furthermore, HMC is voluntarily ensuring compliance with HIQA standards. “We've mapped the JCI standards against the HIQA standards, and we're confident that if we had a HIQA assessment that we would be compliant because of our compliance with JCI,” Shore says.

Accreditation

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CHAMPIONING Patient Safety AS THE NEWLY-APPOINTED DIRECTOR OF CLINICAL GOVERNANCE, PROF OSCAR TRAYNOR BRINGS HIS SKILLS AND EXPERTISE TO HMC IN ITS DEVELOPMENT OF AN INSTITUTION WIDE CULTURE OF PATIENT SAFETY.

PICTURED: Prof. Oscar Traynor

Visibility is probably

MC is committed to ensuring that it operates to the highest clinical and ethical standards. To that end, it has been making significant advancements in its promotion of patient safety. This year saw the appointment of a Director of Clinical Governance in eminent liver surgeon, Professor Oscar Traynor. With a background in surgery, Prof Traynor recently retired from St Vincent's University Hospital where he was the Director of the National Liver Transplant Programme. In addition, Prof Traynor is the Director of the National Surgical Training Centre at the Royal College of Surgeons in Ireland, a position he still holds and one which he believes has given him a particular skillset and insight into patient safety – an ideal résumé for this role.

the most important part of clinical governance, where you go out and you talk to people; talk to them about patient safety issues and get their feedback on things that are causing concern.

Clinical governance essentially concerns the system through which the quality, safety and overall patient experience is put into practise within a healthcare organisation. The word 'governance' may seem to imply a policing approach. However, Prof Traynor explains that clinical governance is actually much more than this: “It's about ensuring that systems and structures are in place to ensure the highest possible standards of patient safety and constantly improving quality of healthcare delivery,” he says. “It's about developing a culture of safety within the organisation where everybody feels that they personally have a committment to safety and improving quality. It's about developing that culture within the organisation.” Prof Traynor emphasises that this must be a collective and individual mindset, where every staff member feels empowered to be a champion of patient safety.

CLINICAL GOVERNANCE IN PRACTISE Developing a culture of safety is not simply a one-time goal to be achieved and then forgotten – it is an ongoing process. To that end, HMC has established a clinical governance committee which meets every two months, and in addition to looking at a process of continuous quality improvement, the committee audits all activities that take place in relation to

patient safety. Prof Traynor explains: “We audit any complications which might occur, we audit infections, any unplanned returns to operating theatre, any reason why there is a higher than expected length of hospitalisation – all of the various parameters to do with patient safety are audited on a regular basis,” he says. Presently, a very important part of the commitee's work is monitoring the introduction of new technology into practise, such as the pioneering CyberKnife. “New technologies do bring their own challenges and we need to always be sure that the technology itself is safe but even more important than that, that the people using it are adequately trained and competent with the use of the technology,” Prof Traynor explains. “With new technologies coming on stream all the time, surgeons, who are in practise and who have done their training maybe 15 or 20 years ago, need to be constantly re-trained in the new technology. We need to be sure that structures are in place, and mechanisms are in place to ensure that people are fully trained and fully credentialed in the use of new technology.” Prof Traynor believes in a hands-on approach when it comes to developing a culture of patient safety. “I think bringing people into committee meetings is not the way to do this. For clinical governance to be effective it needs to be visible,” he says. “Visibility is probably the most important part of clinical governance, where you go out and you talk to people; talk to them about patient safety issues and get their feedback on things that are causing concern.” In the short time he has been with HMC, Prof Traynor notes that an ethos of prioritising patient safety is widespread throughout the Clinic. “I think that there is an institution-wide buy-in to safety and quality here,” he says. “In the time that I'm here I've been very impressed at how this culture pervades the entire organisation. Everybody wants to do the best possible for patient safety and for quality of the healthcare.” With this interactive, communicative approach, the Clinic is well-positioned to continue developing a culture of patient safety, and improving the quality of its healthcare.

Clinical Governance Interview

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INFECTION Prevention & Control

All clinical and nursing staff are educated on a continuous basis on infection prevention and control strategies, while regular audits on hand hygiene ensure a high level of compliance with national hand hygiene policies.”

THE PREVENTION AND CONTROL OF INFECTIONS IS OF PARAMOUNT IMPORTANCE WITHIN A HOSPITAL ENVIRONMENT. AT HMC, A TEAM OF INFECTION PREVENTION AND CONTROL NURSES AND DOCTORS ENSURE EXCEPTIONALLY HIGH STANDARDS ARE ACHIEVED AND SURPASSED WHEN IT COMES TO INFECTION CONTROL.

nfection prevention and control is a very important component of highquality healthcare and the control and prevention of infection is taken very seriously at HMC. A programme of activities to embrace national initiatives and to reduce infection rates has been developed and implemented at the Clinic and the activities which contribute to infection prevention and control are provided by many departments within HMC.

INFECTION PREVENTION TEAM The Infection Prevention and Control Committee in HMC oversees the infection prevention and control programme and is chaired by the Clinic's CEO. It is multidisciplinary and includes representation from all of the major departments in the Clinic. The day-to-day infection prevention and control service is provided by the infection prevention and control nurse, whose main role is providing

advice and support for hospital staff on the management of infection control problems. In addition three consultant microbiologists provide a 24/7 advisory service for clinical microbiology and infection prevention and control.

INFECTION PREVENTION AND CONTROL PROGRAMME The infection prevention and control programme delivered at HMC includes a wide range of activities. All clinical and nursing staff are educated on a continuous basis on infection prevention and control strategies, while regular audits on hand hygiene ensure a high level of compliance with national hand hygiene policies. Surveillance is undertaken on organisms associated with healthcare associated infections (for example, meticillin resistant staphylococcus aureus (MRSA) and clostridium difficile), surgical site infection rates and compliance with strategies

against intravenous line and urinary catheter infections. In relation to the importance placed on hand hygiene in HMC, Dr Lynda Fenelon says: “Antimicrobial resistance is the biggest challenge we face in this century. If this continues to rise at its current rate, we will very soon be left with no antimicrobials to treat serious infections. Appropriate use of antimicrobials and good hand hygiene are our main weapons in the war against resistant organisms.” HMC also participates in national surveillance schemes established by the HSE.

ANTIMICROBIAL STEWARDSHIP Guidelines for antibiotic prescribing are regularly reviewed and updated and advice on antimicrobial prescribing is available through the consultant microbiologists and the Pharmacy Department. The infection prevention and control team at HMC was also very pleased with the results of the recent JCI review, which found infection control services fully compliant with international standards.

Infection Prevention and Control

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MG HEALTHCARE WISHES THE HERMITAGE MEDICAL CLINIC EVERY SUCCESS WITH THE LAUNCH OF THEIR NEW CYBERKNIFE.

MOBI-C

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SMS: Stabilise with Motion Support

When degenerative disc disease occurs it leads to a loss of water content in the disc which increases the range of motion of the segment and can accelerate the degenerative changes. The SMS device is designed to restore the normal biomechanics by off-loading the pressure on the disc and providing mechanical support in both flexion and extension

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Newly launched SteriSpine PS, the worldâ&#x20AC;&#x2122;s first pedicle screw system with sterile single-use instrumentation.

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Developing EMERGENCY MEDICINE at the Hermitage Medical Clinic DR DAVID FOLEY, CONSULTANT IN EMERGENCY MEDICINE, EXPLAINS THE SIGNIFICANCE OF OPENING A TOP LEVEL EMERGENCY DEPARTMENT IN THE HERMITAGE MEDICAL CLINIC.

PICTURED: Dr. Dave Foley

It’s very encouraging that the hospital management has backed us in developing the service and my colleagues here and the inhouse consultants are very supportive in recognising the importance of maintaining and improving the

ince opening in May 2008, the Emergency Department (ED) at HMC has been a source of great pride for the Clinic as it elevates it to one of only three private hospitals in Dublin to offer such a service. Dr Foley saw the opportunity to provide a badly needed acute service to both people in Dublin and the surroinding areas.

and the Homecare teams through an initiative to try and treat people more in a community setting,” says Foley. Both parties have worked hard to get the service up and running: “We are proud to be the clinic that Vhi have chosen for the project as the preferable site for sending patients to see if they are suitable for Vhi Homecare,” adds Dr Foley.

The ED caters for both GP referred patients and walk-in patients. In relation to GP referrals, Dr Foley notes that a key focus for the department is to provide excellent lines of communication between the Clinic and the referring GPs. As Dr Foley explains: “We offer a direct-dial number for GPs to discuss referred cases, so when they call they can speak directly with the ED consultant who has treated the referred patient. I think the fact that the ED here is staffed entirely by consultants differentiates us from public hospitals. Here, you can be sure that you will receive treatment to a consultant standard.”

DEVELOPING PATIENT CARE

EASE OF ACCESS Situated just ten minutes away from Connolly Hospital Blanchardstown, and just off the M50, HMC ED has developed strong links with not just the local community, from the adjacent catchment area, but also further west into the country, with patients coming from counties such as Meath, Kildare and more distant counties like Sligo, Cavan and Monaghan, as well as Dublin. This is largely down to the reputation and proven expertise in service that HMC provides.

department. Dr Foley explains that the ED prides itself on being a specialist service led by emergency medicine consultants with a core group of five full-time ED nurses. However, it is not just in-house hospital services that the ED is looking to base its level of operations. HMC has established a link between the ED and the Vhi Homecare programme. “We’ve built a close relationship with Vhi

The current focus is the new expansion of a purpose-built ED, which will include eight bays for patients. Dr Foley welcomes the news of the expansion: “We’ve had a chance to participate in the new building’s design, which has been very beneficial and means we’ve been able to have a say in how the department will be laid out, making it a friendlier and more efficient environment.” He adds: “It’s very encouraging that the hospital management has backed us in developing the service and my colleagues here and the in-house consultants are very supportive in recognising the importance of maintaining and improving the department.” Once again it is the continuing strong relationship between the Clinic and the GPs in the area that sees a steady stream of patients entering the ED. On average there are 20 patients a day seen in the ED, most of whom are GP referred. Again, Dr Foley emphasises the importance of good channels of communication. “We try to give GPs updates on patients by sending a discharge letter the next day. The feedback about our service has been very good both from patients and GPs to date.” Like many hospitals across the country, HMC is always under pressure to have beds available for patients. Yet Dr Foley believes that despite this pressure, HMC’s ED has proven it provides the best care possible. According to Dr Foley, the staff of the ED will continue to “marry levels of expectation with expertise and hard work”.

Emergency Medicine

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CUTTING EDGE

TECHNOLOGY

THE NEWLY INSTALLED CYBERKNIFE IS OFFERING A PAINLESS, NON-INVASIVE TREATMENT SOLUTION FOR PEOPLE SUFFERING FROM TUMOURS AND OTHER MEDICAL CONDITIONS.

Cyberknife

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PICTURED: Mr. Sultan Khalil, Principle Physicist, Mr. Daniel Rawluk, Consultant Neurosurgeon, Mr. Mohammed Galal, Head of Physics Department and Dr. Jamsari Khalid, Consultant Radiation Oncologist

onsultant Danny Rawluk is well placed to comment on the CyberKnife radiosurgery system. Afterall, it was he who was at the heart of the Hermitage Medical Clinic's bid to adopt the state-of-the-art technology. He was also the one who treated the first patients in Ireland with the CyberKnife last November. CyberKnife is a specialised, robotic, radiosurgery system used for the treatment of (cancerous or non-cancerous) tumours as well as other medical conditions. Its painless, non-invasive form of treatment makes it an attractive option for patients. Here, Mr Rawluk outlines what was behind HMC investing in the specialised radiosurgery system and whether we are likely to see more come on stream in the near future.

COULD YOU PROVIDE SOME BACKGROUND INFORMATION ON HOW CYBERKNIFE RADIOSURGERY EQUIPMENT WORKS? A target is identified in the body with up to date radiological techniques using MRI and CT scans and then that is fed into the computer. The computer generates a treatment plan based upon constraints that we've identified. So for instance, we might say that a certain dose of radiation has to reach the target but we also identify and work out a way to get that dose to the area while sparing and minimising the radiation dose to surrounding tissues. Within those constraints, the physicist will help to support the computer to give it additional information to eventually arrive at a plan for treatment. That plan is then surveyed and reviewed by the treating doctors, which is usually a radiation oncologist and possibly a neurosurgeon for neuro cases. If they are happy then the patient will receive treatment.

WHEN WAS THE TECHNOLOGY FIRST DEVELOPED AND HOW WIDELY AVAILABLE IS THE EQUIPMENT? It was first developed by John Adler in the late '90s. It's available throughout the world

with the greatest number of CyberKnifes in America. I had experience of treating patients under CyberKnife in London for a few years. I often refer patients to Munich for treatment but it's also available in Holland, Germany, France, Italy, the Ukraine and Turkey, among other countries. I was trying to introduce it here four or five years ago and it's taken a long time. Ireland is a few years behind. The technology has been available, as I said, for a long time but the most up to date version has really only been available for about four years.

HOW MUCH WORK WAS BEHIND GETTING IT HERE?

confidence in using a CyberKnife compared to using other systems.

THE FIRST THREE PATIENTS IN IRELAND WERE TREATED WITH CYBERKNIFE RECENTLY. HOW DID IT GO? It was straightforward, it went very well. There's no recovery involved. Having this treatment does not involve any incision in the skin, does not involve any injection. Basically you lie on the couch â&#x20AC;&#x201C; for those three patients, each of their treatments took about 35 to 40 minutes. They lay on the couch, had the mask put over their heads and after about 40 minutes got up and went home.

An awful lot. The impetus for this came from my preferences. I deal with skull base cases and intracranial vascular cases. One of the treatments for such cases is radiosurgery and the programme in Beaumont [Hospital] basically collapsed about five or six years ago for various reasons. I looked at the options of what we could do to address this and, in the process of doing so, I looked at two machines called Gamma Knife and Novalis and I also looked at CyberKnife. I felt CyberKnife would be the best tool to answer all our needs.

WHAT IS THE SIGNIFICANCE FOR HMC GETTING CYBERKNIFE AND DO YOU SEE MORE BECOMING AVAILABLE HERE IN THE NEAR FUTURE?

An alternative system, Novalis, was introduced in St. Luke's and Beaumont hospitals. It's what you call a hybrid â&#x20AC;&#x201C; essentially it can do a lot of what the CyberKnife can do but not to the same degree of sophistication, in my opinion. Other doctors might disagree with me. But regardless of which machine you use, I think most people would agree that the overall results, which can be fairly comparable, are pretty much the same, whether you use a Novalis, a Gamma Knife, or a CyberKnife but each individual person will have their bias and their preference for using each machine.

Patients find it easy to get to HMC from pretty much everywhere in the country. The location is close to the motorway network. We have the largest number of neurosurgeons working in any private facility in the country and offer a comprehensive range of neurosurgical services. So the support is there from the point of view of our neurosurgical patients. There is an established radiation service in the HMC. So therefore, structures are there to support the CyberKnife and treatment delivery.

For instance, people say the Gamma Knife is more accurate, but that's been proven to be not quite the case. In my own personal view, having seen patients treated with the other forms of radiosurgery, I have greater

Yes, hopefully there will be more. There may be reasons to introduce more CyberKnives into Ireland. They're very expensive machinery and that's why you need to have a sufficient number of cases to justify the expense of the machine. The significance for HMC is that it is very well situated strategically to cover the whole country.

The thing that impressed me most about CyberKnife is that it's still evolving. There are other applications which are being developed, being explored and being validated by clinical trials and that means there is certainly much more to come from the CyberKnife than the Novalis, and certainly the Gamma Knife.

Cyberknife

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Dr Clare Faul CONSULTANT RADIATION ONCOLOGIST AT THE HMC DISCUSSES HOW THE CYBERKNIFE IS BEING USED TO REFINE TREATMENT AND BENEFIT PATIENTS. had been referred abroad, the treatment has been available at the HMC since last November, saving considerable expense and time, according to Dr Faul. Cyberknife treatment provides a pain-free non-surgical option for patients who have inoperable or surgically complex tumours or who are looking for an alternative to open surgery, which can bring with it greater risks and a longer recovery time.

PICTURED: Dr Clare Faul, Consultant Radiation Oncologist

he Cyberknife Centre was officially opened by Berndt Wowra, professor of neurosurgery at the European Cyberknife Centre in Munich, on March 1, 2014. It offers a groundbreaking robotic surgery system designed to non-invasively treat tumours throughout the body. Approximately 30 adults with a wide range of intracranial tumours have been treated with Cyberknife Stereotatic Radiosurgery (SRS) at the Hermitage Medical Clinic since November 2013. Acute tolerance has been excellent to date and early results very encouraging, according to Dr Clare Faul, consultant radiation oncologist at the centre. This is being broadened to include the treatment of patients with tumours of the lung, prostate, pancreas and spine, she said. Whereas in the past, patients

Cyberknife treatment provides a painfree non-surgical option for patients who have inoperable or surgically complex tumours or who are looking for an alternative to open surgery, which can bring with it greater risks and a longer recovery time.

Treatment starts with scans and planning. Individual treatment sessions usually last between 30 to 60 minutes, depending on the type of tumour being treated. Most patients are treated in a single session, according to Dr Faul. Where treatment is delivered in stages, this is typically done in a maximum of five sessions. “This treatment can offer hope to patients with tumours that are very difficult to access or that are medically inoperable,” said Dr Faul. The treatment has also proven to be very effective for benign conditions such as trigeminal neuralgia, reducing pain in up to 70 per cent of patients. Dr Faul said that while Cyberknife treatment is not suitable for all patients, it offers a viable alternative for tumours that are difficult to treat surgically. “For small targets and specific indicators, it offers highly targeted radiation,” she said. “The advantage of being a robotic machine is that it moves in numerous different planes around the patient, resulting in pinpoint accuracy of less than one millimeter. The patient is continually tracked during the delivery of the radiation, ensuring the accuracy of radiation delivery,” said Dr Faul. Interest in the system has been growing since the start of the year, according to Dr Faul. “There are other types of stereotatic machines available but the attraction of Cyberknife is that it is the only robotic system that continuously tracks during the treatment delivery, resulting in significant reduction in the radiation of normal tissue,” said Dr Faul. The major health insurance companies in Ireland have approved the treatment for the intracranial sites and other patients are covered on a case-by-case basis, with ongoing discussions taking place, according to Dr Faul.

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BUILDING THE BEST Neurosurgery Services

PICTURED: Prof Ciaran Bolger

With the new facilities schedule to be completed this year it looks like the HMC is on track to become a leading provider of Neurosurgery services in Ireland.

PROF CIARAN BOLGER DISCUSSES HOW THE HMC IS COMMITTED TO BUILDING TOP FLIGHT NEUROSURGERY SERVICES BY INVESTING IN THE BEST FACILITIES POSSIBLE AND DEVELOPING A TEAM OF EXPERT NEUROSURGEONS TO DELIVER A WIDER RANGE OF TREATMENTS TO PATIENTS IN A MORE TIMELY FASHION THAN IS POSSIBLE IN THE PUBLIC HOSPITAL SECTOR.

rofessor Ciaran Bolger is one of Ireland’s leading Neurosurgeons and he is currently treating patients at the HMC. Having trained in Dublin, Liverpool, Australia and America he spent a further 5 years as a consultant in Bristol before returning to Ireland in 2000. Now Professor of Clinical Neuroscience in the Royal College of Surgeons in Ireland, Prof Bolger sees a broad spectrum of neurological conditions at the HMC. As Prof Bolger explains: “I’m a neurosurgeon with a particular interest in spinal neurosurgery so I deal with spinal cord compression, nerve compression, spinal tumours that are pressing on the spinal cord and some brain surgery including brain tumours and vascular surgery.

ADVANCES IN SURGICAL TECHNIQUES The department has grown both in size and in the number of patients it sees, yearon-year. This development is helped by advances in neurosurgery, where surgeons can use considerably less invasive procedures than previously thus reducing down time for patients. “We provide minimally invasive decompression of the spine and minimally invasive stabilisation treatment for patients – such as putting in

instrumentation and screws to stabilise the spine, often using microsurgery. In terms of treatment and patient recovery the vast majority of my patients would only be in hospital for one night, as opposed to a week if we were using conventional techniques. In addition the recovery time is reduced to two weeks with most back in work after four weeks,” according to Prof Bolger. The success of this department has led to increased demand for services this, in turn is driving the extension of its services. “At the HMC we most frequently treat spinal conditions and some brain conditions but we plan to expand this by having a group of us working there to offer the full range of neurosurgery treatments which are currently only available in the public hospital sector thereby offering a much needed private alternative. We hope that by developing the service we can move closer to what is available internationally,” says Prof Bolger.

A HIGHLY SKILLED TEAM There have been many developments at the HMC that have helped the department move closer to this idea. The addition of the CyberKnife is the first step towards treating more complex

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brain conditions. As Prof Bolger expands: “Treatment for brain tumours, using the CyberKnife leads us to next step which is to provide minimally invasive operative intervention for brain tumours. This would be an extension of what we already do. From there we’re able to move onto more complex vascular treatments for different brain abnormalities. We plan to provide the full range of neurosurgical treatments.” Another driving force in this development is the frustration felt by consultants and patients at the limited resources and length of waiting lists for patients to access these services in the public sector. To develop the department to this level and provide a whole range of services in neurosurgery requires

the skills of a highly experienced team of neurosurgeons who can provide cross cover and pool their individual expertise. This is an area that the HMC has invested significantly in, attracting the most skilled neurosurgeons across a range of sub specialisations.

EXPANDING THE SERVICES These developments coupled with a firm commitment to develop new technology led neurosurgery theatre facilities sees the HMC poised to fulfill this ambition. “Computer guided surgery is being introduced, this provides neurosurgeons with sophisticated planning so that they can predetermine precisely what is going to happen during surgery.

“We will also have real time computer analysis in the theatre to guide what we are doing during surgery. “Advances in real time imaging will allow us to perform scans during surgery to see whether the entire tumour has been removed. This means we can continue operating if necessary rather than waiting than the next day for a scan and avoid having to bring the patient back for more surgery,” says Prof Bolger. With the new facilities completed since January 2015 it looks like the HMC is on track to become a leading provider of Neurosurgery services in Ireland.

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A FULLY COMPREHENSIVE SERVICE FOR

CORONARY HEART

DISEASE

SUMMARY

CARDIOVASCULAR DISEASE

Hermitage Cardiology offers a comprehensive range of services starting with risk assessment in the young and in adults and progressing to the investigation and management of all forms of heart disease, backed up by state of the art investigative and interventional facilities which are delivered by consultant cardiologists including: • Specialist Cardiology Consultations • Rapid Access Chest Pain Service • Diagnostic coronary angiography • Access to Cardiac Surgery if needed • Angioplasty & Stenting • Cardiac Diagnostic Services – Holter, 24 hour BP, exercise stress testing • Cardiac Imaging – Echocardiography including 3D, Trans-oesophageal echocardiography • Advanced Cardiac Imaging – Calcium score, Cardiac computed tomography angiography (CCTA) and Cardiac MRI (CMR) with/without stress perfusion • Advanced adjuncts to angioplasty & stenting: FFwR, IVUS and OCT • Cardiovascular risk assessment and management • Adult congenital heart disease • Cardiovascular risk in the young, including assessment of athletes, • Risk of sudden death and inherited disorders • Hyperlipidaemia investigation and management • Electrophysiology (EP) Study & Radiofrequency (RF) Ablation • Pacemaker, Implantable Cardioverter Defibrillator (ICD) & Biventricular ICD

Cardiovascular disease which includes coronary heart disease remains the largest cause of death in Ireland and the world, ahead of cancer and infections. In Ireland, 1 in 6 persons will die of coronary heart disease across all segments of society. Whose life hasn’t been touched, whether through one’s own personal experience or those of friends, family or colleagues?

RAPID ACCESS CHEST PAIN SERVICE While prevention of this disease is the ultimate aim, those who are acutely afflicted by its warning chest pain and/or more serious manifestations such as acute coronary syndromes can depend on the rapid and efficient services provided by the cardiologists at the Hermitage Medical Clinic. Since 2013, there has been an open-access Chest Pain Service that can allow a patient with stable chest pain to be seen, assessed and investigated with an exercise stress test followed by a review with decision by the on-call consultant cardiologist. Patients are often seen within the same day of the call, and never more than 72 hours. Acute chest pains with suspicion of acute coronary syndromes, quite rightly, are dealt with in the usual way by the Emergency Department. Those requiring invasive diagnostic and interventional cardiac procedures may be facilitated by the Cardiac Catheterisation Laboratory (Cath Lab). The Cath Lab is the fulcrum of the cardiology service here at

the Hermitage as with modern cardiology departments everywhere. The Hermitage Cath Lab has a highly skilled and experienced team of nurses, technicians and radiographers supporting the cardiologists in performing coronary angiograms, angioplasties, pacemakers and other procedures at every working day from 8 am to completion if required, and occasionally even outside working hours.

INTERVENTIONAL CARDIOLOGY Dr Tora Leong is the latest interventional cardiologist to join the team at the Hermitage since the beginning of 2013. We now have the ability to deal with the entire spectrum of coronary heart disease from chronic stable angina to unstable angina and acute coronary syndromes, from the chronic stable patient presenting through an outpatient referral, to the acutely ill patient presenting from the Emergency Department. Almost all coronary invasive procedures in the Hermitage cath lab are now performed through the radial artery in the wrist rather than through the femoral artery in the leg. This has revolutionised patient comfort as they can now sit up and walk immediately after a coronary angiogram and angioplasty as opposed to having to lie flat for between 2 to 4 hours as previously done in many other hospitals. They can return to daily activities such as walking, driving and other normal daily activities immediately as their disease

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PICTURED: (left-right) Dr. Tora Leong. Dr. Iftikhar Khan, Dr. John Clarke and Dr. Richard Sheahan

allows. More importantly, this transradial approach has almost completely eliminated the risks of serious vascular complications such as bleeding.

ADJUNCTIVE MODERN CARDIAC IMAGING The team at the Hermitage Medical Clinic utilises modern imaging modalities such as cardiac MRI with stress perfusion to help guide angioplasties in some circumstances. This is particularly important in the complex angioplasties of chronic total occlusions (CTOs) where it is important to first establish the presence of ischaemia and viability of the coronary artery territory that is to be intervened on. CTO interventions are considered the ‘final frontier’ of angioplasty that can naturally carry higher risk. It is the best technology and it is important to document the patient benefit that can be expected after the angioplasty. The use of invasive functional tests such as fractional flow reserve (FFR) is useful in dealing with moderate coronary lesions. In the interests of reducing the number of unnecessary angioplasties, the existence of a functional test such as cardiac MRI or FFR is very useful in the armamentarium of the modern interventional cardiologist. This is complemented with invasive imaging techniques such as intravascular ultrasound (IVUS).

OCT - THE CUTTING EDGE OF INTRA-VASCULAR IMAGING Optical coherence tomography (OCT) is an advanced optical fibre-based system that takes images from within a patient’s coronary arteries. It is an internal, instantaneous image – ‘looking outwards from within’. In contrast to an angiogram, which is a silhouette of the artery created by injecting X-ray dye which although is still the “bread and butter” technique.

The strengths of the Hermitage are that all the technology is here, and the infrastructure and technology is available to provide the best possible care, to what matters most, the patient. Our Consultant Cardiologist colleagues from Charlemont who include Prof Ian Graham, Dr David Mulcahy, Dr Vincent Maher and Dr Deirdre Ward have recently commenced practice in the Hermitage.

OCT is the latest technology in coronary artery investigation and provides an unsurpassed clear and unique view into the interior of coronary arteries to improve the technical result of angioplasty and stenting. It also gives us unique unsurpassed definition and detail to understand coronary artery disease better. OCT is here to stay, and is now part of the armamentarium of adjunctive tools to guide and optimise complex angioplasty and stenting. It is a technique that many cath labs in the country, the UK and Europe still lack. The OCT programme is spear-headed by Dr Tora Leong at the Hermitage.

CONCLUSIONS The Hermitage is geared towards providing the best high-tech medical care, putting it ahead of many in the private sector. What we have to target in HMC is the availability of high-tech state-of-the-art equipment with appropriate specialists and the infrastructure team to provide planned treatments and investigations.

PICTURED: Dr Tora Leong and Dr Iftikhar Kahn, Consultant Cardiologists at the HMC

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ADVANCED CARDIAC IMAGING Modern Imaging Modalities PROF BRENDAN MCADAM AND DR TORA LEONG PROVIDE AN OVERVIEW OF THE QUALITY OF IMAGING MODALITIES AVAILABLE AT THE HERMITAGE AND DISCUSS THE DIAGNOSTIC AND TREATMENT BENEFITS THEY PROVIDE.

he modern approach to the diagnosis of many cardiovascular diseases involves the utilisation of multi-modality non-invasive imaging. The Hermitage Medical Clinic offers a comprehensive range of advanced non-invasive cardiac imaging in addition to the traditional echocardiogram offered by the Cardiology Department. Even so, the HMC has stayed at the forefront of echocardiography with the use of live 3D and contrast-enhanced transthoracic echocardiograms.

NON INVASIVE TECHNOLOGY The Cardiology Department at the HMC offers a range of advanced non-invasive modern cardiac imaging modalities, ranging from CT coronary calcium scoring, CT coronary angiography to cardiac MRI with and without stress perfusion. CT Coronary calcium score can act as a safe and noninvasive means of detecting early coronary atherosclerosis. It utilises CT technology, with low radiation exposure, no use of drugs or IV contrast to detect the presence of calcium in the coronary arteries. Calcium acts as a surrogate for the presence of atherosclerosis. One of the most common applications is for the clinician to further refine cardiovascular risk assessment and may shift the treatment paradigm from preventive lifestyle measures to secondary prevention and the use of drug therapy for risk factors. CT coronary angiography allows excellent imaging of the coronary arteries as well as cardiac structures down to a resolution of less than a millimetre in size in selected patients. Cardiac MRI or its recommended term, cardiovascular magnetic resonance (CMR) has emerged as a specialised and powerful diagnostic test for cardiac diseases of the myocardium once the technical pitfalls of imaging a moving organ has been overcome.

CMR is unique in its ability to image in multiple planes with excellent temporal and spatial resolution and has several advantages over other cardiac imaging techniques without the use of iodinated contrast agents and without the ionising radiation. It offers superb image clarity and tissue characterisation using different MRI techniques and sequences. In addition, the use of gadolinium contrast, utilising its properties of difference in retention by diseased vs. normal myocardial tissue, allows unsurpassed tissue characterisation which help in the diagnosis and characterisation of cardiac tumours, myocardial infarction, and myopathic processes such as genetic cardiomyopathies, inflammatory and infiltrative conditions such as myocarditis, sarcoidosis and amyloidosis.

ADVANCES IN CMR Recent technological advances have led to faster imaging times and CMR can now provide accurate reproducible assessments of cardiac function and provide accurate information on RV regional and global function without making geometric assumptions. This has revolutionised the assessment of the RV as well as the diagnoses of RV cardiomyopathies which are difficult in traditional echocardiography. In addition, CMR is extremely helpful in evaluating cardiac texture in patients with inherited or previously undefined cardiomyopathies to aid in phenotypic characterisation and risk stratification. It is also invaluable in the assessment of patients with complex congenital heart disease. Valvular structures can also be readily evaluated by flow techniques. One of the very helpful applications of CMR is the assessment and guiding treatment in patients with ischaemic heart disease. Patients who present with chest pain

PICTURED: Cardiac Cath Lab Staff: Shyby Chiramattal, Faith Valena, Vincent Naughton, Elena Dosouto, Ellie Mulligan, Maria Sia, Michelle Cummins & Aileen Billington symptoms, can utilise the higher diagnostic accuracy of CMR with stress perfusion as compared to the traditional exercise stress test to detect underlying significant cardiac ischaemia. Similarly, this also applies to patients with intermediate or moderate coronary artery lesions after an angiogram in order to help decide whether revascularisation with either angioplasty or even bypass surgery may be helpful. It can also help decide in a multivessel disease situation which of the lesions are the most functionally significant. In many cases, CMR has changed the management of what and where to stent, sometimes with surprising results. This is the modern multi-modality approach to coronary artery disease that the Hermitage is on the forefront of. In short, CMR has definitely come of age and has evolved into a widely accepted clinical modality which can provide comprehensive non-invasive useful information for the diagnosis of complex cardiac problems.

Cardiac MRI

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SCREENING FOR

HEART SAFETY NEW TO HMC CONSULTANT CARDIOLOGIST, DR DEIRDRE WARD, DISCUSSES THE RISK OF SUDDEN CARDIAC DEATH IN THE YOUNG AND THE BENEFITS OF SCREENING.

PICTURED: Dr Deirdre Ward

The thing with inherited heart disease is that often you don’t know which one you’re looking for even though you know there’s something in the family

r Deirdre Ward has recently joined HMC to facilitate screening for cardiac risk in younger persons. Dr Ward graduated from Trinity College Dublin and spent several years at the Heart Hospital, London, under the tutelage of Prof William McKenna before returning to Ireland to set up the CRY Clinic in Tallaght Hospital. The clinic was set up to support CRYP (Cardiovascular Risk in Younger Persons) and to provide screening for at-risk persons. “The thing with inherited heart disease is that often you don’t know which one you’re looking for even though you know there’s something in the family,” explains Dr Ward. “A lot of people will need several investigations like resting ECG, sometimes an echo and sometimes an exercise test and heart rhythm monitoring. In Tallaght we set up the unit to do all the investigations on the same day and people travel there from all over the country. The Hermitage has agreed to set up facilities here so that we can actually do all the tests we might need.” The group most at risk is those with a family history: If someone in a family has an inherited heart condition then there is a one-in-two chance that immediate relatives will have it. In other circumstances persons with unusual symptoms will also present for screening, and if someone has a concern Dr Ward recommends getting it checked out. Screening can prevent sudden death and other complications, but diagnosis can be difficult: “Some of these conditions can be very difficult to detect, particularly in

the early stages. You need someone with considerable experience to identify them; between myself and the rest of the team here there is significant experience to make a diagnosis confidently. “You also need a centre where there is sufficient expertise to not either over- or under-diagnose the condition.” Dr Ward says the equipment available and the expertise of the staff at HMC is a huge benefit: “We have expertise in imaging particularly with very high standard of echo, we can provide a same-day service and instant reporting. We have very rapid access to cardiac MRI and very high quality reporting from Dr Leong and Dr McAdam. We can implant monitoring devices if we need to and treatment devices like pacemakers and defibrillators can be implanted on site as well. We can basically do everything a patient needs on site.” Dr Ward believes that screening is the best solution to sudden cardiac death in the young. Screening at the CRY Clinic has been life-saving. Conditions have been identified in a number of people and numerous lives saved by either implementing lifestyle changes for some patients or performing surgery to implant mini defibrillators in patients presenting with more serious conditions. Dr Ward is happy to take any referrals for assessment and stresses that much of the initial investigation can be done by telephone to ensure patients only have one visit, so it should be an efficient and inexpensive process.

Cardiology

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Orthopaedics

Joined up

Thinking

PICTURED: Mr Fergal McGoldrick, Consultant Orthopeadic Surgeon

The GP referral is important because when you have complex medical problems the GP is an invaluable source of critical information which can provide important context, where as consultants are very focused on a specialised area.

MR FERGAL MCGOLDRICK, CONSULTANT ORTHOPAEDIC SURGEON, DISCUSSES THE SCOPE AND DEVELOPMENT OF THE ORTHOPAEDICS DEPARTMENT AT THE HERMITAGE AND ITS PLANS TO BROADEN ITS SERVICES IN LINE WITH INCREASED DEMAND.

he Orthopaedics Department is one of the largest serving the HMC in terms of surgery and it continues to grow steadily every year. According to Mr McGoldrick: “We began joint replacement surgery in August 2007 soon after the hospital opened and since then, in terms of numeracy, our joint replacement numbers have steadily increased. We now have a busy team of Orthopaedic Surgeons operating within the department.

interests in spine problems, Mr Imran Sharif, Mr O’Connor and Mr Stefan Byrne have additional interest in trauma management; Mr John Lunn has special interest in shoulder surgery while Mr David Borton has a special interest in foot and ankle surgery. Ms. Olivia Flannery specialities include shoulder and hand & wrist surgery; Mr Paul Murphy specialities include trauma and orthopaedic surgery and major joint replacement surgery.

KEY TREATMENT AREAS

This sizeable department strives to maintain the highest standards, following best practice to match the outcomes as obtained, for example, by the English and Australian National Joint Registries. As part of this, the HMC participated in an audit with UCC to evaluate hip replacement outcomes last year. Best practice is central to the HMC ethos, this is underscored by the fact that the hospital has attained and continues to maintain JCI accreditation – the most rigorous evaluation of the quality of clinical care and patient services delivered by a hospital.

The main services provided are elective, large joint arthoplasty for hip, knee, shoulder and ankle. Arthroscopic joint surgery, is also undertaken for early degenerative changes. In addition, the Orthopaedics Department surgeons regularly treat sports related injuries such as cruciate, shoulder and ankle ligament trauma. Each of the respective Orthopaedic consultants have their own special area of interest in addition to their general activity. As a consequence the HMC have Orthopaedic Consultants covering every area of the speciality. Mr McGoldrick specialises in large joint, including hip and knee replacement/sports injuries with a subspeciality interest in hand; Mr David Cogley has a special interest in minimal invasive hip replacement; Mr Joe Sparkes and Mr Philip O’Connor have special

SETTING STANDARDS

St Luke’s ward is primarily a dedicated Orthopaedic and Neurosurgery ward. Consultants and nursing staff demand the highest standards in terms of hygiene, cleanliness and infection control. The HMC

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routinely, since the hospital opened, swab all incoming patients for MRSA and hence do not have a problem with MRSA hospitalbased infection. If an emergency patient is identified as MRSA positive, they will automatically be isolated upon admission. There is a constant focus on hand hygiene awareness with high-profile signage etc bringing to the fore in the minds of patients, staff and visitors alike the importance of maintaining a high standard of hygiene and avoidance of contamination/infections.

GROWING AND DEVELOPING Several factors are driving the growth in Orthopaedic work at the HMC according to Mr McGoldrick: “The HMC has grown exponentially as patient referral patterns have moved from other hospitals. Part of this has been the location of the HMC. It’s close, easily accessible and its proximity to the M50 makes it readily driveable for patients coming from Dublin and the wider Leinster area. There’s ample parking and patients arrive feeling less stressed, which makes their appointment with their doctor more productive.”

doctors should make them feel at ease, as it can be quite intimidating otherwise for a patient entering hospital. It’s important that the patient’s experience is a pleasant one and they are confident about the proposed treatment. This is particularly important for older patients who may be very apprehensive about coming into hospital. “Patients repeatedly comment that the Pre-Assessment clinic experience here is excellent. They are shown in detail what to expect and given all of the information that they require in a sensitive caring way. Communication is such an important part of what we do as it helps patients feel at ease and more confident about what they are about to undergo.” Ultimately, the HMC is a practical hospital, which has been beautifully designed, where patients feel comfortable being treated.

COMPREHENSIVE CARE

Extending the hospital services is taken to as a carefully managed process to ensure growth is balanced with the quality of care expected by patients. As Mr McGoldrick explains: “The Emergency department brings in a lot of “walking wounded” to the hospital. HMC profile as a consequence has risen positively and progressively in the greater Dublin area due to its efficiency and ease of access. Notwithstanding this, HMC is focused on avoiding extreme pressure on capacity and manages to retain efficient patient throughput without unnecessary admission delay.

A culture of good communication plays a vital role in making patients feel at ease during their treatment. Procedures are explained to them in clear, simple terms and Consultants are happy to answer any queries and discuss options. Resources are provided to the patient to enable them to access further information if necessary. In Mr McGoldrick’s experience the GP plays a central role in providing comprehensive care: “The GP referral is important because when you have complex medical problems, the family doctor is an invaluable source of information which can provide context, whereas consultants are very focused on a specialised area. The hospital is readily accessible from a GP’s perspective and I think that is so important as it goes back to good communication ”

PATIENT EXPERIENCE

SAME DAY ADMISSIONS

The patient experience has from the time they arrive at the HMC until the time they leave sets the HMC apart. Services and medical care are patient focused .The HMC provides a clean, modern setting for treatment. Mr McGoldrick explains how the patient is kept at the centre of the process: “I, feel like my colleagues, that every patient who comes through the door to reception should have the best experience possible with minimal distress. They should be treated with courtesy and provided with appropriate information so that they are clear in their mind and comfortable with their decision-making process. Every person they meet whether it’s reception/ admissions staff, care assistants, nurses or

One of the modern developments in patient care is same day admissions for large procedures, where patients arrive on the morning of surgery having been through a carefully planned pre-assessment. This, coupled with generally shorter hospital stays of 3-4 days for routine joint replacements, means that patients can be home, recuperating much sooner. This is very much in keeping with evolving best practice according to Mr McGoldrick: “Length of stay guidelines have changed so alongside same day joint replacement admission, we have earlier discharge. Enhanced outpatient domiciliary facilities and close follow up means that our service is very much community-based.

SURGICAL CHANGES While joint replacement, by definition, is a major surgical procedure, the trauma of invasive surgery has been refined over time as techniques such as anterior hip incisions are appropriate for some hip replacements. This has a positive impact on the early patient recovery time. Likewise, following international trends, there is a progressive increase in knee implant surgery, due it being a high load bearing joint and we have an aging population living much longer. Our National average increasing BMI is a negative contributory factor. Hip replacements numbers are more static by comparison. This is not unique to Ireland as the statistics are borne out by international figures. Alongside, this the Orthopaedic department is witnessing a growing demand for (uni-compartmental) knee replacements in younger patients. This reflects the change in lifestyles over the last 30 years.

ADVANCES IN POSTOPERATIVE REGIONAL PAIN MANAGEMENT According to Mr McGoldrick, one of the many positive changes to benefit operative patients is the introduction of regional nerve blocks as a form of anaesthesia and pain management. It has become routine now to provide Femoral regional nerve block anaesthesia for hip and Saphenous nerve block for knee joint replacements. This is in addition to the spinal anaesthesia undertaken at the same time, ensuring excellent post-operative pain management. It lasts much longer than traditional spinal anaesthetic, frequently ensuring post-operative first night sleep. As result, it provides a pleasant post-operative experience. Regional block anaesthesia is increasingly popular in shoulder surgery, particularly with elderly compromised patients. The big advantage is that patients have tremendous pain management post operatively and experience nowhere near the level of pain that they anticipate. This ensures more rapid recovery with far less patient distress, according to Mr McGoldrick.

CONCLUSION In summary, Mr McGoldrick feels that the patient care pathway is now much more clearly defined. HMC is patient focused centred on ensuring patients respect, satisfaction, sensitivity and attention to their needs while simultaneously offering, in safety, the highest modern standards of medical care that are available in Ireland today, concludes Mr McGoldrick.

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Orthopaedics

The Backbone of

Surgery MR JOE SPARKES CONSULTANT ORTHOPAEDIC SURGEON AT HMC DISCUSSES DEVELOPMENTS IN ORTHOPAEDIC TREATMENTS AT THE HMC.

MC is dedicated to the consistent advancement and improvement of its orthopaedic practices. The Clinic offers a comprehensive diagnostic imaging department for MRI, CT and Digital X-Ray, has two state-of-the-art orthopaedic operating theatres and also offers an interventional radiology service for orthopaedic patients. Mr Joe Sparkes, Consultant Orthopaedic Surgeon and specialist Spinal Surgeon at the Clinic says: “HMC has state-ofthe-art imaging techniques, one of the cornerstones of good diagnosis, management and treatment planning. In terms of CT scanning, MRI scanning and X-Rays we have the best equipment. The radiology department provides very rapid responses in terms of reporting and investigating, so imaging is good and the turn around times are very quick. “We have access to an entire range of minimal and less invasive spinal surgery equipment. If it’s not stored in the hospital then it’s brought in on a case required basis. “The hospital is very open to new techniques and supports surgeons in advancing new techniques, becoming experienced in them and offering them to patients as an alternative form of surgery,” he says.

CHALLENGES Mr Sparkes believes that Government and the Health Service need to recognise the role played by private healthcare. “Private hospitals are taking an increasing burden in terms of actually looking after the population. If the patient population treated by private hospitals landed in the public system it wouldn’t be able to cope,” 32

The hospital is very open to new techniques and supports surgeons in advancing new techniques, becoming experienced in them and offering them to patients as an alternative form of surgery. he says. “I think there has to be an acknowledgement by the Government and HSE that private hospitals actually provide a very significant outlet for patients who need treatment. “In terms of health insurance there are arrangements in public hospitals for surgeons who work there, who may also work part time in private practice, that Government or the Health Service contribute to the overall cost of insurance based on the work they do. There may come a time when the Government has to consider that if it wants to have private hospitals in terms of elective orthopaedic surgery, then it may have to assist to keep surgeons in practice.” Despite these issues, Mr Sparkes says the multidisciplinary approach to care at HMC is a cooperative and supportive environment to work in. “We hold a monthly multi-disciplinary meeting which allows for peer-review of cases and discussion of difficult or complex cases. “On an informal basis I know night or day I can pick up the phone and ring one of my colleagues for advice. The Hermitage has a very collegial working atmosphere and people are very happy to assist.”

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2246

Synthes Medical Ireland Ltd. Unit 2 Block 10 Blanchardstown Corporate Park Dublin 15, Ireland

SPINE SYSTEMS BACKED BY EXPERIENCE

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Less Pain, More Gain

MR DAVID COGLEY, ORTHOPAEDIC CONSULTANT AT HMC, EXPLAINS HOW MINIMALLY INVASIVE JOINT REPLACEMENT PROCEDURES HAVE REVOLUTIONISED MODERN ORTHOPAEDICS AND HOW NEW TECHNIQUES ARE IMPROVING PATIENTS’ RECOVERY.

ip and joint replacements have been evolving for decades, and HMC is offering the most advanced treatments available in Ireland today. Mr David Cogley is a leader in the field, and has imported innovative techniques from Belgium – without having to cut into muscle, patient discomfort is reduced, as is recovery time. The field has come a long way: the early 1960s saw the first widely-available developments. Prof. Sir John Charnley (1911–1982) was the first person to popularise hip replacement throughout the world with his design of a low-friction arthroplasty. Charnley’s technique for his hip replacement involved removing the trochanter (the piece of bone at the top of the femur) and reflecting the muscles with it. Although the procedure worked and still works extremely well, it involves significantly

more blood loss because both the bone and muscles were cut and the patients took longer to recover. The next advancement in joint replacement surgery saw different approaches being used that did not cut the bone and resulted in shrinking incisions. “Now there has been an evolution towards less invasive surgery throughout all branches of surgery and also in the field of orthopaedics,” explains Mr Cogley. “When it comes to trauma, instead of opening the fracture, we are remotely reducing the fracture and putting metalwork from outside the fracture zone across the affected area to stabilise it. With a fractured shaft of femur, surgeons can make a three centimetre incision to introduce the nail and some small stab incisions to introduce the locking screws.” This has been a significant improvement compared to the old days when surgeons

had to make a big incision to expose the whole femur. Such nailing techniques were transferred to more elective surgery and Kim Berger in the US designed a way of doing hip replacements through two small incisions, one directly transferred from the technique of femoral nailing and the second one used to remove the head of the femur and replace the socket. Michael Noggler in Innsbruck designed a way of performing this surgery through one incision lifting the femur up into the

“Now there has been an evolution towards less invasive surgery throughout all branches of surgery and also in the field of orthopaedics.”

Joint Replacement

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wound to enable placement of the femoral component and using the same approach as Kim Berger to replace the acetabular component. “This, although it is technically more demanding, allows us to do the whole hip replacement through an incision about eight to ten centimetres, whereas Charnley’s standard incision was almost a foot long, but more importantly we are not cutting or damaging the structures underneath,” says Mr Cogley. “Therefore, although we are performing exactly the same hip replacement, it can be done in a way which does not violate the patient’s muscles and tendons around the hip joint and therefore is not as painful and patients seem to recover faster. The incision used is actually a modification of an old incision – the Smith Peterson incision, but we are only using part of that approach. It is useful because if problems are encountered, the incision is extensile, but with the vast majority of patients the surgery can be completed with a ten centimetre incision. Importantly because we are not damaging the patient’s muscle or tendon where most of the pain receptors seem to be, the patients have less pain afterwards and they are able to get up and walk more normally and spend a shorter period of time on crutches. Some of my patients are coming back four weeks postoperatively walking without using crutches and no limp and are then able to go back driving, which is a massive improvement.”

TECHNIQUES FROM ABROAD Mr Cogley travelled to Aalst in Belgium with Erik De Witte to learn the latest surgical techniques and began a close working relationship. “I was very impressed with his technique and after seeing him perform the surgery, attended a course that he ran in Vienna on the topic. For the first three cases I performed here at HMC in June 2010, Dr De Witte came over to assist me. For the following six months I was selective in terms of patients suitable for minimally invasive surgery and for the last nine months I have been performing this approach on all patients and I have received excellent results on patient feedback.”

WORLD-CLASS FACILITIES According to Mr Cogley, Erik De Witte was highly complimentary about the worldclass HMC and its facilities. In fact, he is coming back to run seminars and lectures instructing other surgeons in this technique. Importantly techniques such as this are not just something established surgeons decide to do. One has to be trained and have the mentoring of an expert.

“Aside from the superb operating theatre facilities, staff in the operating theatres have a laudable ability to pick up and run with new techniques and ideas. In addition, physiotherapy and ward facilities are fantastic and we are working towards an integrated programme.” Minimally invasive surgery is just one part of the jigsaw. “You have to have everything else to go with it, so you have the ward, post-operative management, physiotherapy and occupational therapy all very much on board in making this a seamless process for the patient. We are also commencing a rapid rehabilitation protocol where patients will come in the week before surgery and be educated about what is going to happen to them and what joint replacement is about and how things are going to be done,” adds Mr Cogley.

HERE TO STAY Mr Cogley believes that the future of hip replacement surgery and the new generation of surgeons will take to it, as the advantages to the patient are manifold. “Because we’re going in between planes of muscles, it’s quite a safe approach. We’re not denervating any of the muscles around the hip joint,” he says. Anatomically the hip joint is in the front, this is an anterior approach, so once the surgeon goes between the muscles the hip joint is immediately adjacent to them, which makes the surgery easier.

“From the patient’s perspective, they’re very grateful as it certainly reduces pain. The patients won’t notice that the procedure is technically more difficult but the physiotherapist will tell you from day one that the patient can walk more normally. Literally from day one, the patient is out of bed and can walk with crutches. That applies to the vast majority of patients,” he adds. Mr Cogley works with a superb, integrated team from Jessica Lower, who runs the Pre-Assessment Clinic, to Camilla Reilly, Physiotherapy Manager and an excellent group of orthopaedic nurses on the ward who are clued in to joint replacement surgery and know how to maximise patient satisfaction. Over the next year or so, progress will be made on an integrated joint school and rapid rehabilitation programme where patients will be educated and are aware of what’s going to happen to them prior to surgery. “Often patients will come in, are aware they’re getting a hip replacement, but they feel that five years ago people were in hospital for two weeks and wonder why they’re not in hospital for longer,” he says. “Previously, people often didn’t get out of bed for a few days after – we’re now getting people out of bed on the day of surgery, so if patients know about this before they come in, expectations are set and met, then everything is much smoother and patients are a lot happier.” It’s not just the surgery, it’s the whole package, and Mr Cogley and his team at HMC lead the field.

Joint Replacement

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Excelling in Paediatric Care

Neurology, Respiratory and General Medicine HMC OFFERS A COMPREHENSIVE RANGE OF MEDICAL CARE FOR PAEDIATRIC PATIENTS, WITH LEADING CONSULTANTS PROVIDING SPECIALISED CLINICAL CARE IN NEUROLOGY, ORTHOPAEDICS, RESPIRATORY AND GENERAL PAEDIATRIC MEDICINE IN A TIMELY MANNER AND WITH ACCESS TO STATE-OF-THE-ART DIAGNOSTIC AND TREATMENT FACILITIES.

I deal with children who have neurological problems affecting the brain and spinal cord, and the commonest issue for me would probably be children with epilepsy. - Mr David Webb

he Hermitage Clinic provides specialist care and treatment for paediatric patients across a broad spectrum of medical conditions. One such specialist is Dr David Webb, Paediatric Neurologist, who has been practicing at HMC for several years. Dr Webb is highly experienced neurologist who trained in Ireland, England and Canada before gaining extensive experience in major Irish hospitals.

DR DAVID WEBB As a child neurologist, Dr Webb treats all neurological issues in childhood and has a particular interest in childhood epilepsy and neurocutaneous syndromes, as he explains: “I deal with children who have neurological problems affecting the brain and spinal cord, and the commonest issue for me would probably be children with epilepsy. There is a spectrum of neurological conditions some that are very rare and others that are more familiar like migraine. But essentially anything that affects the young child’s brain or nervous system.” This work is supported by the Radiology Department, which has state of the art facilities with the most up to date MRI, CT and PET scanning equipment. This provides a comprehensive neuroradiology service with access to the images throughout the hospital. Assessment may include nerve conduction studies, which are provided by Dr Ronan Walsh.

NEUROLOGICAL SPECTRUM Dr Webb receives paediatric referrals for children up to the age of 16, “I suppose the commonest thing that would be referred to me here in the HMC are children with headache and the vast majority of those

children don’t require continuous follow-up. They need an assessment and reassurance. Some have migraine and need specific advice on that, and some have tension headache, and a small minority have a serious problem but this is actually quite rare. “Another important group are children that have episodes that may look like epileptic seizures but are not. Not every child that has an event with loss of consciousness and jerking is having an epileptic seizure and this is an important part of my work in trying to tease those that are epileptic events and those that have other causes. In terms of my workload of continuing care epilepsy would account for the vast majority of this. “Some children are sent for assessment because they have habitual movements or developmental delay which might have a neurological basis. We also see children who have potentially serious neurological problems – such as children presenting with unsteadiness that might be due to multiple sclerosis or a weakness down one side that might be due to stroke which can occasionally occur in children,” says Dr Webb. Consultants at the HMC have access to the most advanced neuroradiological diagnostic services that ensure children attending the HMC will have their complaints investigated thoroughly and promptly.

PAEDIATRIC RESPIRATORY AND ALLERGIC DISORDERS Respiratory disorders in children represent one of the main areas requiring medical intervention and treatment. It spans the investigation into relatively common chest infections through to asthma, chronic obstructive lung disease, bronchitis,

Paediatrics

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allergy related respiratory problems and the diagnosis of more complex airway diseases including cystic fibrosis. The HMC has an excellent team of paediatric specialists working in this area.

Although asthma forms a big category it can encompass

MR. STEFAN BYRNE

months such as allergic rhinitis or hay fever.

For Mr Stefan Byrne, orthopaedic surgery and predominately paediatric orthopaedics has always being his background. As Mr. Byrne points out, the orthopaedic department at HMC, particularly the paediatric orthopaedics section, offers a wide range of services all under one roof. “ We deal with a lot of injuries, predominantly fractures and soft tissue lacerations , such as knee problems in children. The second area Mr Byrne deals with in relation to paediatric orthopaedics concerns children who have parental or grandparental concerns about “normal variants”. The third and final group Mr. Byrne deals with at HMC is “ the rest of children’s orthopaedics” which he says “ is a very broad area and includes children with hip, lower limb problems, foot problems and things like congenital dislocation of the hips, club feet and other such conditions”.

Once the consultant has seen the child and any diagnostic

DR BASIL ELNAZIR

“In addition, for children over the age of 5 we may perform a bronchial challenge test to prove or disprove the diagnosis of asthma. Diagnostic imaging such as chest x-rays and CT scans are performed where necessary. In certain cases we may do bronchoscopy which is basically a camera test looking down the airways,” says Dr Elnazir.

Specialising in respiratory and allergic disorders in children, Dr Basil Elnazir has been with the HMC since 2009, having trained in Birmingham, Dublin and Wales. Dr Elnazir is a member of several societies including the British Paediatric Respiratory Society, the European Respiratory Society, and the American Thoracic Society. He is the Chairman of the Medical Advisory Committee of the Asthma Society of Ireland.

INITIAL INVESTIGATIONS Referrals to Dr Elnazir range in age from infants to 16 years of age, most are referred by GPs for recurrent respiratory tract infections, recurrent cough and wheezes.

different phenotypes. Some children have problems during the winter months because of viral exacerbation whereas others will have their problems during the spring or summer

tests have been carried out, the results are normally available within 48 hours… Many can be discharged to his or her GP with a follow up treatment plan. - Dr Basil Elnazir

These conditions may relate to poorly controlled asthma, airborne allergens, food allergies or sometimes they are exercise related. “The diagnoastics that we do would be pulmonary function tests, skin prick test for allergies, exercise and bronchial provocation tests. Outside of asthma, the most common conditions treated in paediatric respiratory medicine include recurrent bronchitis and chest infections, chronic cough, food allergy and primary ciliary dyskinesia.

REFINED DIAGNOSIS Many factors can exacerbate the instances of asthma in children. As Dr Elnazir explains: “Although asthma forms a big category it can encompass different phenotypes. Some children have problems during the winter months because of viral exacerbation whereas others have their

problems during the spring or summer months with allergic rhinitis or hay fever. So these are usually diagnosed by skin prick testing and once we establish the diagnosis we individualise the course of treatment depending on the trigger.”

APPOINTMENT AND FOLLOW UP Mr Elnazir recommends that patients come as well prepared as possible to their appointment and bring with them any medication or devices they are currently using along with their asthma management plan and a history of their condition including seasonal patterns and details of any medications that have been prescribed. Once the consultant has seen the child and any diagnostic tests have been carried out, the results are normally available within 48 hours. The exception to this would be immunology tests where results may take a few days. When a condition is diagnosed, some, such as asthma, require ongoing clinical management. Many can be discharged to his or her GP with a follow up treatment plan.

Paediatrics

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Respiratory medicine and allergy are quite closely linked so I have a clinical interest in food allergy and I diagnose and treat patients who have food allergies that are connected to their respiratory condition. - Dr Peter Greally

DR PETER GREALLY Dr Peter Greally is a consultant in paediatric respiratory medicine, treating common conditions such as asthma, nasal allergies, recurring chest infections and sleep disorders in children. He sees children from the point of evaluation and diagnosis, right through the treatment and ongoing management of their condition. Many of his patients are with him until they turn 18 and transfer to adult services.

start in primary school but it depends on the rate at which the allergy is resolved.”

SLEEP DISORDERS AND OBESITY

He has a special interest in the link between allergy and respiratory problems, as he explains: “Respiratory medicine and allergy are quite closely linked so I have a clinical interest in food allergy that I diagnose and treat patients who have food allergies that are connected to their respiratory condition.

Another part of Dr Greally’s caseload is the treatment of sleep disorders, which is a growing issue and is increasingly linked with childhood obesity. As Dr Greally explains: “Sleep disorders are an emerging problem, particularly developed countries and it parallels the increase we are seeing in children with obesity. The two go hand in hand and I think certainly any kind of management plan that addresses a sleep apnea problem certainly would need to address the weight management issue. Some children may not be obese they may just have simply large adenoids and tonsils in which case the treatment for that is ENT referral.”

“The common ones start in infancy, usually egg and milk. Then as they get older peanuts and tree nuts such as hazelnuts and brazil nuts, kiwi fruit and shellfish can cause allergic reactions. Although you can be allergic to almost any food these would account for about 90 percent of the allergy patients that I see. We investigate patients for these and track them at certain intervals to see whether the allergy is improving. Often, allergies that have developed in infancy they can resolve. So, we may be able to perform a challenge test, which hopefully the child will pass and go on to a normal diet, ideally before the children

The obesity trend has worrying implications for health in later life with up to 30 per cent of pre adolescent children in Ireland shown to be either overweight or obese, many of these are already showing signs of high blood pressure and high cholesterol and the likelihood is that they will go on to develop cardiovascular disease as adults. “The lifestyle that people have adopted as we have become more affluent is promoting this unhealthy generation. I think that some people believe that the next generation’s life expectancy in a developed country, such as ours, maybe actually lower than their parents,” concludes Dr Greally.

FOOD ALLERGIES

Paediatrics

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EXPERT

DIAGNOSTICS DR DAVID O’DONNELL, CLINICAL DIRECTOR OF RADIOLOGY AT HMC, OUTLINES THE DEPARTMENT’S QUALITY INTERVENTIONAL SERVICE, OFFERING PATIENTS CLINICAL EXCELLENCE IN A STATE-OF-THE-ART FACILITY.

PICTURED: Radiology Staff

Radiology

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he Department of Diagnostic and Interventional Radiology in HMC has grown from strength to strength since its inception in 2007 and now performs up to 40,000 diagnostic and interventional examinations per year with an increasing range and complexity to ensure the optimum outcome for our patients. Staff includes 6 consultant radiologists and over 40 radiographers, healthcare assistants and administrative staff. Dr David O Donnell, Clinical Director of Radiology at HMC, outlines the department’s quality diagnostic and interventional service. The Hermitage Medical Clinic is committed to providing excellence in patient care and ensures that patients are attended to by highly skilled and empathetic staff using state-of-the-art facilities in comfortable surroundings. The Radiology Department offers an outstanding level of expertise and cutting edge technology. We have some of the most advanced diagnostic imaging equipment available today. That list includes: • Digital general X-ray • Ultrasound • 64-slice CT • 1.5T MRI, cardiac MR and mobile MRI • Digital fluoroscopy • Interventional radiology • Digital mammography • Nuclear medicine, SPECT/CT and PET/CT

DIGITAL X-RAY AND ULTRASOUND Patients can be referred from the emergency department, internally from within HMC and also from external specialists, with approximately 40 per cent

of referrals coming from external GPs. X-ray is the most frequently-used tool at the disposal of the Radiology Department. Ultrasound is also a first line investigative tool, capable of accessing almost every area of the body and is also routinely used as a guide when performing interventional procedures such as image guided biopsies.

CT AND MRI The 64 slice CT (Computed Technology) scanner allows for three dimensional imaging for diagnosis and follow up. It can also be utilised for image guided interventional procedures for example when performing biopsies, for therapeutic image guided pain injections of joints and on spinal nerve roots. The MRI (Magnetic resonance Imaging) equipment at HMC has a 1.5 tesla magnet giving the highest quality images of the brain, the spine and particularly the musculoskeletal system without the use of radiation. A Mobile GE scanner to extend its MR service has recently being introduced to the Hermitage. GE 1.5T Signa HDxt Optima Edition 23 with 2014 software applications provides a high level of image quality ideal for detailed inspection of tissue structures

DIGITAL FLUROSCOPY AND INTERVENTIONAL RADIOLOGY The Radiology department has a dedicated suite offering a full range of fluoroscopy and interventional procedures including barium studies, joint injections through to angiography, angioplasty, stent placement and embolisation procedures. This service is lead by consultant interventional radiologists assisted by our dedicated nursing team.

DIGITAL MAMMOGRAPHY The department’s dedicated Breast Clinic

Radiology

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The Radiology Department offers an outstanding level of expertise and cutting edge technology. We have some of the most advanced diagnostic imaging equipment available today

runs a triple assessment breast session every Tuesday afternoon. This consists of a clinical examination with a breast surgeon and a combination of ultrasound, mammography and interventional procedures e.g. FNA (Fine Needle Aspiration) and core biopsy as necessary. The consultant radiologist is on site to speak with and reassure patients of their results on the same day.

NUCLEAR MEDICINE SPECT/CT and PET/CT Nuclear Medicine investigates molecular changes in the body rather then just the physical changes in the tissues anatomy. In nuclear medicine procedures, the patient is injected with a radioapharmaceutical which localises to specific organs or cellular receptors. A special camera, called a gamma camera is used to detect the distribution of the radiopharmaceutical in the body. A true 3D scan of the body may be performed using SPECT/CT; in which the molecular changes are fused with the CT anatomical images. Positron Emission Tomography (PET) is a 3D imaging technique when combined with Computed Tomography (CT), enables physicians to more accurately diagnose disease, infection and inflammation in the body. In PET/CT, a special type of radioactive sugar, 18F FDG (Fluorodeoxyglucose) is injected into the patient’s vein. This radioactive sugar will help indicate whether or not a lesion is benign or malignant. PET/CT is an invaluable tool in the early detection of cancerous cells and is also used to assess a patient’s response to treatment chemotherapy and/or radiation therapy.

PICTURED: Dr Dave O’Donnell, Consultant Radiologist with Ms Rachel Darkin, Radiology Services Manager clinical standards and patient focused care. In addition to this the Hermitage Medical Clinic has invested in IT infrastructure that provides excellence in time management and patient care efficiency. The Hermitage Medical Clinic installed a PACS (Picture Archiving and Communication System) when it first opened in 2007 which was progressive and a significant investment at the time. All imaging is acquired in digital format, and the PACS enables the consultant radiologists to manipulate the images and produce reports using VR (Voice Recognition) which are immediately available electronically to clinicians on completion. PACS gives us such as vast range of capability of interpreting the acquisition data than we used to have on the single projection provided by traditional film imaging. Since 2007, the advances in technology have been substantial and in order to ensure patients and referring clinicians continue to receive the very best services available, HMC replaced the existing model with a state-of-the–art PACS last year.

ADVANCES IN TECHNOLOGY The Radiology Department at HMC offers a full range of advanced diagnostic technology and interventional imaging services which offer excellence in terms of

The new system has improved workflow and efficiency, providing referring physicians with immediate access to diagnostic-quality images and reports

both on-site and remotely, making access to expertise easier than ever. This system provides users with customisable functionality and new advanced software tools needed to deliver the best possible care to all patients. Users are able to explore anatomy, pathology and physiology with speed, predictability, and confidence. Additional software applications have improved the management of critical findings by allowing the radiology department to communicate and track the receipt of a critical finding to insure it is managed appropriately. Means of communicating electronically with our referring clinicians and patients will reduce the time spent on administrative processes and will allow all users ease of access to our services providing an improved Radiology experience for all.

THE FUTURE The Radiology Department at the Hermitage Medical Clinic is focused on quality and service development to meet the needs of our customers in 2015 and beyond. We continue to make every effort to ensure that we provide the best in clinical and professional standards and look forward to the new technology coming on board this year.

Radiology

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A LIGHT

for BPH treatment

IN JULY 2013, THE HERMITAGE CLINIC BECAME THE PROUD OWNER OF ONE OF THE MOST ADVANCED KTP LASER-TREATMENT MACHINES FOR ENLARGED PROSTATES AVAILABLE ON THE MARKET. MR BARRY JONES IS ONE OF FOUR CONSULTANT UROLOGISTS AT THE HERMITAGE AND HAS SEEN VAST IMPROVEMENTS WITH THIS TREATMENT THROUGH THE YEARS.

raditionally, BPH has been treated through a surgical procedure known as transurethral resection of the prostate (TURP). It is performed by visualising the prostate through the urethra and removing tissue by electrocautery or sharp dissection. However, according to consultant urologist Mr Barry Jones, the advent of laser treatment in BPH has proven so far to be significantly better in terms of efficiency and patient's recovery: “It's a very good piece of equipment. The reason I promoted bringing this technology to the HMC was because of the number of cardiology patients who would be taking various medications to thin the blood. Medication like warfarin, plavix and others cause a lot of bleeding if you're to go for a surgical option. Because there's a cardiology focus in the Hermitage, the GreenLight XPS laser is a good fit.”

QUICK RECOVERY TIME For the patient, the benefits begin, in nearly all cases, the next day when they are allowed to return home and are often

back in work or engaging in other activities only days after the procedure. Through TURP, a patient would have had to remain in hospital for a number of days and followed up with a significant amount of time with uncomfortable urination, known as troublesome dysuria, which would gradually pass. This does not mean that patients using the GreenLight laser will be completely free of discomfort afterwards. According to Mr Jones, while the majority of patients will be fully recovered in a matter of days, some may find the process takes a little longer: “Some people get troublesome dysuria which is the uncomfortable passing of water. That can go on for four weeks or six weeks after the procedure but it always settles down. The problem is it's hard to predict who will get it however. I've been working with GreenLight lasers for a number of years now and I still can't identify who you would expect to have this. Many, many others have no discomfort at all and they're back to work within days after the procedure. It can be annoying at most to the patient for a few weeks and it might only affect about 30 per cent of people. Patient feedback

from the procedure has been exceptionally good. There are remarkable people who have no discomfort from day one and they're back in work two days later or on the golf course. They would be in the majority.”

EXPANDING THE SERVICE So far the numbers of patients attending the urology department for the procedure has been consistent with, on average, about six people having the procedure each week. Along with Mr Jones, there are three other urological consultants based in the department who operate the GreenLight XPS laser, Mr Ijaz Cheema, Mr Kashif Siddiqui and Mr Denis O'Sullivan. Mr Jones now believes it's a case of promoting the significant benefits that the treatment will bring to those experiencing BPH: “When I started doing the procedure in July, I was doing four or five cases a week. Most of my referrals come from other colleagues at other hospitals but not necessarily GPs. It's nice to get them but we can be doing much bigger numbers once the word gets out just how beneficial this new treatment is.”

Urology

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RAPID, SPECIALIST

BREAST CARE HMC’S SCREENING AND SYMPTOMATIC BREAST SERVICE PROVIDES THE GOLD STANDARD OF CARE FOR WOMEN IN THE DIAGNOSIS AND ASSESSMENT OF BREAST CANCER. CONSULTANT SURGEON, MR MICHAEL ALLEN AND CONSULTANT RADIOLOGIST, DR GAVIN BRIGGS SPECIALISE IN THE INVESTIGATION AND TREATMENT OF BREAST DISEASE. TOGETHER, THEY RUN A ‘ONE-STOP’ CLINIC AND HAVE SEEN THE SIGNIFICANT BENEFITS THIS COMPREHENSIVE SERVICE CAN BRING.

ith the number of women being diagnosed with breast cancer in Ireland increasing over the last number of years, the importance of breast screening has become even more vital in the fight against this killer condition. At HMC, the latest technology and techniques make the one-stop Breast Clinic one of the most sophisticated in the country. As part of the symptomatic service at the Clinic, women coming in to be assessed go through full triple assessment. Performing all necessary tests on the same day saves valuable time and expense for women who may be visiting HMC from outside the greater Dublin area, who otherwise would have to travel back and forth a number of times for individual tests.

TRIPLE ASSESSMENT The systematic service, known as ‘triple assessment’, is held in the Radiology Department at HMC every Tuesday afternoon and evening. The assessment begins with a consultation with Mr Allen who will take a relevant history of any breast symptoms and perform a clinical examination. The patients are then sent to the Radiology Department where a digital mammogram (low dose X-ray) is performed. Dr Briggs can detect changes to the breast tissue up to two years before any lump is detected. The process itself only takes 20 minutes but could make an enormous difference to the lives of

hundreds of women across the country. The next step may involve ultrasound, which complements a mammogram and helps differentiate between different types of breast tissue. An ultrasound uses a series of ultrasonic waves that pass through the breast, using a hand-held device. The whole procedure only takes 15 to 20 minutes and is both non-invasive and does not use potentially harmful radiation. Finally, if deemed necessary, a needle biopsy will be offered to patients that day. The tissue sample is sent to the Pathology Department where it is assessed by a consultant pathologist. HMC's Breast Clinic has direct links with Beaumont Hospital and all patients undergoing biopsy are discussed at the multidisciplinary team meeting each week. Mr Allen will convey all results directly to patients following this meeting, at which stage any further treatment necessary will be discussed and organised.

this all-inclusive Breast Clinic one of the best in the country. He says: “The Breast Clinic has been running for over four years and during that time we have seen the demand for the service increase week on week, particularly from GP referrals. Due to the demand we hope to expand the team over the next number of months.” Dr Briggs adds: “Certainly the quality of the equipment has allowed us to offer the very best to our patients. If a patient requires further diagnostic evaluation after a mammogram and ultrasound, we also have CT, PET CT, MRI and radio-isotope bone scanning, so we offer the full gamut of breast services from initial presentation right through to breast treatment for the unfortunate people in whom we discover breast cancer.” To schedule appointments please call (01) 645 9042/9043

HMC not only provides a diagnostic service, but also offers the full range of treatment options including surgery, radiotherapy and chemotherapy. This is under the care of a team of dedicated oncologists who also work closely with the breast diagnostic team. Women can therefore be reassured that if the worst is discovered, all of their care will be seamlessly organised for them at a time of huge anxiety and concern. Dr Briggs believes the highly-trained staff and excellent facilities on offer at HMC make

PICTURED: Dr Gavin Briggs

Breast Care

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RADIATION ONCOLOGY RADIATION ONCOLOGY IS A SIGNIFICANT DEPARTMENT IN HMC PROVIDING CANCER TREATMENT IN LINE WITH BEST INTERNATIONAL GUIDELINES IN BOTH DAYWARD AND IN-PATIENT ONCOLOGY SETTINGS.

adiation oncology is a growing area of specialisation at the HMC since consultant radiation oncologist Osama Salib opened the centre in 2007 and treated his first patient in July of that year. Mr Salib gained his medical degree MB BCh in 1984 before obtaining a DMRT Diploma in Clinical Oncology from the Royal College of Radiologists in London in 1994 and the Fellowship of the Faculty of

Radiologists RCSI in 2002 FF RCSI. Radiation oncology is used to treat all types of cancer at the HMC and also some nonmalignant conditions; both radical – aimed at curing the disease and palliative treatment – designed to arrest the condition and reduce the symptoms - are provided. As Mr Salib explains: “We treat all forms of cancer in all locations of the body; both from the point of diagnosis and via referral from external consultants. We have a case mix

Radiotherapy

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at when devising a treatment plan are, the type of cancer; the stage of cancer; the performance status of the patient; the patient’s age; and any medical comorbidities. For example a young woman with early stage breast cancer will indicate radical treatment however a very elderly gentleman with prostate cancer, poor performance status, who presents with several other co-morbidities such as recurrent heart attack or bad bronchitis may indicate a different form of treatment. You actually think of the intention of the treatment and he may have other comorbidities that will actually accelerate his death before any cancer would,” says Mr Salib.

PRE AND POST-OPERATIVE THERAPY “We deliver radiotherapy either pre or post surgery depending on the type of cancer being treated. In rectal cancer, radiotherapy is usually delivered pre-operatively and in breast cancer it is usually delivered postoperatively. In lung or cervical cancer it may be the primary form of treatment and often no surgery is required. It depends on the type of cancer. With pre-operative radiation we down-stage the cancer, reduce the blood supply in the surgical field and we mobilise the tumor and shrink it, which gives the surgeon better, clearer resection margins,” Mr Salib explains.

of patients who have been diagnosed at the HMC via the emergency department where the diagnosis is established and they are under the care of a cancer specialist from the HMC, plus we get referrals from external sources of private patients who elect to go to the HMC for various reasons.”

TREATMENT PLAN Once a patient is referred their treatment plan is devised. “The key factors we look

The HMC team takes a truly multidisciplinary approach with key departments working together to develop and deliver the patient’s treatment plan and meeting regularly to review all casework. The main disciplines involved include the radiology department who provide diagnostic and interventional procedures, a comprehensive pathology department, a dedicated dietetics department and really well trained occupational therapists. There is a palliative care consultant linked to the hospital plus two dedicated medical oncologists on site.

WORLD CLASS TECHNOLOGY As you’d expect with a hospital of this stature, the technology is world class and gives patients the assurance that they will receive the best treatment possible. Newer, more sophisticated technology offers reduced treatment times and a highly targeted approach to destroying cancer cells and shrinking tumors. “We can deliver most forms of radiotherapy, including stereotactic radiotherapy. We certainly use the most up to date technology to deliver the different forms of radiation. The HMC has 3D conformal planning and 4D planning with Image Guided Radiotherapy (IGRT), we also have Intensity Modulated Radiotherapy, a Stereotactic facility and the new Cyber Knife. One of the most recent advances is Cone Beam imaging where you can see the radiation live on screen during the treatment,” says Mr Salib.

DELIVERING ON PATIENT EXPECTATIONS The clinicians understand dealing with a cancer diagnosis is traumatic and difficult for patients and that they require treatment that is both timely and caring. “Patients attending the HMC expect excellent service, technology, treatment times and protocols that are in line with best international guidelines. Following treatment patients receive ongoing support, all of our patients are seen four to six weeks after treatment. At that point some may be discharged to their referring consultant while others will continue their treatment follow-up with the Hermitage,” concludes Mr Salib.

PICTURED: Dr.Jamsari Khalid, Jonathan Rosser, Clinical Specialist Radiotherapy; Gillian Moore, Clinical Specialist Radiotherapy; Niall Fox, Radiation Therapist; Bernie McCafferty Clinical Specialist Radiotherapy; Feargal Blaney, Radiation Therapist; Donna Hughes, Radiation therapist; Aoife Good, Senior Radiation Therapist; Mohammed Galal, Physicist; Niamh Byrne, Radiotherapy Administrator; Rachel Miller, Senior Radiation Therapist; Catherine Rahill, Dosimetrist and Sandra Kelly, Physicist.

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Timely, Quality

ONCOLOGY

CARE

MEDICAL ONCOLOGY AT THE HERMITAGE PROVIDES CANCER PATIENTS WITH FIRST CLASS TREATMENT AND CARE. THIS GROWING DEPARTMENT FORMS PART OF A COMPREHENSIVE ONCOLOGY UNIT WORKING WITH PATIENTS FROM THE POINT OF DIAGNOSIS RIGHT THROUGH THEIR TREATMENT PLAN AND FOLLOW UP. PROF JOHN KENNEDY, DR DAVID GALLAGHER AND DR PATRICK THORNTON DISCUSS THE IMPORTANCE OF GROWING THE PROVISION OF ONCOLOGY SERVICES AT THIS TIME.

he Medical Oncology Department provides a comprehensive range of medical treatments to patients with cancer. The department forms part of a multidisciplinary team providing medical, surgical and radiotherapy treatments for cancer along with diagnostic services including radiology and pathology. According to recent statistics released by the Irish Cancer Society, Ireland has an average of 30,000 new cases of cancer diagnosed each year with this number expected to rise to over 40,000 per year by 2020. The need for oncology care has never been greater in this country, and when it comes to setting standards, HMC stands at the forefront.

DAY UNIT TEAM The Oncology Day Unit at the HMC, incorporating a haematology clinic, has been in operation since January 2008 and has made a significant impact on the lives of people suffering from cancer. Currently the medical oncology team consists of consultant oncologists, Prof Kennedy and Dr Gallagher; two consultant haematologists, Drs Thornton and Murphy; and Dr O’Siorain who runs palliative medicine. The service on offer in the department includes treatments for neo-adjuvant, adjuvant and metastatic oncology,

"The Unit also has excellent access to consultant radiologists and radiotherapists on site, thus preventing delays for patients.” 48

palliative patients and for haematology, leukaemia, lymphoproliferative disorders, such as myeloma and lymphoma and haemochromatosis and other nonmalignant blood diseases amongst others. The unit has some of the most advanced oncology facilities in the country, offering expert advice in patient assessment and evaluation; education of planned treatment for the patient and their family; psychosocial support and liaison with many national cancer support groups as well as medication delivery including chemotherapy administration and management. Consultant Haematologist, Dr Patrick Thornton, deals with many patients who require services such as chemotherapy. “We accept both GP and consultant referrals to the unit and have a large catchment in and outside Dublin including counties Meath, Louth and Cavan. There we see patients who are suffering from both malignant and non-malignant haematology conditions. We treat patients with chronic leukaemia, lymphoma, myeloma, myelodysplasia, myeloproliferative disorders and haemochromatosis. However, because of our ED we also diagnose more intensive cases, such as acute leukaemia and aggressive lymphomas. On these occasions we work in partnership with Beaumont Hospital.

PROGRESS IN LEAPS AND BOUNDS Consultant Medical Oncologist Prof John Kennedy, who has based his private practice at HMC for four years now, believes the key to the success of the unit lies in its accessibility. “It’s a full service unit with good adjacency to the Radiology Department.

This access to diagnostic tools means that the patient’s response to the treatment can rapidly be re-evaluated and if necessary changes can be made.” He adds: “The Unit also has excellent access to consultant radiologists and radiotherapists on site, thus preventing delays for patients.” For Dr Thornton, the excellent staff and the Clinic management's adaptation to change has added to the success of the unit. “Our unit is currently being modernised and expanded which will see it double in size, and thus we will be able to accept more patients. Also, there are currently two fulltime nurses, a clinical nurse manager and a clinical nurse specialist in oncology.” Dr David Gallagher is the most recent addition to the team. He trained as a medical oncologist and medical geneticist and worked at the Memorial Sloan-Kettering Cancer Centre in New York. This year he chose to set up his Medical Oncology practice at the HMC. As Dr Gallagher explains: “I think we’re starting from quite a small base, we don’t have large numbers of cancer patients being treated with chemotherapy in the HMC currently but the facilities are there for that to happen. A recent release of statistics show that cancer diagnoses will increase significantly between now and 2020. Cancer treatment requirements are likely to increase nationally and HMC is well positioned geographically and also in terms of the service provided to meet this need. “We treat a broad range of cancers at HMC. breast cancer, colorectal cancer, prostate cancer and lung cancer represent the most common presentations. Some of these

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present electively through the surgical services at HMC, and others present as emergencies to the A&E department. It’s a relatively small medical oncology service compared to other hospitals but a comprehensive range of therapies are available at the HMC.

DELIVERING TARGETED TREATMENTS Although the number of cancer cases is increasing year on year, and is predicted to do so for the foreseeable future, the treatment of cancer is evolving and there have been significant improvements in both treatments and outcomes. According to Dr Gallagher: “Cancer care is becoming more

PICTURED: Prof John Kennedy

precise, by that I mean that treatment is more tailored both towards the make up of the tumour and towards the people who have the cancer. "And that is the main progress that is happening in the field. The molecular understanding of cancer has improved considerably in the relatively recent past.” Research is yielding results in terms of the identifying active agents that are coming on to the market sooner in most cases. “There used to be a considerable lag but that is reducing, it used to take seven to 10 years for a new drug to come to market. Now there are innovative ways of bringing exciting drugs more quickly through the registration and approval process.

PICTURED: Dr David Gallagher

MEETING THE CHALLENGES This progress when coupled with excellent oncology staff and facilities can have a big impact on a patient's experience and ultimately on outcomes. In Dr Gallagher’s view: “It’s a state of the art facility with strong staff. From a patient perspective, an important part of the cancer journey is the experience once the quality of care is established and ensured. "The HMC is well located and is an accessible place for patients. It’s a nice facility, the waiting times on the day of treatment are short – this efficient approcach makes the day-unit in the Hermitage attractive for patients.”

PICTURED: Dr Patrick Thornton

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Seeing The

Future

BY DR ANDRA BOBART-HONE, CONSULTANT OPHTHALMOLOGIST AND HERMITAGE CLINIC MEDICAL ADVISORY COMMITTEE OPHTHALMIC REPRESENTATIVE.

Ophthalmology at the Hermitage Medical Clinic is now in its 7th year We currently have 10 practising ophthalmologists in the HMC that all engage in Outpatients and perform different surgeries.

There is an Ophthalmologist available Monday to Saturday for clinics for direct referral. There are later evening clinics on Tuesdays and Fridays.

Surgeries that are performed at the Hermitage include cataract, in the near future- corneal cross linking for keratoconus, the different levels of corneal graft surgery , investigative and diagnostic surgeries, tubes or endoscopic DCR for blocked tear ducts, glaucoma laser, lid surgeries, intravitreal injections for retinal problems and macular degeneration, vein occlusions etc, diagnostic biopsies, corneal surgery, dry eye surgeries, pterygium surgery, orbital tumor surgery,

All of the Ophthalmologists see general adult ophthalmology referrals (glaucoma, diabetic screening and evaluation, retinal problems, decreased vision, cataract, anterior segment and other acute complaints) but there are some with subspecialty in Cornea, Contact lens related problems, Dry eye, Macular degeneration, Retinal disease, Oculoplastics, Uveitis and Paediatric patients.

Mohâ&#x20AC;&#x2122;s reconstructive surgery post-lidtumor surgery in conjunction with a dermatologist Dr Patrick Ormond and squint surgery.

There is an Optometrist that does Humphrey visual fields for glaucoma and other problems, and specializes in refraction, IOL ( intraocular lens A- scans) and the Pentacam for corneal topography.

There is also an Orthoptist that specialises and therefore can assess squints, nerve palsies, diplopia and can arrange both Humphrey and Goldmann visual fields and Hess tests usually after referral by a doctor be it an Ophthalmologist or Neurologist. Humphrey visual fields and OCT (Ocular Coherence Tomography) are carried out in the HMC. Diagnostic services available at the clinic include corneal topography, fluorescein angiography and ICG angiography and through the Clinic we have the use of a YAG laser machine for YAG capsulotomies and peripheral iridotomies and there is the use of argon laser as well. In addition there is a rapid access clinic to diagnose and treat Macular disease and degeneration.

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Challenges in Ophthalmology CATARACT Cataract surgery is ever evolving. There have been some exciting new developments in the operation with the adjunctive use of lasers but the operation still requires a surgeonâ&#x20AC;&#x2122;s hands nonetheless. The advent of multifocal lenses has made this an exciting development at the Hermitage Clinic.

DIABETES The projected increase worldwide of type 2 diabetes will be one of the greatest challenges for practitioners and the health service in Ireland. Diabetes in the eye can cause delayed healing, cataract and diabetic retinopathy. It is important to have regular (at least yearly depending on control) dilated ocular examination with an Ophthalmologist once diagnosed as a diabetic.

immunosuppressant type treatments and surgical intervention. Problem dry eye should be referred to an Eye Specialist.

GLAUCOMA The prevalence of glaucoma is on the rise probably secondary to improved diagnostics, but also due to an ageing population and diabetes. The diagnosis of glaucoma is made by a corrected intraocular pressure test in conjunction with a Humphrey 24-2 SITA standard visual field test, evaluation of the drainage system of the eyes by gonioscopy and dilated pupil assessment of the optic nerve. Treatment initially is one or more topical intraocular-pressurelowering medication, then secondly laser as an adjunct and if all fails, then surgery.

DRY EYE Dry eye is now recognized as an ever increasing entity that will significantly pose a very expensive economic challenge in a lot of countries. Dry eye is not only uncomfortable but can alter vision depending on which of the three layers of the tear film is affected. The treatment of dry eye is a multi-step and sometimes a multi disciplinary problem. The treatment in addition to topical therapy can involve medical, dietary, lifestyle and sometimes

MACULAR DEGENERATION Macular degeneration is a disease of an ageing population with risk factors including family history, smoking and ultraviolet light exposure. Diagnostic tests for this include detailed dilated pupil examination, Ocular coherence tomography and Fluorescein angiography. Care of this debilitating disease that can cause loss of central vision includes nutritional supplements (based on trials) and UV exposure minimization with approved UV light blocking sunglasses. The treatment is either by laser or injected agents both of which are offered here at the Hermitage clinic.

Paediatric Ophthalmology All children with decreased vision and or squint should be seen at least once by an Ophthalmologist for a detailed dilated cycloplegic examination and refraction as amblyopia may occur (irreversible failure to develop visual acuity in the absence of organic disease) and also to outrule intraocular masses and retinal problems.

highly recommended The specialist may engage in the treatment of difficult cases with the intervention of an orthoptist.

Decreased vision with amblyopia is often treatable before the age of eight and a half/nine but binocular and stereoscopic vision may be impaired permanently as well so early Eye specialist referral is

The treatment of decreased vision, squint and high astigmatism/ keratoconus may involve a multi-step approach.

Any child with high astigmatism should also be referred to an Ophthalmologist as amblyopia and keratoconus may ensue.

Why the Hermitage? The Hermitage Clinic offers a comprehensive service in Ophthalmology. Direct referral to the consultants is the best way to fast track both adult and paediatric patients. We are always happy to be called directly if there is any immediate concern and one of us can usually facilitate urgent cases quickly. On a personal note we have a pretty admirable back up service with each other at the clinic probably as most of us trained together at some stage. More importantly we offer a wide range of Ophthalmic testing and investigation that is ever expanding.

The HMC has a comprehensive selection of ancillary services and Consultant specialties that is sometimes necessary in Ophthalmology diagnoses and so the idea of a â&#x20AC;&#x2DC;one-stop centreâ&#x20AC;&#x2122; for diagnosis and rapid referral is certainly better for patients. Finally the Hermitage Clinic Ophthalmology group has a wonderful advantage in the CPD Multi-Disciplinary meeting that is held every month with Radiology and Neurology to discuss cases. In addition we hold our own internal CPD Eye group meetings to discuss cases, diagnostics and pathology-related Ophthalmology at the clinic.

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Sleep therapy

at HMC SLEEPING DISORDERS HAVE BECOME QUITE COMMON IN IRELAND AND CONSULTANT IN RESPIRATORY AND SLEEP MEDICINE AT HMC, DR LIAM CORMICAN, SAYS IT’S AN AREA THE CLINIC IS DETERMINED TO ADDRESS.

reating people with sleep-related breathing disorders is a major priority at HMC. The Sleep Disorders Unit has been a pivotal part of what the Clinic does, providing excellent medical care with expert advice on all forms of sleep related breathing disorders. And yet it is a low-profile topic on the Irish healthcare scene – so why is it taken so seriously at HMC? “The reason it’s so important is because we spend a significant proportion of our lives sleeping,” explains Respiratory and Sleep Medicine Consultant Dr Liam Cormican. “The field is relatively new, with the therapy only having been developed in the early 1980s. What happens during sleep is very important.” It touches every aspect of our lives, be it work, family or leisure, and the knock-on effects of poor sleep should not be underestimated. At HMC, Dr Cormican and his team deal with a variety of sleep related breathing disorders.

BEGINNING TREATMENT The team at HMC go the extra mile to ensure that patients receive the best medical care available. Upon arrival at the Sleep Disorder Unit, patients are put through a rigorous examination to find the root of the problem. “When a patient comes in we take a detailed history and examination,” says Dr Cormican. “The history and examination usually looks for signs of respiratory and sleep-related disorders. We conduct a diagnostic work up, with blood, chest X-rays and lung function tests. Sleep questionnaires are completed and if necessary we go ahead and do an

overnight polygram,” he adds. HMC is one of a limited number of private hospitals that offers full nocturnal polysomnography. This involves the patient sleeping in a single room at night and having continuous recording of their EEG, oronasal airflow, thoracic and abdominal wall movement oxygen saturation, pulse rate, ECG, sleep position and blood pressure. The Sleep Disorder Breathing Unit is wellequipped with technologically-advanced equipment and a team of experts to provide the best medical care in the country. “ We employ full nocturnal polysomnography which is the gold standard for the diagnosis of sleep-related breathing disorders and other sleep problems,” Dr Cormican explains. Dr Cormican trained in respiratory and sleep disorders in London, and was a consultant respiratory physician at King's College Hospital before returning to Ireland. Applying what he learned in London to HMC wasn’t difficult, he says. “The facilities here are second to none, and because of that investment, the patients who come to HMC can be diagnosed quickly and by experts.”

and work lives. Moderate to severe sleep apnoea is also associated with hypertension,” he says. If sleep-related breathing disorders are not treated properly, the effects on a person’s wellbeing could be potentially disastrous. “Severe sleep apnoea has been shown to be a cause of heart death and when it’s untreated it is a risk factor for road accidents. It’s thought that 20 per cent of this is caused by sleep apnoea,” says Dr Cormican.

FOCUSING ON THE FUTURE Significant investments in staff and equipment have helped to define HMC as a leader within the field, and Dr Cormican looks forward to a bright future and expanding the good work to date. After all, being one of only a handful of hospitals which provide sleep disorder diagnosis therapy gives his work a prominent place in the hospital’s unique offering to patients. “This is a fascinating field and one can make a huge difference to people’s lives,” he says. “It’s an excellent place to work, and it’s one of the few hospitals that has almost every speciality under one roof. The ethos is about clinical excellence and the patient is at the centre of every decision.”

TECHNOLOGY IN DIAGNOSIS The most common problem the unit treats, according to Dr Cormican, is sleep apnoea. “It affects one in 25 men and one in 50 women. Sleep disorder breathing is associated with sleep deprivation – loss of slow-wave sleep, meaning that the person feels tired and sleepy throughout the day. This can often lead to short-term memory loss and impaired concentration with the individual underperforming in their social

However, as the future may hold opportunity for Dr Cormican and his team, it also creates a challenge to highlight what the Clinic has to offer. “At the moment we’re in the process of increasing awareness about the unit amongst GPs and physicians in the locality and we need to continue this work.” Certainly the future for Dr Cormican, HMC and their patients is bright, with continued investment in the area bound to have long-lasting effects on patients’ quality of life.

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Ahead of the game MR JOHN KINSELLA GIVES AN OVERVIEW OF THE ENT FACILITES AND SERVICES ON OFFER AT THE HMC. THE FACULTY IS ONE OF THE LARGEST IN IRELAND, WITH EIGHT SPECIALIST ENT CONSULTANTS CURRENTLY BASING THEIR PRIVATE PRACTICE AT THE CLINIC.

ermitage Clinic has a team of eight highly qualified and experienced ENT Consultants. We are able to provide comprehensive evaluation and treatment of all adult and paediatric ear, nose and throat problems, whether simple or complex. Subspecialty interests include head and neck surgery, rhinology/rhinoplasty, otology and paediatric ENT. Each of our ENT Consultants is co-appointed to one or more of our public hospitals. This provides excellent cooperation with major teaching hospitals such as St. James’s/Tallaght and Beaumont.

WHY HMC? ENT/Head and Neck Surgeon John Kinsella was appointed at St. James’s/Tallaght Hospitals in 2004 and has always based his private practice at HMC. “The facilities

are fantastic; I love the design of the main foyer, the wards and theatres. The grounds are beautiful and there is plentiful parking. It has by far the best location of any private hospital in Dublin with easy access from the city and neighbouring counties but even from places like Athlone, Monaghan and Cavan. People coming from outside Dublin love the fact that they don’t have to negotiate city traffic to come here.” “The medical facilities are first-class, making it much easier to provide outstanding ENT work-up and treatment. We have state of the art radiology on-site as well as audiology (hearing tests) and speech and language therapy. The theatre set up is really good with excellent up-to-date technology and equipment. We also provide allergy workup (including skin testing) and treatment (including immunotherapy).”

SPECIALITY SERVICES HMC is able to offer paediatric and adult out patient and in patient services. A very large number of routine ENT operations are performed here including grommets, tonsils and adenoids, nasal septoplasty, rhinoplasty, endoscopic sinus surgery, laryngoscopy and oesophagoscopy. Mr Kinsella and Professor Timon have very busy thyroid, parathyroid and salivary gland surgical practices . They also screen numerous patients for head and neck cancer at HMC. They then liaise with the head and neck team at St. James’s to work out management strategies for their cancer patients. We have sub-specialist ear surgeons including Mr Conlon and Mr Hone who perform complex middle ear and mastoid surgery. Mr Lacy has particular expertise in complex anterior skull base and sinus surgery. Mr Gaffney and Mr SavageJones are also excellent surgeons.

ENT

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Expert Medication Management at the HMC

ustin O'Sullivan leads the Pharmacy team at the HMC, which is composed of two other pharmacists Brian and Naomi, and two pharmacy technicians Audrey and Debbie. Their focus is to ensure that the patient receives the appropriate medication to manage, treat or aleviate their condition. Patient safety is critical, and at the HMC we are proud to have a fully quality assured system of managing both the prescribing and dispensing of medicines.

PICTURED: Justin O'Sullivan, Pharmacy Manager at HMC.

PATIENT SAFETY IS CRITICAL, AND AT THE HMC WE ARE PROUD TO HAVE A FULLY QUALITY ASSURED SYSTEM OF MANAGING BOTH THE PRESCRIBING AND DISPENSING OF MEDICINES.

The first step in the process is the admission phase; a pharmacist reconciles a patient’s medical history with the medication prescribed by the admitting doctor. This may require a call to a community pharmacist or a GP. Research shows that it is at the interfaces of care that there is the greatest risk of a medication error occurring. The interfaces of care are admission, transfer and discharge. This reconciliation check is carried out by a clinical pharmacist (CP). The CP is physically available at the ward level to make interventions on behalf of patients and will be in a position to check the patient’s renal and liver function, current state of health and social history of the patient to check the appropriateness of medication that is prescribed for them.

DISPENSING The second step in the process is the dispensing phase. HMC’s system ensures a photocopy of the prescriber’s original orders are used to dispense the medication; this removes the possibility of transcription error. From this order the pharmacy team can directly interpret the doctor’s order, which is then dispensed within a quality assurance system to individual patients. The medication is delivered to a container for the individual patient on the medication cart. The dispensed pack also has three unique identifiers to aid nurses in administering the correct medication to the correct patient. As part of the initiatives undertaken to reduce the likelihood of medication errors on discharge, HMC has changed the discharge prescription to an A4 size from an A5 size, which includes an area to identify medication allergies. The prescription has prompts to improve prescribing and each line is numbered to aid communication between healthcare professionals in the community with those in HMC. Other safety initiatives undertaken are the identification of 'high alert' and 'look-alike, sound-alike' medications and building strategies around reducing risks of potential errors. The Pharmacy Department also clinically screens haematology/oncology prescriptions and coordinates the manufacture off-site for delivery to patients in the oncology day ward.

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Expertly managing pain LIFE CAN BE EXCEEDINGLY DIFFICULT FOR THOSE WHO LIVE WITH CHRONIC PAIN, BUT DR JOE FITZGERALD AND DR CONNAIL MCCRORY AND THEIR PAIN MEDICINE TEAM AT HMC TRY TO MAKE THINGS MORE BEARABLE.

hronic pain is a destructive force: debilitating of body and mind, it can grind away and can often be very difficult to treat. The field of pain medicine aims to make a difference in people’s lives by diagnosing and treating the cause of pain, thus reducing pain and helping patients return towards a normal life. Dr Joe Fitzgerald is one of two pain medicine consultants at HMC. He graduated from Galway and trained in Ireland, the US (Yale) and the UK (Edinburgh) before moving back to Dublin in 2006 as a full-time pain physician at St James’s Hospital. Dr Connail McCrory graduated from the RCSI and trained in Ireland, the UK (Birmingham) and Sweden (Karolinska). He was appointed to St James's Hospital in 2002 and established the pain medicine service there, serving as the Medical Director of Pain Medicine. He is also Senior Lecturer in the School of Medicine, Trinity College Dublin and is a Primary Investigator at Trinity College Institute of Neuroscience. Of the service offered at HMC, Dr McCrory says: “We provide assessment, diagnosis and treatment for patients with both chronic pain and cancer pain. The practice includes clinical psychology assessment and treatment as appropriate.” Dr Fitzgerald adds: “The most common complaints are patients with chronic, non-malignant pain

conditions such as neck and back pain. Our treatments range from medication optimisation to a full range of interventional treatment in theatre, rehabilitation and general co-ordination of care.”

EXCELLENT FACILITIES Dr Fitzgerald has been at HMC since it opened and during that time has seen it change, develop and expand. One trend that he has noticed is the steady increase of GP referrals to the department at HMC. “This is partly due to the improved access to diagnostics like MRI scans and X-rays,” he says. “Our practice is 50/50 GP referral and consultant-based”, adding that the “GP referral has certainly increased – it’s very much a feature of the last number of years. As the hospital has become more established and its reputation has grown it’s now a well-recognised healthcare provider and provides a full spectrum of services to patients”. The location also offers its advantages. “The infrastructure here is great,” says Dr Fitzgerald, and “the Clinic serves a large catchment area for west Dublin, into midLeinster and extending further and further, which makes it very attractive for patients”.

TREATMENT PROCESSES Obviously, there are a variety of different causes for pain, from cancer to degenerative spinal disease and neuralgia, and tracing the

source can be difficult. The first step is clinical assessment. Then Fitzgerald and McCrory can draw in radiological investigation, blood tests and provocation testing in theatre. In the case of progressive cancer, the aim is to enable the patient to be fully awake and interactive with their family and friends for as long as possible. Dr McCrory says: “In relation to treatment, we offer a comprehensive range of options including: rhizotomy, nerve root pulsing, vertebroplasty, neurolysis for cancer pain, spinal cord stimulation and intra-thecal therapies for both multiple sclerosis and advanced cancers.” What of the future? Both Fitzgerald and McCrory would like to expand the offering even further, using other interventional techniques like neuromodulation. “We’re keen to develop it here,” Dr Fitzgerald says, “and it would be part of a pain management programme stretching into fields such as pain psychology, physiotherapy and occupational therapy”. For now, though, the department is involved with the broad spectrum of patients arriving at the doors of HMC. “General medicine, cardiology, orthopaedics, neurology, urology, general surgery – we see a lot of different aspects.” With chronic pain a daily reality for a significant percentage of the Irish population, it’s a field that can go a long way towards improving people’s lives. At HMC, the expert help of Drs Joe Fitzgerald and Connail McCrory is at hand.

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Day Care at HMC THE DAY CARE UNIT AT HMC OFFERS A WIDE VARIETY OF SERVICES, WHICH INCLUDE ENDOSCOPY, DAY CASE AND MINOR SURGERY PROCEDURES.

PICTURED: PJ Briscoe, CNM 2, Caroline Shaw, Maria Waters and Hannah Rooney

ne of the busiest departments in the Clinic, HMC’s extensive Day Care Unit offers a combined service for day care patients, including endoscopy, minor operatives, an infusion service and a dressing and plaster clinic. The CNM II in charge of the unit, Patricia Jane Briscoe is proud of the Clinic’s offering to its patients.

ENDOSCOPY SERVICES Ms. Briscoe says: "HMC offers the most efficient method for a patient to undergo an Endoscopy procedure through a process of direct referral from GPs. Adding: “A GP can refer a patient for Gastroscopy, Colonoscopy or Sigmoidoscopy directly to us, which makes a procedure much quicker and more cost effective for the patient.” This Direct Access Referral Service is accessible through most of our consultants such as Dr. Barbara Ryan, Prof. Susan Mc Kiernan, Dr. John Hollingsworth, Mr. Eadhbhard Mulligan, Dr. Richard Farrell, Mr. Eoin Mooney, Prof. Thomas Walsh and Prof. Paul Neary. Each direct referral is assessed by each consultant prior to scheduling of a procedure as not all patients are suitable for direct access”.

Ms. Briscoe adds: “We provide a diagnostic and therapeutic Endoscopy service, with specialities including gastroenterology, respiratory, urology and ENT.” Some of the therapeutic services in Endoscopy available at HMC, include haemorrhoidal injections or banding, dilatation of strictures, variceal banding, peg insertion and haemostasis of GI bleeds. The Endoscopy unit was one of the first units to be established in HMC and over the years has seen unprecedented growth. Ms. Briscoe says: “HMC’s Endoscopy service also offers a full and comprehensive followon treatment to patients, with direct access to specific expertise in the fields of surgery and radiology, including CT Colonography” The Endoscopy Unit offers a service from 7 am to 8pm Monday – Friday, with a Saturday service facilitated twice monthly at present.

The Infusion Nurse Role is provided by Ms. Caroline Shaw RGN. Ms. Briscoe adds: “Consequential to the substantial demand for and the rapid growth of this service, we now have an efficient nurse led infusion service well established”.

CONTINUED GROWTH The current facilities offer the most modern equipment available located in one Endoscopy room, one minor-op room, a dressing clinic and 20 theatre beds which deal with both adult and paediatric cases. In addition to our regular services, in our Day Theatre we are providing an efficient Laser Varicose Veins Service for our Vascular Patients and some Ophthalmic Services, for example Lucentis Injections. HMC has plans to bring further expansion to the clinic by providing an additional Endoscopy Procedure Room and a Minor Operative Procedure Room.

INFUSION SERVICES Ms. Briscoe says: We are currently facilitating an Infusion Service to a range of specialities including Neurology (Dr. Ronan Walsh, Dr. Martin Ruttledge, Dr. Brian Murray), Rheumatology (Dr. Trevor Duffy and Dr. Donough Howard) and Gastroenterology (Dr. Susan McKiernan, Dr. Barbara Ryan, Dr. John Hollingsworth and Dr. Richard Farrell).

Ms. Briscoe adds: "Patient safety and an efficient, quality care is paramount in our Day Care Unit. We aim as a multidisciplinary team to provide our clients with a high standard, professional, innovative service. The Daycare Team members are all very excited and looking forward to being a part of our future development plans."

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NURSING & CLINICAL SERVICES NURSING SERVICES Patients and families experience the best nursing care in a compassionate, supportive, interdisciplinary environment that embraces and advances professional nursing practice, education, leadership and research. An integrated structure is provided which is conducive to the provision of high quality nursing care as well as the opportunity for the professional growth and development of each individual nurse. This is achieved through the effective use of resources and equitable access to, and participation in, education and research programmes. In addition there is continued development of our nursing roles and services. The department of nursing at Hermitage is comprised of registered nurses, nursing services managers, clinical nurse managers, clinical nurse specialists, clinical facilitators, nurse educator, health care assistants and unit secretaries. This talented group of healthcare providers practice on in-patient, day care, diagnostic and critical care units as well as peri-operative and interventional cardiology. Our diverse and dynamic nursing team is supported by a strong, visionary and visible group of nurse leaders who encourage professional growth and foster a healthy work environment. Optimal care delivery is created through interdisciplinary collaboration and partnerships that promote a safe, positive, knowledgeable, creative and trusting practice environment. As vital members of the interdisciplinary team, nurses are responsible to effectively communicate information related to patient care. The founder of modern nursing, Florence Nightingale, said, “For we who nurse, our nursing is something which, unless we are making progress every year, every month, every week, we are going back. No system shall endure which does not march.” The nursing department continuously seeks to develop, challenge and mentor nurses through the advancement of their practice and encourage strong teamwork .

EDUCATION AND DEVELOPMENT FOR NURSES In the Hermitage Medical Clinic we offer a range of Nurse Education Programmes for Professional Development. Graduate Development Programme. A programme designed to develop and upskill the newly qualified Staff Nurse. Transition Programme to Acute Hospital Nursing Care A pathway from longterm residential to Acute Care Nursing. Management Development Programme. A learning map for Nurse Managers. Foundation Course in Intensive Care Nursing. A six month course combining theory and competencies in ICU/HDU Nursing. Foundation Course in Peri-operative Nursing. A 6 month course combining theory and competencies in Peri-operative Nursing. All our courses are approved for NMBI Continuing Education Units (CEU)

CLINICAL SERVICES CARDIOLOGY DEPARTMENT Our Specialist Department is staffed by a very experienced team of cardiac technicians . Our department is currently open from 9am to 5pm Monday to Friday (GP direct access). Cardiology tests include: Exercise stress testing, Echocardiography including bubble, 3D and contrast studies, Transoesophageal echocardiography (on a daycare basis), Resting ECG, Ambulatory 24 hour BP monitors, Ambulatory 24 and 48 hour Holter monitor, Event monitors (1 week), Pacemaker follow-up, Defibrillator (ICD) follow-up, Loop recorder download. PHYSIOTHERAPY DEPARTMENT The Hermitage Medical Clinic provides a patient focused physiotherapy service that is centred on best evidence based practice to provide high quality patient care. With our state-of-the-art rehabilitation service providing the following: GP Direct Access Outpatient Service, Neck and Back Rehabilitation, Sports & Orthopaedic Rehabilitation, Rheumatology and Arthritis Service, Post-Operative Care, Lymphoedema Services and Lymphoedema Care, Inpatient and Outpatient, Respiratory Physiotherapy, Occupational Health, Medico-Legal / Insurance Services, Inpatient and Outpatient, Neurological

Rehabilitation, Orthotic Prescription and Biomechanical Evaluation. ONCOLOGY DAYCARE DEPARTMENT The Oncology Day Unit at the HMC incorporates haematology also. The service on offer in the department includes treatments for neo-adjuvant, adjuvant and metastatic oncology, palliative patients and for haematology, leukaemia, lymphoproliferative disorders, such as myeloma and lymphoma and haemochromatosis and other nonmalignant blood diseases amongst others. NEUROPHYSIOLOGY DEPARTMENT The Neurophysiology department provides diagnostic testing for seizures, encephalopathy/confusion, non epileptic seizures, carpal tunnel syndrome, polyneuropathy, compression neuropathies, radiculopathy, myopathy, neuromuscular junction disorders, autonomic disorders, multiple sclerosis (evoked potentials) and trigeminal disorders. LABORATORY The Pathology Department at Hermitage Medical Clinic is one of the largest independent laboratories attached to a private hospital in Ireland. Areas of operation include Clinical Biochemistry / Endocrinology / Point of Care Testing, Haematology, Blood Transfusion, Microbiology, Immunology and Cellular Pathology. The Department is accredited by INAB (Irish National Accreditation Board) RESPIRATORY DEPARTMENT The Respiratory / Sleep Studies Department provides: Pulmonary Function Tests: used to confirm the diagnosis and track the progression of respiratory disease, as well as enabling clinicians to assess an individual’s response to a given therapy. Mannitol Challenge Test: used to confirm the diagnosis of asthma when there is diagnostic uncertainty. Skin Prick Allergy Test: these include foods, inhalants (pollen, dusts, and animal dander), insect bites and drugs.. Sleep Studies: A Sleep Study is a diagnostic recording of physical activities that occur during your sleep time.

Clinical Care Services

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EDUCATION & SOCIAL ENGAGEMENT KAREN WALSH, MARKETING AND COMMUNICATIONS MANAGER AT HMC OUTLINES SOME OF THE NUMEROUS EVENTS AIMED AT ENCOURAGING INTERACTION BETWEEN THE CLINICS AND GPS AND COMMUNITY

PICTURED: Karen Walsh, Marketing & Communications Manager, Eamonn Fitzgerald, CEO, and Marie Peelo, Fundraising Coordinator, Pieta House

H PICTURED: Mr. Weng Lee, Consultant Ophthalmic Surgeon & Mr. David Borton, Consultant Orthopaedic Surgeon

MC holds GP educational evenings on different specialities, which are all CPD accredited. These meetings are normally bi-monthly and cover the majority of subjects which are beneficial to general practice. Our Annual GP study Day is held every year in November and includes a broad range of presentations. We also hold educational evenings for GPs in neighbouring counties. We hosted a CyberKnife Symposium in February last year featuring international clinicians presenting on this new noninvasive treatment solution for people suffering from cancerous / non-cancerous brain tumours and other medical conditions (breast, lung, prostate & respiratory).

PICTURED: Brent Pope MC, Mr. Danny Rawluk, Consultant Neurosurgeon, Mr. John McCormack, CEO Irish Cancer Society & Mr. Eamonn Fitzgerald, CEO

For the past five years, we have hosted an annual Hermitage Medical Clinic GP Golf Day and supported various charities including Sick Doctor Scheme and Pieta House. Our Golf Day this year is in aid of Pieta House, a suicide and self-harm crisis centre founded by psychologist Joan Freeman. It first opened its doors in Lucan,

Co. Dublin in January 2006, and there are now four Pieta House centres throughout Dublin, one in Limerick and one in Roscrea, Co. Tipperary. Two new centres opened in December 2013 – Tuam Co. Galway and Bishopstown in Cork. A centre opened in Castleisland Kerry in February 2014. HMC is also proud to support the work of St Francis Hospice, the Irish Cancer Society, the Irish Heart Foundation and Heart Children Ireland and it has done so for the past four years through the organisation of a Charity Ball. We are delighted to host these events, as it marks the Clinic’s contribution to the message of cancer awareness and cardiac disease. We are also delighted to be able to help St Francis Hospice, the Irish Cancer Society, the Irish Heart Foundation and Heart Children Ireland in a very practical way by helping to raise funds for their work. Hermitage also supports the Colour Dash Run for the Irish Cancer Society in July. Hermitage is also the official sponsor of St Catherines Park Playground in Lucan.

Social

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Consultant

DIRECTORY CARDIOLOGISTS DR. ANGELA BROWN Secretary: Angela Tel: (087) 9004766 Fax: (01) 8901945

DR. DAVID MULCAHY Suite: 36 Secretary: Samantha Tel: (01) 6459716 Fax: (01) 6459714

PROF. BRENDAN MCADAM DR. JOHN CLARKE Suite 38 Secretary: Una Tel: (056) 7775133 Fax: (061) 415726

DR. PETER CREAN Secretary: Yvette Tel: (01) 2834159 Fax: (01) 2064220

PROF. IAN GRAHAM Suite: 36 Secretary: Janet Tel: (01) 6459715 Fax: (01) 6459714

DR. IFTIKHAR KHAN Secretary: Nicola Suite 11 Tel: (01) 6459084 Fax: (01) 6459564

DR. TORA LEONG Suite 29 Secretary: Daran Tel: (01) 6459742 Fax: (01) 6459569

DR. JONATHAN LYNE Secretary: Alex Tel: 087 622 1793 Fax: 01 902 3932

Secretary: Mary Tel: (01) 8573721 Fax: (01) 8571130

DR. DAVID P. MOORE Secretary: Geraldine Tel: (045) 989702 Fax: (045) 989726

DR. RICHARD SHEAHAN Suite 38 Secretary: Sarah Tel: (01) 8574744 Fax: (01) 8372503

DR. DEIRDRE WARD Secretary: Debbie Tel: (087) 2793046 Fax: (01) 6459451

CARDIOTHORACIC SURGEON MR. MICHAEL J. TOLAN Suite 38 Secretary: Anna Tel: (01) 6459687 Fax: (01) 6459686

DERMATOLOGISTS DR. JANE BARRY Suite 12 Secretary: Triona Tel: (01) 6459793 Fax: (01) 6459568

DR. VINCENT MAHER

MR. JOHN KINSELLA

Tel: (01) 6459016 Fax: (01) 6459460

Suite 29 Secretary: Maeve Tel: (01) 6459640 Fax: (01) 6459641

MR. SAMUEL KUAN Tel: (01) 6459016 Fax: (01) 6459460

ENDOCRINOLOGIST DR. JOHN MCDERMOTT Suite 27 Secretary: Marie Tel: (01) 6459632 Fax: (01) 6459631

ENT SURGEONS MR. BRENDAN CONLON Suite 24 Secretary: Linda Tel: (01) 6459601 Fax: (01) 6459604

MR. PETER LACY Suite 24 Secretary: Trish Tel: (01) 6459600 Fax: (01) 6459604

PROF. CONRAD TIMON Suite 28 Secretary: Irene Tel: (01) 6459635 Fax: (01) 6459636

GASTROENTEROLOGISTS DR. GERARD CLARKE Secretary: Pauline Tel: (0906) 400104 Fax: (0906) 400100

MR. ROBERT GAFFNEY

DR. JACK HOLLINGSWORTH

Suite 20 Secretary: Jackie Tel: (045) 982340 Fax: (045) 989796

Suite 19 Secretary: Janet Tel: (01) 6459608 Fax: (01) 2831471

MR. STEPHEN HONE

DR. SUSAN MCKIERNAN

Suite 8 Secretary: Nuala Tel: (01) 6459545 Fax: (01) 6459547

Suite 31 Secretary: Mary Tel: (01) 6459651 Fax: (01) 6459654

MR. RORY MCCONN WALSH

DR. ASGHAR QASIM

Suite 38 Secretary: Denise Tel: (01) 6459383 Fax: (01) 6459686

DR. SANDRA KIRKE

DR. ANDREW MAREE

DR. PATRICK ORMOND

MR. HOWARD SAVAGE JONES

DR. BARBARA RYAN

Suite 22 Secretary: Mary Tel: (01) 6459566 Fax: (01) 6459808

Suite 4 Secretary: Paula Tel: (045) 982340 Fax: (045) 989796

Suite 19 Secretary: Marese Tel: (01) 6459605 Fax: (01) 6459606

Secretary: Lyndsey Tel: 087 3817894 Fax: 01 4103745

EMERGENCY MEDICINE DR. DAVID FOLEY

Secretary: Trish Tel: (01) 6459444 Fax: (01) 6459568

Tel: (01) 2064561 Fax: (01) 2064229

Suite 21 Secretary: Lisa Tel: (086) 2257691 Fax: (045) 989796

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DR. CLAIRE SMYTH

MR. HUGO PRINS

Secretary: Helen Tel: (086) 7848442 Fax: (01) 6459606

Suite 20 Secretary: Sinead Tel: (01) 6459613 Fax: (01) 6459599

NEPHROLOGIST DR. MUHAMMAD AKRAM Suite 11 Secretary: Mary Tel: (051) 359913 Fax: (051) 359915

GENERAL, BREAST & VASCULAR SURGEON MR. MICHAEL J. ALLEN

GENERAL SURGEON MR. EOIN MOONEY

Suite 25 Secretary: Hazel Tel: (01) 6459620 Fax: (01) 6459624

Suite 20 Secretary: Mary Tel: (01) 4966262 Fax: (044) 9329937

PROF. PETER J. CONLON

GENERAL, BREAST & ENDOCRINE SURGEONS PROF. ARNOLD HILL

GYNAECOLOGISTS DR. KELVIN BOOS

NEUROLOGISTS DR. MARK EDWARDS

Suit 32 Secretary: Cathy Tel: (01) 6459656 Fax: (01) 6459657

Suite 15 Secretary: Rona Tel: (01) 6459580 Fax: (01) 6459581

DR. YAHYA KAMAL

DR. BRIAN MURRAY

Suite 1 Secretary: Maria Tel: (087) 3625010 Fax: (01) 6848913

Suite 3 Secretary: Catherine Tel: (01) 6459520 Fax: (01) 6459522

HAEMATOLOGISTS DR. PHILIP MURPHY

DR. MARTIN RUTTLEDGE

Secretary: Teresa Tel: (01) 8093760 Fax: (01) 8093758

MR. COLM P. POWER Secretary: Marie Tel: (087) 2338235 Fax: (01) 8571130

GENERAL & GI SURGEON PROF. TOM WALSH Suite 1 Secretary: Deirdre Tel: (01) 8228954 Fax: (01) 8202284

GENERAL/ COLORECTAL SURGEONS MR. EADHBHARD MULLIGAN Suite 31 Secretary: Mary Tel: (01) 6459650 Fax: (01) 6459654

PROF. PAUL NEARY Suite 2 Secretary: Mairead Tel: (01) 6459516 Fax: (01) 6159515

GENERAL ONCOPLASTIC SURGEON MR. DHAFIR ALAZAWI

Tel: (01) 8092622 Fax: (01) 8369561

Secretary: Mary/Edel Tel: (01) 8379311 Fax: (01) 8379411

Suite 15 Secretary: Rona Tel: (01) 6459580 Fax: (01) 6459581

DR. PATRICK THORNTON

DR. RONAN WALSH

Suite 31 Secretary: Anne Tel: (087) 6102636 Fax: (01) 6459679

Suite 2 Secretary: Madeline Tel: (01) 6459517 Fax: (01) 6459515

INTERNAL MEDICINE DR. PAUL KELLY

NEUROLOGIST (PAEDIATRIC) DR. DAVID WEBB

Suite 27 Tel: (01) 6459745 Fax: (01) 6459631

DR. MUHAMMAD RIZWAN UDDIN Suite 11 Secretary: Adrienne Tel: (01) 6459560 Fax: (01) 6459564

MEDICAL ONCOLOGISTS PROF. JOHN KENNEDY

Suite 15 Tel: (01) 6459582 Fax: (01) 6459581

NEUROSURGEONS MR. ZULFIQAR ALI Suite 9 Secretary: Kim Tel: (01) 6459077 Fax: (01) 6459551

PROF. CIARAN BOLGER

Secretary: Annette Tel: (086) 6690416 Fax: (01) 4103428

Suite 33 Secretary: Angela/Michelle Tel: (01) 8368847 Fax: (01) 8368859

DR. RAY MCDERMOTT

MR MOHSEN JAVADPOUR

GENERAL & VASCULAR SURGEONS MR. SAYED ALY

Secretary: Judith Tel: (01) 4142012 Fax: (01) 4142092

Secretary: Catherine Tel: (01) 8376727 Fax: (01) 837 5925

Suite 1 Secretary: Fatima Tel: (086) 6699748 Fax: (01) 6459597

DR. DAVID GALLAGHER

MR. MICHAEL KELLEHER

Secretary: Sarahjane Tel: (01) 6459995 Fax: (01) 6459494

Secretary: Stephanie Tel: (01) 8425010 Fax: (01) 8283083

Secretary: Nariman Tel: (086) 1013945 Fax: (01) 5044296

MR. JABIR NAGARIA Suite 35 Secretary: Debra Tel: (01) 6459005 Fax: (01) 6459672

MR. DONNCHA O’BRIEN Suite 25 Secretary: Eileen Tel: (01) 6459623 Fax: (01) 6459629

MR. DAVID O’BRIEN Secretary: Chris Tel : (01) 8529318 Fax : (01) 8529319

MR. DANIEL RAWLUK Suite 3 Secretary: Suzanne Tel: (01) 8375648 Fax: (01) 8375648

MR. MUHAMMAD TAUFIQ SATTAR Secretary: Linda Tel: (086) 8073646 Fax: (01) 8375071

MR. STEVEN YOUNG Suite 9 Secretary: Caoimhe Tel: (01) 6459550 Fax: (01) 6459551

OPHTHALMIC SURGEONS MS. ANDRA BOBART Suite 8 Secretary: Nuala Tel: (01) 6459545 Fax: (01) 6459547

MS. ELIZABETH CHACKO Tel: (086) 1586076 Fax: (01) 4908666

MR. MICHEÁL GALLAGHER Suite 35 Secretary: Rachael Tel: (087) 3288009 Fax: (059) 9143894

DR. AIDEEN HOGAN Suite 7 Secretary: Phil Tel: (01) 6459541 Fax: (01) 6459543

MS. RIZWANA KHAN Suite 7 Secretary: Shauna Tel: (01) 6459542 Fax: (01) 6459543

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MR. WENG LEE Suite 17 Secretary: Jane Tel: (01) 6459590 Fax: (01) 6459591

MR. PAUL O’BRIEN Suite 7 Secretary: Mary Tel: (01) 2064596 Fax: (01) 2831033

MR. MARTIN O'CONNOR Suite 29 Secretary: Noeleen Tel: (01) 6459458 Fax: (01) 6459641

MR. K. RAVIKUMAR Suite 17 Secretary: Jenny Tel: (01) 6459593 Fax: (01) 6516510

MR. AYMAN SAEED Suite 5 Secretary: Liz Tel: (044) 9329940 Fax: (044) 9329942

ORAL SURGEON MR. DARREN MCCOURT

Suite 35 Secretary: Jenny/Lorraine Tel: (01) 6459670 Fax: (01) 6459672

MR. STEFAN BYRNE Suite 27 Secretary: Maureen Tel: (01) 6459637 Fax: (01) 6459631

MR. DAVID COGLEY Suite 6 Secretary: Ann Tel: (057) 9324866 Fax: (057) 9324877

MS. OLIVIA FLANNERY Suite 16 Secretary: Annette Tel: 01 6459526 Fax: 01 6459589

MR. PADDY KENNY Suite 16 Secretary: Marie/Eileen Tel: (01) 6459585 Fax: (01) 6459589

MR. PETER KEOGH

MR. IMRAN SHARIF

DR. CONNAIL MCCRORY

Suite 13 Secretary: Eilish Tel: (01) 6459570 Fax: (01) 6459571

Suite 19 Secretary: Michelle Tel: (01) 2064585 Fax: (01) 2831471

MR. JOE SPARKES

DR. VALERIE POLLARD

Suite 15 Secretary: Fiona Tel: (045) 889245 Fax: (045) 889141

Secretary: Carol Tel: (01) 8576939 Fax: (01) 8574637

PAEDIATRIC DENTISTS DR. BARBARA COYNE Suite 10 Secretary: Christine Tel: (01) 6459555 Fax: (01) 6459556

DR. DAVID FINUCANE Secretary: Christine Tel: (01) 6459555 Fax: (01) 6459556

Suite 26 Tel: (01) 6684357 Fax: (01) 6603919

Tel: (01) 6684357 Fax: (01) 6603919

Suite 6 Secretary: Geraldine/Jean Tel: (01) 6459562 Fax: (01) 6459563

PAEDIATRICIANS (GENERAL & RESPIRATORY) DR. BASIL ELNAZIR

Suite 5 Secretary: Jacinta Tel: (01) 6459530 Fax: (01) 6459532

Secretary: Aine / Louise Tel: (01) 2135638 Fax: (01) 2135685

ORTHODONTIST DR. TOM HOULIHAN

MR. PHILIP O’CONNOR

Suite 26 Tel: (01) 6684357 Fax: (01) 6603919

Secretary: Patricia Tel: (01) 6459393 Fax: (01) 6459636

DR. JASON OWENS

DR. ABIGAIL MOORE

Tel: (01) 6684357 Fax: (01) 6603919

MR PAUL MURPHY

Secretary: Christine Tel: (01) 6459555 Fax: (01) 6459556

DR. PAUL O’REILLY

MR. JOHN LUNN

ORAL & MAXILLOFACIAL SURGEON MR. J. CLIFF BEIRNE

DR. RORY MAGUIRE

Suite 26 Tel: (01) 6684357 Fax: (01) 6603919

ORAL, MAXILLOFACIAL & COSMETIC FACIAL SURGEON MR. PADRAIG O’ CEALLAIGH

Suite 14 Secretary: Rachel Tel: (01) 6459575 Fax: (01) 6459577

Suite 10 Secretary: Christine Tel: (01) 6459555 Fax: (01) 6459556

DR. SIOBHAN LUCY

Suite 16 Secretary: Emma Tel: (01) 6459586 Fax: (01) 6459589

MR. FERGAL MCGOLDRICK

PERIODONTISTS DR. DECLAN CORCORAN

Suite 10 Secretary: Christine Tel: (01) 6459555 Fax: (01) 6459556

Suite 5 Secretary: Jacinta Tel: (01) 6459533 Fax: (01) 6459532

ORTHOPAEDIC SURGEONS MR. DAVID BORTON

DR. EIMEAR NORTON

Suite 29 Secretary: Bernadine Tel: (01) 4144128 Fax: (01) 4142191

PLASTIC/ RECONSTRUCTIVE SURGEON MR. NADEEM AJMAL Suite 25 Secretary: Jackie Tel: (01) 6459621 Fax: (01) 8376130

PLASTIC SURGEONS MR. EAMON BEAUSANG

DR. PETER GREALLY

Suite 32 Secretary: Catriona Tel: (01) 6459655 Fax: (01) 6459657

Secretary: Naoimh Tel: (01) 4142188 Fax: (01) 4142188

MR. DAVID O’DONOVAN

Tel: (085) 2347358

Suite 12 Secretary: Ciara Tel: (01) 6459565 Fax: (01) 6459568

PAIN MEDICINE DR. JOE FITZGERALD

PROSTHODONTISTS DR. EDWARD COTTER

Suite 6 Secretary: Mary Tel: (01) 2064622 Fax: (01) 2109396

Suite 10 Secretary: Christine Tel: (01) 6459555 Fax: (01) 6459556

PALLIATIVE MEDICINE DR. LIAM O’SIORAIN

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DR. EAMON CROKE Secretary: Christine Tel: (01) 6459555 Fax: (01) 6459556

DR. KEVIN O’BOYLE Suite 26 Tel: (01) 6684357 Fax: (01) 6603919

RESPIRATORY PHYSICIANS/ SLEEP MEDICINE DR. LIAM CORMICAN Suite 7 Secretary: Annemarie Tel: (01) 6459540 Fax: (01) 6459543

DR. JOHN L. FAUL PSYCHIATRISTS DR. ELIZABETH CYRAN Tel: (087) 7459766

DR. MIKE SCULLY Suite 22 Secretary: Mary Tel: (01) 6459566 Fax: (01) 6459808

RADIATION ONCOLOGISTS DR. CLARE FAUL Secretary: Patricia Tel: (01) 4065043 Fax: (01) 6459128

Secretary: Pia Tel: (056) 7775280 Fax: (01) 6459543

DR PAUL KELLY Suite 27 Tel: (01) 6459745 Fax: (01) 6459631

PROF STEPHEN LANE Suite 38 Secretary: Jane Tel: (01) 4142703 Fax: (01) 4142989

DR. IAN FRASER

RHEUMATOLOGISTS DR. CHIFAN CHEU

Secretary: Hilary Tel: (01) 4065166 Fax: (01) 6459128

Secretary: Lisa Tel: (086) 7203388 Fax: (044) 9231001

DR. OSAMA SALIB

PROF. TREVOR DUFFY

Secretary: Hilary Tel: (01) 4065062 Fax: (01) 6459128

Suite 27 Secretary: Aisling Tel: (01) 6459630 Fax: (01) 6459631

PROF FRANK SULLIVAN Tel: (01) 6459045 Fax: (01) 6459128

RADIOLOGISTS DR. GAVIN BRIGGS Tel: (01) 6459042 Fax: (01) 6459128

DR. RONAN BROWNE Tel: (01) 6459042 Fax: (01) 6459128

DR. SEAN CURRAN Tel: (01) 6459042 Fax: (01) 6459128

DR. DAVID O’DONNELL (Clinical Director) Tel: (01) 6459081 Fax: (01) 6459128

DR. DONOUGH HOWARD Suite 18 Secretary: Rachel Tel: (01) 6459595 Fax: (01) 6459597

DR. RUTH ZUTINE LEE Secretary: Breda Tel: (087) 9005451 Fax: (01) 6961071

SPECIAL NEEDS DENTISTRY DR. CAOIMHIN MACGIOLLA PHADRAIG Suite 10 Secretary: Christine Tel: (01) 6459555 Fax: (01) 6459556

DR. JOHN SHEEHAN Tel: (01) 6459082 Fax: (01) 6459128

DR. JOHNNY WALKER Tel: (01) 6459313 Fax: (01) 6459128

UROLOGISTS MR. BARRY JONES Suite 39 Secretary: Anne Tel: (01) 6459694 Fax: (041) 9803132

MR. IJAZ CHEEMA Suite 2 Secretary: Leonie Tel: (01) 6459459 Fax: (01) 6459515

MR. DENIS O’SULLIVAN Suite 39 Secretary: Ann Tel: (01) 6459690 Fax: (01) 645 9692

SPECIALIST CLINICAL SERVICES AUDIOLOGISTS ORLA JONES Suite 24 Secretary: Ann Tel: (01) 6459603 Fax: (01) 6459604

LIGIA BARBOSA

MR. KASHIF SIDDIQUI

Secretary: Ann Tel: (01) 6459603 Fax: (01) 6459604

Suite 21 Secretary: Catherine Tel: (01) 6459618 Fax: (01) 6459616

COUNSELLOR/ PSYCHOTHERAPIST MARJORIE MCNEILL

VASCULAR MEDICINE DR. MARY-PAULA COLGAN Suite 30 Secretary: Cathy Tel: (01) 6459648 Fax: (01) 6459649

VASCULAR SURGEONS MR. PRAKASH MADHAVAN Suite 30 Secretary: Clare Tel: (01) 6459645 Fax: (01) 6459649

MR. DERMOT MOORE Suite 30 Secretary: Catherine Tel: (01) 6459646 Fax: (01) 6459649

MR. SEAN O’NEILL Secretary: Rachel Tel: (01) 6459683 Fax: (01) 6459649

MEDICAL DOCTOR WITH SPECIALIST INTERESTS ALLERGIST DR. JOE FITZGIBBON Suite 21 Secretary: Caroline Tel: (01) 645961

Suite 21 Tel: (086) 8495296

DIETICIAN ELAINE MCGOWAN Suite 18 Secretary: Cathy Tel: (01) 6459617

NEUROPSYCHOLOGISTS DR. NIALL PENDER Suite 9 Secretary: Suzanne Tel: (086) 6005074 Fax: (01) 6459551

DR. MARIE MCCARTHY Secretary: Suzanne Tel: (086) 6005074 Fax: (01) 6459551

OPTOMETRIST SHEILA LEE Suite 17 Secretary: Jane Tel: (01) 6267212 Fax: (01) 6459591

ORTHOPTIST CLARE SHEEHAN Suite 7 Tel: (087) 9955399

ORTHOTIST COLM O’LAOIRE Suite 35 Tel: (086) 4082043

SPEECH & LANGUAGE THERAPISTS MARIE-THERESE O’CALLAGHAN/ GILLIAN O’NEILL Suite 20 Tel: (01) 6459612

PATRICIA GALVIN Suite 15 Tel: (01) 6459582

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General Patient

INFORMATION THE MANAGEMENT AND STAFF OF HMC TAKE GREAT CARE TO ENSURE YOU RECEIVE THE VERY BEST OF TREATMENT WHILE UNDER THEIR CARE. HOWEVER, THERE ARE SOME THINGS YOU CAN DO AS A PATIENT TO ENSURE YOUR STAY IS AS STRESS-FREE AS POSSIBLE.

ADMISSIONS

PUBLIC TRANSPORT

On arrival, please go to Reception, in the main atrium, and you will be directed to the appropriate area for registration. Here you will be asked to verify some personal details and your health insurance information (if applicable). Please bring any referral letters, x-rays or CDs as provided by your consultant or GP.

The following bus routes stop near HMC: Buses from Pearse Street: 25, 26, 25A, 66, 66A, 66B, 67, 67A Buses from Aston Quay: 40 Buses from Blanchardstown Centre: 239 Buses from Tallaght: 210

HEALTH INSURANCE Before admission, please check with your insurance company that your policy covers you for accommodation and treatments that you require and if a policy excess is payable. Patients are liable at the time of admission for any charges not covered by their insurance company. Insurance company excesses and patient shortfalls must be paid on the day of admission. On admission, please bring details of your insurance cover.

NON-INSURED PATIENTS Non-insured patients are required to pay for treatment in full on the day of admission. Please contact the Patient Accounts Department at (01) 645 9250 for an estimate of your treatment cost prior to admission. The estimate will cover hospital costs only. Professional fees for consultant medical staff are not included in the cost quoted by the Clinic and will be issued to you separately by your consultant.

MEDICATION Please bring all your prescribed medications in their original containers and a copy of your current prescription with you. It is imperative that you tell your nurse or doctor what medication (even nonprescription medication) you are currently taking.

RELIGIOUS/PASTORAL CARE The Hospital Oratory is located near the main reception area. Our chaplain is Fr. Tomy George and can be contacted at (01) 645 9796. Arrangements can be made for patients of all denominations to receive visits by their respective clergy.

Please refer to www.hermitageclinic.ie for more information.

USEFUL NUMBERS Main Reception: (01) 645 9000 Accounts (Patients): (01) 645 9250 Admissions: (01) 645 9009 Cardiology: (01) 645 9450 CyberKnife Centre: (01) 645 9045

SMOKING POLICY

Diagnostic Imaging: (01) 645 9042

For a healthier environment, HMC and grounds are a non-smoking area. Smoking is not permitted at entrances.

Emergency Department: (01) 645 9016

RESTAURANT AND SHOP

Neurophysiology Department: (01) 645 9292

The restaurant is open for patients and visitors. Breakfast, lunches, dinners and snacks are available daily. There is a shop located in the main Reception which sells a range of products including newspapers, magazines, sweets and snacks.

CONNECTIVITY Each bedside has a HI-Med system which provides TV, radio and internet services free of charge. If you would like to make use of the HI-Med telephone at the bedside, you will be provided with a HiMed card. Each card has a deposit requirement of â&#x201A;Ź5 which is refundable. Patients and visitors can use their wireless laptop PCs in the hospital as high-speed internet access is also available.

PARKING

Pulmonary Function Lab.: (01) 645 9853 Phlebotomy Services: (01) 645 9037 Physiotherapy Department: (01) 645 9012 Radiotherapy Department: (01) 645 9045

There is a public car park located beside the Clinic which is open 24 hours. The car park paystation is located in the main Reception area.

General Patient Information

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PROUDLY

ASSOCIATED WITH

THE INSTALLATION OF THE CYBERKNIFE.

PROUDLY

ASSOCIATED WITH

THE INSTALLATION OF THE CYBERKNIFE.

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230265 Glenbeigh.indd 1

FREEPHONE 1800 946 398 DAMASTOWN WAY, info@grm.ie DAMASTOWN BUSINESS PARK, www.grm.ie DUBLIN 15.

FREEPHONE 1800 946 398 DAMASTOWN WAY, info@grm.ie DAMASTOWN BUSINESS PARK, www.grm.ie DUBLIN 15. 12/06/2015 17:43 12:51 11/06/2015

HERMITAGE MEDICAL CLINIC

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HERMITAGE

Billing for minor procedures Electronic side one and patient signature collection Electronic submission via eClaims

Completion of claim forms Tracking of payments Follow up with patients and insurers

A&E collection review & system changes Side one review & collection Reporting and documentation

1890 222 777 info@medserv.ie @MedservIreland www.medserv.ie

ISSUE 3

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BUILDING FOR THE FUTURE: NEW TECHNOLOGIES

CYBERKNIFE: CUTTING EDGE TECHNOLOGY

OVERVIEW OF THE HERMITAGE MEDICAL CLINIC

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