Dr Eoin O Rathallaigh, SpR, CUH 

Dear readers,

As the winter draws in and we enjoy a return to some semblance of pre-pandemic normality, we’d like to welcome you to a special edition of the UCC Anaesthesiology Newsletter featuring the recent ICU4U2 Charity Cycle to the Garden of Remembrance in War Memorial Park, Dublin.

The cycle and Remembrance Ceremony allowed us to honour those who we have lost due to the pandemic, and their loved ones, as well as raise funds for four fantastic charities- Alone, Aware, Aware NI and Breakthrough Research. We congratulate Dr Patrick Seigne and all the other organisers, participants and everyone who contributed to this wonderful event.

We hope you enjoy a quiet moment to peruse this month’s edition, and while celebrating our recent collective clinical, academic and personal achievements.

From the first issue of January 2022, the British Journal of Anaesthesia will move to online access. In July 2022, BJA Education will also move to a digital format, with an opt-in service for print editions for a further twelve months until June 2023.

Standing on the shoulders of giants.

Dr Oonagh Hickey, Consultant Anaesthetist, CUH

On 9th September, Mr Michael O’Sullivan (Consultant Neurosurgeon) chaired a very special Grand Rounds at the CUH, celebrating 50 years of neurosurgery in Cork. In attendance were Mr Ted Buckley (Consultant Neurosurgeon) and Dr Seamus Harte (Consultant Anaesthetist) who, on the first Monday in June 1971, undertook the first neurosurgical procedure in Cork at St Finbarr’s Hospital. Various speakers outlined the past, current and future development of the neurosciences in Cork, including neurosurgery, neuroradiology, neurology and neuropathology. I had a personal interest as my father, Dr Matt Hickey, was the first neuroradiologist appointed to Cork- and the second in the country- in 1976.

September UCC Anaesthesiology Newsletter- focus on Green Anaesthesia Week

Welcome to the September UCC Anaesthesiology Newsletter. We hope that this provides a platform where we can stay informed and connected across the UCC Anaesthesiology team and beyond. We wish to send a special greeting to our overseas readers, including those based in Australia and New Zealand (Aoife- I’m glad that the Tunnock Tea Cakes arrived safely- Eoin). We welcome contributions on clinical and academic topics, teambuilding and social outings, general interest, and updates from our diaspora. Please feel free to contact Dr Eoin O’Rathallaigh, SpR, CUH or myself at yesuccanews@gmail.com.

Hello everyone and welcome to the August edition of UCC Anaesthesiology News (UCC-AN). I’d like to thank Dr. Oonagh Hickey for welcoming me on board the editorial team as we take a monthly look at professional, academic and social events within the UCC Teaching Hospital Group’s Anaesthesiology Departments. If the catchphrase hasn’t already been commissioned, maybe we might consider rebranding the newsletter to “Yes UCC-AN”?

10… 9… 8… 7… 6…

That’s about as far as you get, counting backwards, as you wait for surgery to begin – and that’s all most people know about what I do. 

But what happens between you conking out and waking up? And what does the anaesthetist have to do with it all? Do they just sit around playing sudoku while the rest of the team do all the hard work? And why are they so obsessed with what time you ate dinner?

ROTATE FOR A NEW EXPERIENCE

Dr Parvaiz Hafeez, Consultant Anaesthetist and College of Anaesthesiology Tutor

The last year and a half have been very challenging and difficult due to Covid disease and its social restrictions. During this period, trainees in the specialty of anaesthesia and intensive care medicine faced lots of stressful situations and long hours but they served with extreme professionalism and bravery. We really are very proud of our doctors for their brilliant performance in these exhausting months.

A lot of credit goes to the trainees and consultants for organising team building activities cycling, running/walking and kayaking. Let’s hope that Covid will be a thing of the past and that life moves towards normality.

Undoubtedly, trainees rotating within the various anaesthetic departments as well as doctors coming from other cities will enjoy their time here & experience great clinical exposure and learning. Obviously the cultural and social component of this region is amazing, and we hope you enjoy it.

Wishing you all the very best!

Dr Orna Ní Choileain, SHO, Cork University Hospital

Dear all, I’d like to thank Dr Oonagh Hickey for the invitation to write the introduction to the second newsletter. It’s an intimidating task to follow on from the prolific Dr Brian O’Brien, so I will play to my strengths and keep it brief. 

I am writing on behalf of this year’s crop of beginners. We started our careers in anaesthesia at the height of a global pandemic and have finished the year in the midst of a ransomware attack. I’m sure I’m not alone in hoping these events will be once in a career occurrences. I had been warned that the learning curve of the first six months would be steep, but no one expected the many conversations discussing our favourite FFP masks or that we would have gone so long without seeing one another’s faces. I also definitely did more cycling than I ever had before!

Dr Brian O’Brien, Chairman

Dear all, I’m grateful to Oonagh Hickey for the invitation to provide a departmental update for our website, and indeed, for her and Prof Shorten’s initiative in establishing and advancing the website itself. This is a difficult era for personal communication, and we grow ever more reliant on electronic means to keep in touch. Thus, further development of the website is timely. In any given year, with such a large team, there are inevitably defining experiences - successes and failures, moments, indeed, of triumph and despair. Some are collective phenomena, like the current pandemic, others individual, such as the births, deaths, and various career landmarks that punctuate our calendar. Every six-month term will involve cards or texts of condolence and congratulations, interspersed with exam dates, graduations and interviews.

The third wave of the COVID 19 pandemic put significant strain on the nation’s healthcare service. Frontline healthcare workers across the country, including the members of the CUH Department of Anaesthesia, were faced with the challenge of caring for a rapidly increasing number of critically unwell patients presenting with COVID related illnesses in addition to addressing the usual service requirements. As always, teamwork, professionalism and compassion were abundant- both within the Department and across the many fantastic healthcare teams in which we function. However, as the clinical situation stabilised and the vaccine program was rolled out, we found time to regroup and to formally welcome the new colleagues who had joined us during this time.

The College of Anaesthesiologists of Ireland and the Faculty of Pain Medicine will hold the next Congress of Anaesthesiology on Thursday and Friday, 20th and 21st May 2021. The Congress will be delivered virtually and will be jointly hosted by the CAI and the Faculty of Pain Medicine. The theme of the Congress 2021 is the safety and well-being of patients and health professionals. During the 2-day

Delegates will also get the chance to attend workshops on pain medicine, regional anaesthesia and peri-operative medicine (PoCUS). Among the novel sessions are: the Sustainability Session, The Inaugural Brian Kavanagh Session and an interactive session on how to: develop an application to secure Specialist Registration. The event registration is not yet open but you can register your interest by sending an email to Lucia Zelenska at congress2021@coa.ie.

Department of Anaesthesia and Intensive Care

As part of the ongoing efforts to maintain morale in a time of social distancing and altered work practices, Dr Aoife O’Loughlin (SpR) and Dr Claire Healy (SHO) organised a “Who’s hand is it anyway?” photograph competition, inspired by Dr Patrick Hassett (Consultant). Members of the Department were invited to submit a photograph of their hand while including an item which would serve as either a clue or a red herring. Such items included a fencing foil, a copy of Peig, Game of Throne’s embroidery, a shark’s tooth, a machete, two dogs and a rather cute baby. A photo of a handstand and an audio clip of superb piano playing were also included and served to remind us that our colleagues are not just talented clinicians.

The Henry Hutchison Stewart Scholarships are awarded annually by the National University of Ireland to medical students at NUI universities. In UCC, students are nominated by School of Medicine to sit the HHS exam in Anaesthesia based on the quality of a literature review completed as part of their research project. The NUI examination itself is essay-based, with titles being circulated to nominees one week in advance.

The CUH Anaesthesia department has been rising to the challenge of keeping up morale and being sociable while maintaining social distance and a large workload.  As a part of this, we held two contests over the Hallowe’en: a Jack O ‘Lantern competition and a baby photo guessing game.

With all the boredom of lockdown, I saw the new student medical journal was being started up and an email was sent to all students looking for submissions. On different placements, from multiple doctors, there was a strong message that research experience would be beneficial, if not required, for different applications or interviews. I am not usually one to care too much about the future, usually hoping things will work out while refusing to put in any real effort. But the monotony of lockdown was the main contributor to revisiting the torment of my literature review. Writing it earlier in the year was one of the worst experiences in college, writing most of the weekend before it was due, with very little guidance, or even idea of what a literature review was.

The Irish Pain Society held a very successful virtual Annual Scientific Meeting on Saturday the 10th of September, 2020. Dr Khaled Masaud, presenting research conducted on determinants of pain after breast surgery at Cork University Hospital, was honoured to receive both the inaugural Raftery Medal 2020 for best poster submitted by a doctor in training and the Irish Pain Research Network (IPRN) Award for original research.

New appointments as Adjunct Clinical Lecturer at UCC.

Congratulations to the following on their appointments to UCC as Adjunct Clinical Lecturer for the
coming academic year (2020/21).
Dr. Emma May Lyons (MUH)
Dr Aogán Ó Muircheartaigh (CUH)
Dr John Robert Sheehan (CUH)
Dr Aoife O'Loughlin (CUH)
Dr. Corina Soare (CUH)

The role of Adjunct Clinical Lecturer is newly established by the School of Medicine and entails developing and delivering teaching to medical students and doctors in training. Our new ACLs have been informed of their appointments by Professor Paula O’Leary, Dean of the School of Medicine. The appointments are made by the President of UCC based on the recommendations of the theAdjunct Committee of the College of Medicine and Health. Our Department is grateful to the appointees for taking on these extra responsibilities and wish them well for the year ahead.

Abnoos Mosleh-Shirazi is a 4th year medical student at University College Cork. Recently,  Abnoos received a medical undergraduate research supplement award for a project in the area of regional anaesthesia.

UCC medical students Sinead Forde and David Reidy presented their work virtually at the prestigious World Institute of Pain Congress in Rome on August 26-29, 2020. Both research projects were supervised by Dr Dominic Hegarty , Pain Management Specialist at the Mater Private Hospital and Honorary Treasurer of the World Institute of Pain. Sinead’s work identified a close association between self-perceived disability outcomes and self-efficacy for function in patients with chronic low back pain. David’s work supports the inclusion of the Prescribing Skills Assessment tool in the pre-registration requirements for Irish medical students.

A bitter-sweet memory will be the retirement of Dr Rodney Meeke. To call him a legend is an understatement. He is an excellent clinician, an enthusiastic teacher, and an absolute gentleman. He is hugely popular with staff throughout the hospital. Given the need for social distancing, the CUH canteen was utilised to facilitate colleagues (current and retired) from the CUH and the other city hospitals to wish him well. The guests of honour were his daughter Joanna and son Dr James Meeke. Rodney will be missed but we wish him the very best in his future adventures.

The Health Research Board (HRB), the College of Anaesthesiologists of Ireland (CAI), and the Irish Clinical Academic Training programme (ICAT) come together to boost research careers amongst Ireland’s future academic clinicians.

With this initiative, clinicians in anaesthesiology, intensive care and / or pain medicine will soon have further opportunities to pursue careers as academic clinicians and gain valuable skills in combining clinical research with their clinical practice.

This year’s winner of the Delaney Medal Competition was Dr Dylan Finnerty for his project entitled  “a Prospective, Randomised, Double-Blind Clinical Trial comparing Erector Spinae Plane Block with Serratus Anterior Plane Block for Quality of Recovery and Morbidity after Minimally Invasive Thoracic Surgery” [ppt]. One of the panel of judges Professor Adam Sapirstein of Johns Hopkins Medical Centre, US described Dr Finerty’s work as “A tour de force project and presentation. A clinical trial that can change practice is a profound undertaking. The presenter demonstrated how and why this was done. The results were indisputable and the project will have lasting impact”.

Anaesthesiology has become the first medical discipline in Europe to express a unified and comprehensive vision for Competency-based Training and Education (CBMET). In a Consensus Statement produced jointly by the European Board of Anaesthesiology (UEMS) and the European Society of Anaesthesiologists published in the European Journal of Anaesthesiology, the Statement expresses the need for and methodology required to change to CBMET.

On Friday 24th January, as a continuation of the monthly “Coffee and a Gas” initiative, members of the CUH Anaesthetic Department gathered in the Anaesthetic Office for pizza. This provided an excellent opportunity for us to welcome new members to our Department and to chat in a relaxed non-clinical environment.

On Saturday, the 14th of December, a brave group of anaesthetists from the Cork University Hospital Anaesthetic Department and their family members gathered at the “Cork on Ice” ice-rink. The more experienced of the group took time out from skating backwards to assist those who had never done battle with ice and gravity before. Having survived the session unharmed, the group retired to the café for hot chocolates and a debrief. There was an outbreak of “bunny ears” while the group photographs were being taken followed by a spontaneous round of applause for Dr Jemima Nilan  who had organised the outing.

Irish Doctors for the Environment is a group of doctors and medical students in the Irish Healthcare System who came together almost two years ago. We encompass a broad spectrum of specialities who all believe in one thing: environmental health is human health. We aim to create awareness, interest and implement action around environment health and the impact it has on our patients’ health.

The major medical journals: the Lancet and New England Journal of Medicine are in agreement-this is the consensus opinion of the medical community-climate change is real, and it is undoubtably the biggest issue to face us in the coming years. We must act, we must inform. Committing to this issue is arguably the single best use of our medical degrees and higher level training.

On the 16th of December, members of the CUH Anaesthetic Department gathered for the last Coffee and a Gas session of the year. Dr Jan Brohan, Consultant Anaesthetist, brought spiced beef (a Cork Christmas delicacy) and many more brought in home baked foods. We had the largest attendance yet for one of the CUH coffee and a gas sessions, with two NCHD’s coming in from home specially for the occasion- one with home made brownies straight from the oven.

Dr Dorothy Breen and Prof George Shorten, with the support of the Clinical Research Facility-Cork have been awarded EU 280,000 jointly by the HRB and HSE to fund a patient safety research project entitled; PROTECT. The Research Collaborative in Quality and Patient Safety (RCQPS) award  is intended to promote research in quality and patient safety in healthcare. PROTECT  aims to determine the effectiveness of an interdisciplinary,  outcomes-based, team training programme for Safety Huddle performance in decreasing the incidence of patient adverse events. The study will be conducted in Cork University Hospital and University Hospital Waterford.

We are delighted to announce that Dr Karthik Srinivasan recently received the  HSE Open Access Researcher of the Year 2019 award from Ms Ana Terres, Deputy National Director HSE. The award made jointly with Prof George Shorten was based on the work on proficiency based progression training in epidural placement at Cork University Maternity Hospital. “Proficiency-based progression training: an ‘end to end’ model for decreasing error applied to achievement of effective epidural analgesia during labour: a randomised control study”.

We spiced up the November "Coffee and a Gas" with some delicious homemade Lamb Qorma and Chicken Biryani which was very kindly prepared by Dr Nasser Khan, Senior Registrar, and his lovely wife Sadia. We had the best turnout yet. Soft drinks were provided, and some of the Department were convinced to try Tanora for the first time- a classic Cork favourite.

The Association of Anaesthetists of Great Britain and Ireland (AAGBI) first promoted the "Coffee and a Gas" initiative in 2017 to promote team building and wellness within Anaesthetic Departments (https://anaesthetists.org/). The hope is that encouraging members of Departments to chat in an informal environment will empower staff to discuss issues and concerns more openly and will lead to reduced stress levels. The AAGBI has also recently become a member of the "Zero Suicide Alliance". The AAGBI website contains very useful links and resources for supporting members and promoting wellness. The AAGBI suggested that Anaesthetic Departments around the UK and Ireland would hold a "Coffee and a Gas" during the week of 18th-22th November and we were very happy to coordinate our monthly meeting with this.

The ASSERT Centre (Application of the Science of Simulation to Education, Research and Medical Technology) at UCC has entered into a landmark partnership with Vodafone Ireland, becoming the first 5G telemedicine and medical robotics training centre in the world. The announcement was made by the Táiniste and Minister for Foreign Affairs and Trade, Simon Coveney TD, at the launch event on 13th of August 2019.

ASSERT enables clinicians, industry and academics across a broad spectrum of healthcare research to design, develop, deploy and trial innovative and disruptive healthcare solutions, in a simulated healthcare environment that deliver real world solutions for healthcare problems in the developed and developing world.
The ASSERT Centre showcases real-time monitoring, telemedicine, and robotic surgery, integrated with wearable Internet of Medical Things-based devices. This provides a consolidated ecosystem that truly digitizes healthcare to provide personalised, precise, predictive, participatory and timely healthcare that benefits patients, their caregivers, healthcare professionals and healthcare providers.
The ground-breaking 5G announcement is set to revolutionise healthcare delivery across Ireland and the world, with ASSERT in Cork to become a Vodafone 5G global centre of IoMT excellence for healthcare and end-to-end solution development.
 

Gut Microbiome and Persistent Postoperative Pain After Breast Cancer Surgery

For the presentation of this research work in the Congress of College of Anesthesiologists of Ireland this year (2019), we are delighted to announce that Khaled Massaud won the AbbVie Scholarship Competition. He was competing for the scholarship with Hassan Ahmed who also presented his research work “Proficiency based progression training for epidural analgesia in labour” which is conducted in CUH.

To celebrate World Anaesthesiology Day on October 16th, 2019, the college of Anaesthesiologists of Ireland Committee of Anaesthesia Trainees (CAT) promoted a National Coffee and a Gas Day. The Association of Anaesthesiologists of Great Britain and Ireland (AAGBI) promotes the Coffee and a Gas Initiative to address anaesthesia wellbeing and mutual support. Cork University Hosptial is a particularly busy hospital, with an ever-expanding Department of Anaesthesia working across many clinical areas. We support a monthly Anaesthetic Coffee and a Gas Session, and we find it to be a great opportunity for members of the Department to meet and chat in an informal non-clinical environment. It also introduces a great sense of fun ino the Department.We are delighted to facilitate the CAT initiative. Coffee and Halloween themed doughnuts were provided. Celery sticks and low-fat humus were available for the 'My Body is a Temple' crew following the good-natured circulation of #healthylivesmatter and #fitshaming messages. One of the organisers ate a lot of left-over celery over the following few days.Dr Nasser Khan, Senior Registrar, has volunteered to make 'Nice and Spicey' curry for the November Coffee and a Gas session, which will be ery welcome as the winter sets in.

Organisers: Dr Murray Connolly, Spr5 (CAT Committee, Irish representative AAGBI), Dr Oonagh Hickey, Dr Brian O'Donnell, Dr Niamh McAuliffe, Consultant Anaesthetists.

Dr Dorothy Breen and colleagues have just published an important research article in the BMJ Open describing how proficiency based progression training improves clinical communication. Simulation-based training is being increasingly deployed for both technical and non-technical skill acquisition in healthcare with the aim of reducing medical error and patient harm. There is a need for an evidence-based approach to such training to ensure that the resources utilised can reliably deliver a quantifiable improved skill set rather than just an enhanced educational experience. Proficiency-based progression (PBP) training is a form of outcomes-based training that involves training individuals to achieve a proficiency benchmark against a set of clearly defined objective metrics. It has been robustly shown to improve the performance of individuals undertaking technical procedures metrics. PBP methodology has not previously been applied to simulation-based training for non-technical skills yet communication failures are a significant source of medical error and preventable adverse events equal if not greater than errors due to lack of technical skill. This study shows the effect of such training on communication for the Deteriorating Patient.  

Prof George Shorten presenting at the TechConnect Live exhibition on, 'how training doctors with artificail intelligence (AI) could improve patient outcomes'. AI refers to the capacity of a computer to perform operations analogous to learning and decision making in humans. Machine learning is one advanced application of AI concerned with developing computer programs that automatically improve with experience.

In May, eleven brave members of the CUH Anaesthetic Department reported to Oysterhaven for team building activities. We kayaked across the bay, where we were encouraged to stand up in the kayaks. This led to random acts of piracy such as ramming, attempted capsizing and some terrible jokes. We were then challenged to run the length of the very slippery “moonwalk” inflatable. The Consultants were enthusiastic if ungraceful, but youth and agility won out. This was followed by a very competitive race to the shore on two giant paddleboards. Bragging rights were exercised over a well-earned lunch.

Exam focussed tutorials take place weekly in Cork University Hospital on Tuesday mornings. These are open to all anaesthesiology trainees within the Cork area who are preparing for the College of Anaesthesiologists of Ireland membership or fellowship examinations. These tutorials comprise of interactive discussions surrounding exam topics and sample exam questions, with advice for exam technique from experienced examiners. These tutorials will be tailored to meet the needs of the exam candidates, in so far as is possible. Exam candidates are advised to contact the Cork University Hospital Anaesthesiology Exam Tutor, Dr Janette Brohan for more details- janette.brohan@hse.ie.  

Prof. Shorten will present on 'Equations that come up in Part 1 MCQ exam' in 1A/1B tutorial room at 7am on Tuesday the 30th.

The human gut microbiota consists of trillions of bacteria which have co-evolved with humans to live symbiotically in the gastrointestinal tract. In recent times, the influence of the gut microbiome (collective genome of all mircoorganisms) on the body in health and disease has come to the fore. Studies have revealed how alterations in the composition of the gut microbiota influence normal physiology and contribute to a variety of diseases. Accumulating data, including that from Dr. O’Mahony’s lab, now indicates that central nervous system function and behaviour can be influenced by the gut microbiota.

Medical errors account for as many as 250,000 deaths in the US every year. A significant proportion of such errors (44% by one estimate) are related to procedural skills. Although simulation based training methods have been developed to address the deficiencies in training, there is limited evidence to show it reduces procedural errors or that it improves patient outcomes. By employing a tool known as “Pro­fi­ciency-based pro­gres­sion (PBP)” we were able to show improved pa­tient outcomes. Pre­vi­ous in­ves­ti­ga­tions of med­i­cal train­ing using this tool have fo­cused on the per­for­mance of the doc­tor rather than a mean­ing­ful pa­tient out­come.

The Cork Academy of Regional Anaesthesia (CARA) was incorporated in 2015 to provide high quality, contemporary postgraduate training to anaesthetists and allied health professionals in Ireland and across Europe. Since 1999 the regional anaesthesia specialists in Cork University Hospital have held an annual cadaveric peripheral nerve block course in University College Cork. Our aim has always been to produce state-of-the-art educational experiences drawing on the combined resources of an exceptionally well-trained and experienced faculty and world class facilities. Key priorities of CARA are: (1) the translation of novel and contemporaneous training curriculae and assessment tools into deliverable units of education; and (2) the support of ongoing research.

“In anaesthesia and critical care, as in medicine in general, use of machine learning makes it possible for every new patient to take direct advantage of the data and experience accumulated by the treatment of a large number of previous patients with a similar condition.” This is the claim made in an editorial in the British Journal of Anaesthesia by Dr Karthik Srinivasan (Tallaght Hospital, Dublin), Dr Ingerid Reinertsen (SINTEF, Norway) and Prof George Shorten (UCC).

Facing Africa is a British charity which twice a year funds a volunteer team of 3 Anaesthetists, 4 Surgeons and a number of Nurses to go to Addis Ababa in Ethiopia where they perform reconstructive surgery. The disease Noma is an acute, rapidly progressive, necrotising infection of the mouth. It begins as a small, gingival ulcer and results in gangrenous necrosis of the surrounding facial tissues. Survivors of acute Noma usually have severe disfigurement and functional impairment including trismus, oral incontinence, difficulties eating and speech problems. The Facing Africa charity seeks out these patients in very remote, rural areas of Ethiopia, Sudan and Somalia and brings them to Addis Ababa for nutritional and medical care prior to performing complex and frequently multi-stage operations (often over several trips and years) before helping to integrate them back into their homes.