Robotic Surgeries to be Streamed Live to University of Limerick GEMS

UL Hospitals Group began live-streaming robotic surgical procedures from the operating room in University Hospital Limerick (UHL) to the new Clinical Education and Research Centre (CERC) at the weekend, as part of the educational component of the Group’s robotic surgical programme. The next step is to live-stream to lecture theatres in University of Limreick’s Graduate Entry Medical School (GEMS).

Three-hundred-and-sixty degree live streaming will now form part of surgical training and medical education for GEMS students and students across all healthcare and medical disciplines from University of Limerick (UL). It will also form a strong educational component for non-consultant hospital doctors/registrars, nursing staff and allied health professionals working in the UL Hospitals Group.

On Saturday, November 25, more than 100 consultant urologists, colorectal surgeons, senior registrars, gynaecologists and health professionals from around the country watched the inaugural live-stream of a robotic surgical procedure at the annual South West Urological Meeting held in the state-of-the-art CERC building which was jointly funded by the Health Service Executive and University of Limerick

The surgery was carried out by renowned consultant urological surgeon and honorary senior lecturer, Guy’s Hospital and King’s College London, Mr Ben Challacombe, who was invited by the UHL robotic team to perform this surgery with them.

“It is a great honour to come to UHL and to demonstrate complex robotic kidney surgery using the new live streaming technology, I would like to thank the team at UHL for inviting me, the teamwork and professionalism of the whole surgical team here in Limerick is second to none,” Mr Challacombe said.

In November last year, UHL became the first public hospital in Ireland to perform colorectal, kidney and adrenal surgical procedures using the Da Vinci Xi Dual Console Robot. One year on, over 110 colorectal, adrenal, kidney and other urological cases have been performed.

The Da Vinci Xi technology has particular advancements not available with standard keyhole surgery. 3D-HD visualisation provides surgeons with a highly magnified view, virtually extending their eyes and hands into the patient, almost as if the surgeon were ‘standing inside the abdomen and reaching out to the organs’. The robot is secured or ‘docked’ to the patient and has four working arms (each requiring only an 8mm skin incision) to which operating instruments are attached. Once docked, the robotic arms and instruments are controlled by the surgeon, or surgeons, who are seated at the consoles nearby. The instruments are extremely precise, with no tremor, and they can in fact achieve activities not possible with the human hand, though they would never replace the human hand, they are completely controlled by the surgeon.

Professor J. Calvin Coffey, Foundation Chair of Surgery GEMS, UL and general and colorectal surgeon, UHL, explained the enormous benefits of the live-streaming technology for students: “To date, surgical lectures at GEMS have taken place using video or powerpoint presentations; students do not have access to cadavers. Now, with our new live-streaming technology, students can observe complex operations live and interact from the classroom with the surgeons in the theatre. They can view the anatomy of the patient close up and observe the robotic arms and instruments, providing an unrivalled educational opportunity.”

“The robotic programme at UL Hospitals has been developed to bring the highest international quality standard of robotic surgery to the Midwest Region providing equity of access to all patients. Up to now, robotic surgery has been embedded in the private sector, apart from gynaecologic surgery. For the past year, it has been available to public and private patients alike with over 110 cases performed across colorectal, adrenal, kidney and gynaecological disciplines,” said Professor Coffey.

Speaking about the benefits to surgeons (trainee and trainers), consultant urologist, robotic surgeon at UHL and Chair of the South West Urological Meeting Mr Subhasis Giri added, “The Da Vinci dual console allows two surgeons to operate in synergy with pooling of expertise and maximising patient benefit in complex cases in a multidisciplinary setting. This also greatly facilitates dedicated robotic training for the surgeons of tomorrow, which to date is not available anywhere else in Ireland. Now, with 360 degree live-streaming from the operating room (OR), all of our residents can not only observe this surgery and 360 degree perspective of the operating theatre, but can also see a ‘robots-eye-view’ of the inside of the patient and ask practical questions to the surgeon or any member of the theatre team in real time. While technical skills are important, young surgeons also need to learn how to manage the stresses of the actual OR , it’s difficult to learn this from a simulated environment”.

The next step is to live-stream to lecture theatres in UL, the other hospitals within UL Hospitals Group and then globally using the new technology, where students, doctors and medical professionals will be able to log onto the web based live-stream system using a password. Whilst the current live-streaming technology is in 2D, it is envisaged that this will soon be available in 3D.

UL, academic partner to UL Hospitals Group, donated €135,000 to the project for Audio Visual and training equipment and a further €22,000 was donated from the UL MELG (Medical Education Liaison Group) Fund for Live Streaming equipment this year.

Des Leddin, Head of the Graduate Entry Medical School (GEMS) at University of Limerick commented: “At UL, we are delighted to have access to this marvellous teaching tool for our students, allowing them to observe complex operations ‘live’ alongside our top surgeons. Not only will this experience be educationally enriching but I believe that it will also inspire the next generation of high-tech surgeons”.

Colette Cowan, CEO of UL Hospitals Group commented, “Since the robotic programme ommenced last year, we have begun to substitute keyhole surgery with robotic surgery where it’s possible at UHL and the benefits to our patients are enormous. Today, we have seen the huge educational benefits of the robotic programme for our young surgeons and for medical students alike, which is enhanced with the new live streaming technology. I know that I am immensely proud to see this come to fruition and I hope that it will serve them well in their careers into the future”.

Robotic surgery represents the highest international standard of surgery worldwide and is the most advanced form of key hole surgery available to patients. Data from UL Hospitals Group demonstrates that post-operative recovery is twice as fast with robotic surgery than with standard keyhole surgery, with an average postoperative hospital stay of approximately four days. There is also minimal blood loss and a reduction in post-operative pain with robotic surgery.

The Da Vinci Xi program continues to develop under the guidance of Ms Suzanne Dunne, head of strategy UL Hospitals Group and Project Manager for the Robotic Surgery Program. According to Suzanne, “Three components have been fundamental in the program’s success to date; team collaboration and engagement, the multidisciplinary Robotic Assisted Surgery (RAS) forum and the significant data analysis which is collated weekly. The data is crucial in term of patient outcomes, quality improvement, performance and financial monitoring”.

The robotic program was recently further strengthened by Mr Colin Peirce who has developed the robotic assisted program for colorectal surgery. Mr Peirce has also coordinated educational courses, published in Techniques of Coloproctology on the usage of the Dual Console, and delivered international lectures on the topic.

The Da Vinci Xi robotic programme at UL Hospitals Group cost €2.8 million in total and was supported by the Midwestern Hospitals Development Trust, the JP McManus Benevolent Fund, University of Limerick and UL Graduate Entry Medical School. Valued at approximately €2.6m, the Da Vinci Xi robot and equipment was donated by the Midwestern Hospitals Development Trust and funded with the generous support of the JP McManus Benevolent Fund. The CERC development is a partnership project between UL Hospitals and the University of Limerick (UL) and is co-funded by both the HSE and UL with an overall project cost of circa €12.75m. The CERC accommodates and supports the comprehensive educational, training and research needs of both the UL Graduate Entry Medical School and the UL Hospitals medical community across all disciplines.

UL Health Research: Connecting Our Future

On Thursday 19th May 2016 Dr Pat Kiely, GEMS Senior Lecturer in Molecular Biology, hosted a public event outlining how collaborative research is helping us target Ireland’s diseases.

Medical students, nursing students, parents, school kids, teachers and the general public were invited to take part in a public forum discussing how we can target these diseases head on by working together with researchers from around the world. The audience enjoyed contributions from leading researchers in their fields covering topics from scientific research, to health awareness and health education that were disseminated to the audience on a relatable level, especially for those from a non-scientific background.  Invited speakers and topics on the night included;

Professor Dorit Ron, University of California, San Francisco – Alcohol abuse disorders and addiction.

Professor Rosemary O’Connor, University College Cork – Cancer biology and diabetes.

Prof Aideen Long, Trinity College Dublin – Immune system functions in health and disease.

Prof Marco Racchi, University of Pavia, Italy – Alzheimer’s disease.

Dr Giorgia Egidy: Pasteur Institute, Paris – Melanoma

pat kiely.png
Pictured above: Dr Pat Kiely and his lab team from UL GEMS along with speakers from the event, Prof Dorit Ron, Prof Rosemary O’Connor, Prof Aideen Long, Prof Marco Racchi, Dr Giorgia Egidy, Prof Lasse Jenner, Dr Emanuela Crosini along with visiting postgraduate students from Denmark and University College Cork.

UL GEMS And UHL Research Wins At Irish Society Of Clinical Microbiologists

Dr Ciara O’Connor, MD candidate at University of Limerick’s  Graduate Entry Medical School, has been awarded the Irish Society of Clinical Microbiologists prize for best Oral Presentation at a meeting held in Dublin on 27th Feb 2016.

Dr O’Connor, who is supervised by Prof Colum Dunne (GEMS Director of Research) and Dr Nuala O’Connell (Consultant Microbiologist and Adjunct Clinical Senior Lecturer at GEMS), presented two studies focused on the clinical challenges posed by multidrug-resistant bacteria: “A report of the first outbreak of New Delhi metallo-beta-lactamase (NDM) – 1 carbapenemase producing Enterobacteriaceae in Ireland” and “Irrepressible carbapenemase-producing Enterobacteriaceae in the Mid-West of Ireland? A retrospective epidemiological and microbiological review of 140 isolates from 2009 to 2015”.

Dr O’Connor has also recently published a report describing the incidence of a multidrug-resistant bacterial outbreak and its successful management, with a focus on patient outcomes.

This can be found here: http://www.journalofhospitalinfection.com/article/S0195-6701(15)00031-6/abstract and

The Photograph shows (left to right): Prof HGM Niesters, UMC Groingen Holland, Dr Ciara O’Connor (GEMS and University Hospital Limerick) and Dr Susan Knowles, President of the Irish Society of Medical Microbiologists.

UL GEMS signs MOU with leading US Medical School

(L-R) Professor Javier Escobar, Associate Dean for Global Health (Rutgers), Emmeline Searson GEMS International, Professor Paul McCutcheon UL Vice President, Eugene Griffin, Limerick City & County Council, Professor Vicente Gracias, Medical School Dean (Rutgers),Christy O’Connor, Limerick City & County Council, Professor Michael Larvin Head of the GEMS and Sharon Nolan GEMS
(L-R) Professor Javier Escobar, Associate Dean for Global Health (Rutgers), Emmeline Searson GEMS International, Professor Paul McCutcheon UL Vice President, Eugene Griffin, Limerick City & County Council, Professor Vicente Gracias, Medical School Dean (Rutgers),Christy O’Connor, Limerick City & County Council, Professor Michael Larvin Head of the GEMS and Sharon Nolan GEMS

The University of Limerick has signed a Memorandum of Understanding between its Graduate Entry Medical School (GEMS) and one of North America’s leading comprehensive medical schools, the Robert Wood Johnson Medical School, located in New Brunswick, New Jersey and part of Rutgers, The State University of New Jersey.  The agreement will facilitate the exchange of undergraduate and postgraduate students studying Medicine between both institutions. It will open up opportunities for UL medical students to study overseas as part of their programme at GEMS.  It is also hoped to develop research collaboration.

There is an added dimension to this new agreement as Limerick and New Brunswick are sister cities, linked by direct flights daily between Newark and Shannon airports. This agreement is particularly important for the city of Limerick as it builds on relationships initiated through Limerick City and County Council and the City of New Brunswick. Key in the development of the emerging relationship were Eugene Griffin at Limerick City & County Council, and Professor Bill Shannon, UL GEMS Director of International Liaison.

The agreement was signed on behalf of UL by Professor Paul McCutcheon, Vice-President Academic & Registrar,  he commented:  “The University is moving forward later this year with its new five year Strategic Plan, ‘Broadening Horizons’, one of the aims of which is to further strengthen the institution’s international profile.  This MOU presents exciting opportunities for co-operation, not only of benefit to both medical schools, but also for wider collaboration between our Universities.”

The MOU was signed during an official visit to UL by leading faculty at Robert Wood Johnson Medical School, including Professor Javier Escobar, Associate Dean for Global Health and Professor Vicente Gracias, Medical School Dean and Chief Executive for the Robert Wood Johnson Hospital group.  Commenting on this new agreement, Professor Michael Larvin, Head of the GEMS, said, ‘We are delighted to have concluded this new agreement with Robert Wood Johnson Medical School and Rutgers University.  We are all looking forward to developing the relationship between both institutions, and to realising the significant opportunities this offers both our students and research staff.’

Robert Wood Johnson Medical School encompasses 20 basic science and clinical departments, hosts centres and institutes including The Cardiovascular Institute, the Child Health Institute of New Jersey, the Center for Advanced Biotechnology and Medicine, the Environmental and Occupational Health Sciences Institute, and the Stem Cell Institute of New Jersey. The medical school maintains educational programs at the undergraduate, graduate and postgraduate levels on its campuses in New Brunswick and Piscataway and provides continuing education courses for health care professionals and community education programs. In addition, Robert Wood Johnson Medical School has 34 other hospital affiliates and ambulatory care sites throughout the region.

UL Celebrates Conferring of 156 Students of Medicine & Clinical Therapies

Special Distinction Awards recipients (left to right), Jennifer Johnson, First Prize in the Discipline of Obstetrics and Gynaecology, Aine Fox, Swords Co. Dublin, First Prize in the Discipline of Paediatrics, Carla Henderson, Canada, First Prize in the Discipline of General Practice/Primary Care, Deirdre Smith, Kilbride Co. Meath, First Prize in the Discipline of Psychiatry, Emma Tierney, Ennis Co. Clare, First Prize in the Discipline of Medicine and winner of overall student prize, and James Dalrymple, Curragha Co. Meath, First Prize in the Discipline of Surgery.
Special Distinction Awards recipients (left to right), Jennifer Johnson, First Prize in the Discipline of Obstetrics and Gynaecology, Aine Fox, Swords Co. Dublin, First Prize in the Discipline of Paediatrics, Carla Henderson, Canada, First Prize in the Discipline of General Practice/Primary Care, Deirdre Smith, Kilbride Co. Meath, First Prize in the Discipline of Psychiatry, Emma Tierney, Ennis Co. Clare, First Prize in the Discipline of Medicine and winner of overall student prize, and James Dalrymple, Curragha Co. Meath, First Prize in the Discipline of Surgery.

The University of Limerick celebrated the graduation of 156 students today from the Graduate Entry Medical School (GEMS) and Clinical Therapies Department. Among the graduates 106 doctors were conferred with their medical degrees as they became the 5th graduating class of the Graduate Entry Medical School at the University of Limerick. 50 Clinical Therapies graduands received their awards – 24 from the MSc in Occupational Therapy and 26 from the BSc in Physiotherapy, the 10th graduating class of the Physiotherapy programme at UL

Established in 2007, the Graduate Entry Medical School Programme at UL is open to graduates from any discipline and employs practical and interactive approaches to learning.
Among the doctors who graduated at UL today are students with undergraduate degrees varying from zoology, business, law, languages and sociology. The programme is also the only medical education programme in the country founded on the modern pedagogical principles of Problem Based Learning (PBL).  PBL encourages team-working and self-directed enquiry, both skills being vital for their future careers in the fast moving world of medicine.

 

 

Speaking at the conferring ceremony Professor Don Barry, UL President, paid tribute to the Health Service Executive, “I’d like to acknowledge the support of the healthcare community – the many practices, clinics and hospitals, their consultants, doctors, nurses, therapists, managers and all of the healthcare professionals who gave so willingly of their time to engage our students and allow them their first glimpses into their future careers.  I would like to pay particular tribute to the Health Service Executive and to express my appreciation for the support that we have received from its staff at local, regional and national levels.  We are looking forward to the opening next September of the Clinical Education and Research building, a shared facility to be located on the University Hospital Limerick campus which will enhance the delivery of our healthcare programmes but also support the post-graduate education services required by the University Hospital Limerick community.
The four-year Bachelor of Science in Physiotherapy is the only academic physiotherapy programme in Ireland outside of Dublin. The programme is accredited by the Irish Society of Chartered Physiotherapists and this year celebrates the 10th year of Physiotherapy Graduates.   The Masters of Science in Occupational Therapy is the only graduate-entry Occupational Therapy course in the country and is accredited by both the Association of Occupational Therapists of Ireland and by CORU, Ireland’s multi-professional health regulator.

“Today 50 graduates from Clinical Therapies will cross the stage to receive their degrees. These qualifications represent many years of study, thousands of hours in work placements and grueling assessments.  26 students have completed the four-year Bachelor of Science in Physiotherapy – the only physiotherapy academic programme in Ireland situated outside of Dublin. 24 students have also graduated from the Masters of Science in Occupational Therapy, the only graduate entry Occupational Therapy course in the country.  Increasingly, health systems are trying to address health needs in the community and primary care settings to reduce the need for costly hospital-based services. Building on this trend, our Masters course is unique as it assists modern healthcare practitioners to evaluate their practice and extend, or refocus, their skills and knowledge to meet the new challenges of healthcare provision,” said Professor Don Barry.

UL Team to partake in Paramedics World Championships

The UL GEMS Paramedic Team - Mark Dixon, Alan West and Noel Carmody
The UL GEMS Paramedic Team – Mark Dixon, Alan West and Noel Carmody

In preparation for the second intake of Paramedic Studies Practitioner Entry candidates at UL (September 2015), a team of three Emergency Medical Educators from the Graduate Entry Medical School will be the sole and first Irish representatives in Rallye Rejviz 2015 the Paramedic World Championships. Competing against over 100 emergency rescue teams from 20 countries including the USA, New Zealand, Japan. Germany and the United Kingdom our crew with over 60 years experience between them, will match their skills amongst the best teams in the world.

The event, which commences today in Knouty, in the Czech Republic requires teams to address 24 unknown patient scenarios over a 50KM circuit, all to be completed in a straight 24hour endurance shift. Previous tests of knowledge and stamina have included mass accidents, terrorist activity, recreational injuries, industrial accidents, road traffic collisions and an array of patients with medical conditions.

Mark Dixon, Team Member and Paramedic Studies Course Lead said this week:

‘We need to ensure our Paramedic Studies’ students have the best possible learning experience during their course in UL. This means not only the best and most up to date programme but also that our tutors are regularly tested to ensure we can offer the highest standard of education—what better way than to measure ourselves against the global leaders in emergency care’

 

UL researchers find simple blood iron test predicts fatal outcomes in the general population

Members of the Kidney Health Research Consortium at the Graduate Entry Medical School and University Hospital Limerick. (left to right) Dr Ells Gillis, Darya Yermak, Dr Mohamed Elsayed, Dr Liam Casserly, Professor Austin Stack, Professor Ailish Hannigan, Dr John Ferguson, Dr Hatim Yagoub, Dr Waleed Mohamed.
Members of the Kidney Health Research Consortium at the Graduate Entry Medical School and University Hospital Limerick. (left to right) Dr Ells Gillis, Darya Yermak, Dr Mohamed Elsayed, Dr Liam Casserly, Professor Austin Stack, Professor Ailish Hannigan, Dr John Ferguson, Dr Hatim Yagoub, Dr Waleed Mohamed.

 

Study finds extreme levels of Transferrin Saturation Ratio reflecting blood iron levels linked to increased risk of death.

A new study led by researchers at the Graduate Entry Medical School (GEMS), University of Limerick (UL) has found that people with low levels and very high levels of a commonly measured laboratory test, the “transferrin saturation ratio” are at an increased risk of death. The test is a measure of the amount of available iron in the bloodstream with low levels generally reflecting a state of iron deficiency and high levels suggesting a relative excess.

The study found that subjects with extremely low transferrin saturation levels (less that 17.5%) were at a 45% higher risk of death. On the other hand, the risk of death was also significantly higher for subjects with very high levels of transferrin saturation above 31.3 %. According to primary author, Professor Austin Stack, Foundation Chair of Medicine at University of Limerick Graduate Entry Medical School, and Consultant Nephrologist at University Hospital Limerick, “the transferrin saturation ratio” is a commonly used blood test to assess the amount of iron in a patient. Low levels of transferrin saturation ratio generally indicate iron deficiency, while high levels;-traditionally > 50% indicate an excess of iron, which can be detrimental to health. High levels usually occur in states of iron overload like haemochromatosis, multiple blood transfusions and cirrhosis. There is some uncertainly as to what the optimal levels of transferrin saturation ratio are to maintain normal health, and while some studies to date have shown that low levels are associated with elevated death risk, others have suggested the contrary.”

In this study of 15, 823 adults from the Third National Health and Nutrition Examination Survey (NHANES III) conducted from 1988 to 1994 in the US and with follow-up 2006, the research team sought to examine in detail the risks associated with transferrin saturation ratio and determine the optimal levels that were associated with best survival. “In this very large population-based study, we found that individuals at both ends of the spectrum-people with very high and very low levels were at increased risk of death” said Professor Stack. This pattern of association was what we call a j-shaped relationship. We found that adults with the lowest levels of transferrin saturation ratio (< 17.5 %) had higher percentage of anaemia and several other chronic conditions like heart disease, diabetes, and poor socioeconomic status, indicators that might have accounted for the higher rates of death. Yet, when we accounted for these factors in our analysis, low levels continued to predict higher death risk.”

“What was even more surprising, was that adults who had high transferrin saturation ratio > 31% also experienced higher rates of death, a relationship that was not accounted for by levels of inflammation or other medical conditions.” “When we looked at the relationship between transferrin saturation and deaths from cardiovascular disease, the results were even more striking. A low transferrin saturation ratio less than 17.5 % increased the risk of cardiovascular death by over 200% while a higher TSAT level above 31% increased the risk by almost 60%” said Dr John Ferguson PhD, biostatistician and senior author of the study. “We believe that these results have important practical implications for the wider medical community” said Professor Stack. Our analysis suggests that the optimal transferrin saturation range for patient survival should be between 23% to 40% and that careful clinical assessment is warranted for patients with low and high levels in order to identify states of iron deficiency or iron excess. Our study demonstrates that transferrin saturation ratio is a useful prognostic tool in assessing a patient’s health and while we support the correction of low transferrin saturation levels in the general population, we would also advise caution against excessive iron loading to levels beyond 40%.

 

The study ‘Transferrin Saturation Ratio and Risk of Total and Cardiovascular Mortality in the General Population’ is published by Quarterly Journal of Medicine (QJM): An International Journal of Medicine and authored by ¹²³Austin G. Stack MD MSc, ²Arif I. Mutwali MBBS, ¹³Hoang T. Nguyen PhD, ¹³Cornelius J. Cronin MBBCh, ¹³Liam F. Casserly MBBCh MSc, John Ferguson PhD

The Graduate Entry Medical School is leading a number of national and international projects to evaluate the health status and clinical outcomes for patients with chronic disease in order to improve patient outcomes. The study was performed at the Graduate Entry Medical School in collaboration with the Departments of Nephrology and Internal Medicine, University Hospital Limerick.