Trinity Medical News Newsletter of the Trinity College Medical Association - No. 34, Autumn 2009

- The Trinity Biomedical E k k ~ c e s Development (Aiden &mid

- Illness and Medical Studen& @oi& M&&)

- Clinial Skills: TCD experience (Aileen PQltt~rsora)

I - Interview with Head of Depqrtment o Medical Gerontology

Trinity Medical News is published twice yearly by the TCD Medical Alumni Association, an affiliate of the TCD Association and Trust.

Editor: Joe Keane (1988)

www.medicine.tcd.ie/alumni/

Correspondence to: Trinity Medical News, TCD Medical Alumni Association, Faculty of Health Sciences, Chemistry Building, Trinity College, Dublin 2, Ireland. email: medalumni@tcd.ie

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Welcome to this edition of the Trinity Medical News, timed to coincide with the annual meeting of the Trinity College Medical Association (Aug 28th). We have some good talks lined up for the afternoon, so if you can't make it, we hope to see you next August. Thanks to our members who contributed articles on our school news, and other matters such as Erasmus, and rugby: that Italian rogue, Giovanni Morelli, has even called back to serve us more wine. Alumni giving for medical research has hit a high point, with the Seamus O'Floinn fund for respiratory re- search. This is a very good sign of our members and faimilies generosity and vi- sion. We thank Zhanna, Mary and Nick who made it happen.

Tercentenary Celebrations Kick-Off

MEDICINE ~wrv C a L m MLH

300YEARS OF EXCELLENCE

I n M a r c h , i n p r e p a r a t i o n f o r t h e celebrat ion of 300th anniversary in 2011, the School of Medicine launched its tercentenary website.

I n developing t h e tercentenary website we hoped to bring together the school's r i c h h i s t o r y , its I achievements and i m m e d i a t e p l ans . The website contains information about current educational p r o g r a m m e s , o u r r e s e a r c h l e a d e r s , partnerships and key student activities. I A brief history of Trinity medicine was prepared by Davis Coakley, Professor of Medical Gerontology, who is an authority on the history of Irish medicine.

There is an outline of our ambitious goals i n associat ion wi th t h e t e r c e n t e n a r y , which inc lude : developing innovative academic p r o g r a m m e s ; s t r e n g t h e n i n g international partnerships; building

mot Kelleher, Ht icine and Vice Pi a1 Affairs, speak1 I rcentenary websit

t h e T e r c e n t e n a r y Board and Tercentenary Committee and others who contribute generously in various ways to help the school continue its 300-year tradition of excellence.

"Alumni Stories" section aims to become a repository of recollections of the School's graduates. I hope all of you will read the stories written by Dr. David Sowby and Prof. Pierce Grace and send in your own recollections.

a new home for t h e School of Medicine in the new TCD Biosciences Please visit t he website http:// D e v e l o ~ m e n t . which i s due to www.medicine.tcd.ie/tercentenarv/ - - . .. .

open inearly i o l l in tirne for the regularly to keep abreast of all the tercentenary; and exploring lyinity developments in connection with the medical history in close association tercentenary and, more importantly, with colleagues from the School of plan to come and participate in the Histories and Humanities. celebrations in 20 11.

The website also highlights the support of people who are assisting the School of Medicine to implement its tercentenary priorities including

Professor Dermot Kelleher Head of the School of Medicine and

Vice Provost for Medical Affairs

The New School of Medicine Building

The School of Medicine will celebrate

its tercentenary in 2011 and happily

to coincide with the momentous

occasion the new School building will

be opened. From its in origin in the Anatomy

building near t h i site of the Berkley

Library, the school has occupied many

premises. The anatomy department

is housed in a lgth century building

including a museum, on the main

campus. Physiology and Biochemistry

are taught in separate buildings

and the administration is housed in

totally inadequate facilities in the old

Chemistry Building.

However all is about to change! The

Trinity Biosciences Development

has begun a s part of the Pearse

Corridor Development Plan. The

new Biosciences Development will

facilitate the College's strategic

interest in Medical Education and

translation research. The building

will provide modern facilities for the

development of Medical Education

and research but will also stimulate

interaction between the City of Dublin

and the oldest School of Medicine in

Ireland.

The new building will be innovative

in that i t will be a combination of

an Education/Research facility with

commercial space. The overarching

concepts include: Transforming

Trinity College Dublin into a frontier

for research to benefit human health

and society and to integrate the

environment beyond biology. As well

as housing the new School of Medicine

the Development will contain a

Centre for cancer Drug Discovery,

a Centre for Bioengineering and

Medical Device Technologies, a n

Immunology Research Centre and a

centre for Translation Neuroscience.

The total area of the Development will

be 29,400 sq.m contained in 7 stories

above and 3 below ground. The total

area of the School of Medicine will

be 4,200 sq.m and will contain two

300 seater lecture theatres, fourteen

seminar rooms and a n anatomy

of graduates of the Medical and

Dental Schools and the consultant

staff of our teaching hospitals. The

-

class room. The school will also

contain a cadaveric dissecting room

and research laboratory, teaching

laboratories and a PAC room, reading

rooms and histology, microscopic and

electro physiology laboratories.

The new School building will make

sure TCD School of Medicine remains

a t the forefront of Medical Education

both in Ireland and Internationally.

Medical students will be able to arrive

in the campus in the morning, deposit

the backpack in a locker and enjoy the

most modern teaching environment

under a single roof.

All new buildings cost a lot of money.

As President of the Trinity College

Medical Association (TCMA) I have

launched a campaign together with

the Foundation to ask for the support

TCMA would like to furnish a seminar

room for undergraduates. If we can

collect sufficient money to do this we

will erect a plaque with the names

of the donors. This will be testimony

for the future of the interest and

support, which you as members of the TCMA, Staff of the Medical School,

Consultants in our teaching hospitals

and graduates show. We need your

support for this new building. It is a

development of which we can be proud

and its completion will ensure a place

for the TCD School of Medicine into

the future.

Professor Shaun McCann.

Professor of Academic Medicine and

President of TCMA.

Tercentenary of the School of Medicine

I t is a pleasure and a privilege to write as president of the Trinity College Medical Association (TCMA) about the tercentenary of the School of Medicine, which will be celebrated in 2011. The School, originally called the School of Physic, is the oldest in Ireland and has undergone radical change recently.

The School was officially opened in 1711 following the construction of the Anatomy School Building. Sir Patrick Dun, who was also Physician to King William 111 (William of Orange), was intimately involved in its construction and subsequently Sir Patrick Dun's Hospital. He provided financial stipends, which facilitated the teaching of medicine by the Professors. The School and i t s associated hospitals have undergone much

Hospitals ably assist me. The new curriculum will be in place by 2011. The course has been reduced from 6 to 5 years and the number of EU students has doubled since 2004. A controversial issue is the introduction of the HPAT examination by the Department of Education. This examination, administered centrally, is now a requirement for all those hoping to enter Medical Schools in Ireland. The examination is taken in the February before the Leaving

Certificate and is based on non- m e m o r i s e d k n o w l e d g e , cogitative ability a n d r eason ing skills. The results of the HPAT will be combined with , the 'points' in the CAO in an effort to widen the base of s u c c e s s f u l e n t r a n t s t o

iteration in the past 300 years but the Curriculum Committee under the Chairmanship of Professor John Reynolds initiated real change in the modern curriculum. The Fottrell report and the Medical Council spurred on this change. With the reorganisation of t he University came the creation of a new Division of Education. This Division under my direction has been charged with the implementation of curriculum change. Dr Mar t ina Hennessey, Senior Lecturer in Education and Consultant Clinical Pharmacologist in St James's Hospital and Dr Aileen Patterson, Lecturer i n Medical Education together with Administration Staff in the School and its main teaching

Medical Schools . . a n a to r eauce reliance entirely

on academic ability. In keeping with the Bologna Agreement, the School is changing to a modularised a n d semester i sed course. The School h a s in t roduced m a n y innovations including small group teaching, Problem Based Learning (PBL) and an early introduction to clinical medicine in the first year. A particularly exciting development irSL the introduction of student-selected modules in the first year, which include the history of medicine, film, language and perception among others.

A major change h a s been the introduction of clinical skills teaching which begins in 2nd year and continues

throughout the undergraduate course. Excellent clinical skills tutors and first-rate laboratories in AMNCH and S t James 's Hospital have facilitated this. A research module is being introduced in 2nd year and this will hopefully stimulate interest in the intercalated MSc after 3 1 ~ yea r . Pathology, Microbiology and Pharmacology continue to be taught mainly in 3rd year but are now systems based. A new module in Global Health is very popular as is the 'evidence-based' module and film, which stimulates lively debate on ethical and other issues pertaining to medicine in the world.

Primary care, Psychiatry, Obstetrics1 Gynaecology and Paediatrics will be taught in the 4th year with Medicine and Surgery, together with electives and intern shadowing in final year.

Enthusiastic administrative support from highly motivated and competent staff is necessary to implement these changes. We are lucky to have both. In 2011, the tercentenary, we will be in a position to celebrate in style. The TCMA together with Professor Kelleher and his Tercentenary committee will make sure that the activities of the School of Medicine become widely known throughout Ireland and Internat ional ly. A series of International Conferences, Seminars , Lectures, and social events will ensure the success of the celebrations.

I look forward to meeting you all during this unique year.

Shaun McCann. Professor of Academic Medicine.

President of TCMA.

The Trinity Biomedical Sciences Development: A Translational Research Centre for 21st Century

The Trinity Biomedical Sciences Development : A Translat ional Research Centre for the 21st Century

* A new chapter is about to open in the long history of medical research a t TCD. Famous Trinity physicians such as William Stokes and Robert Graves made observations, published them, treated patients and taught their students. Rapidly emerging as part of the College Pearse Corridor Development plan, the Biomedical Sciences Development s h a r e s this ethos. The Development will combine Education and Research Facilities, in a very different world. This is the also the most ambitious construction project in the history of the College. The building will house the new School of Medicine and a new Biomedical Research facility providing integration of research themed around understanding and intervening in disease processes. This promises to provide a vibrant environment, exposing s tudents to the latest in medical research and will be open for the School Tercentenary celebrations.

Modern translational research may seem very different to the work of our illustrious predecessors, but a t its heart requires observation being applied to improve patient care. In the modern world this means bringing together many strands of research and expertise. But the goal remains the same. Taking advances made by TCD researchers in cancer, immunology or understanding of brain disorders to the point that they inform clinical practice.

The focus of the Biomedical Sciences research will be on established TCD strengths in Immunology, Cancer, Bioengineering and Neuroscience. The Facility will bring together

like-minded researchers spanning five Schools: Medicine, Pharmacy & Pharmaceutical Sciences, Chemistry, B iochemis t ry & Immuno logy and Engineering. Spread across 17,500 sq.m laboratory space i s being designed with the input of pharmaceutical industry expertise to integrate core technologies in immunology, s t ruc tura l biology, medicinal chemistry, formulation and translational medicine. This will enable the discovery and development of new diagnostic tests, therapeutics or medical devices under one roof. Industry involvement i s crucial in bringing promising discoveries to the point where they improve patient care. A novel aspect of this development is the provision of space

for complementary and collaborative industrial research partners, in the pharmaceutical and biotechnology sectors. This will allow promising ideas to grow into new enterprises or to be developed with major multinational companies into new therapies.

You can participate-from designing the logo to finiancially supporting breakthrough science and innovation. For a peek behind the hoardings, and more details visit our website (http:fi www. tcd.ie/biosciences/webcam~.

Dr Aiden Corvin, Director of Research, School of

Medicine

Illness and Medical Students

"Medical Students and Doctors are human too"

We, as health professionals, recognise the concept tha t "illness does not belong to us, it belongs to them, the patientsn (1) --

Medical s tudents and doctors, however, are a t least as prone to minor and major illnesses as their non-medical peers.

4

Doctors frequently self- investigate, self-diagnose, self- prescribe, self-

4 treat, self- refer and self- follow up. They deny their own symptoms, physical or psychological, and delay seeking help (2)

The first national conference, in Ireland, on the health of doctors was held in 2005. I t identified a culture within the profession tha t leads doctors and medical students to believe tha t they are expected to present themselves a s being superhuman. I t also identified the fear of many doctors and students t h a t i l lness, be i t physical or psychological, may impact on their career and their standing among their peers and the difficulty that many doctors experience when they find themselves in the role of the patient.

A systematic review of psychological d i s t r e s s i n US and Canadian Medical students identified a higher prevalence of anxiety, depression and psychological distress in students a t medical school than in the general population. Approximately a quarter of US medical students suffer mental illness with 7-18% having substance use disorders (3).

Occupational causes of mental stress in medical students may include adjustment to the Medical School environment, ethical conflicts, exposure to dea th and human suffering and personal life events (4).

How do we reduce the s t igma associated with mental illness?

Initially we must educate doctors and medical students that they too have healthcare needs, develop support systems to deal with these needs and recognise the difficulties that exist in terms of confidentiality with medical schools or employers.

The Changing Minds campaign, www.rcpsvch.ac.uk/campaiPns/ -ineminds.

run by the Royal College of Psychiatrists in the UK sought to challenge this stigma. It launched an education campaign that successfully brought informat ion i n t o t h e public domain on the incidence and prevalence of mental illnesses, the likely outcomes with treatment, and provided detailed public information on six areas, Anxiety, Depression, Schizophrenia, Dementia, Alcohol and other drug misuse and Anorexia and Bulimia.

Follow- up of the effectiveness of the campaign showed an up to 40% reduction in the perception of stigma associated with mental illness in the general population.

Medical schools can assist depressed s t u d e n t s by address ing i ssues such as the stigma of using mental health services, confidentiality, and documentation. Early treatment of impaired future caregivers may have far-reaching implications for t he individual students, their colleagues, and their future patients(5,6)

College Resources

Trinity College has a comprehensive system of supports for s tudents with mental heal th difficulties. These include the College Health Service where GP care is augmented by the College Psychiatrist, The' Student Counselling Service, The Disability Service (which includes a n Occupational Therapy Service, Unilink), The Tutorial Service and The College Chaplains.

In addition, The Student 2 Student service, provided by students trained

in listening and assisting students in distress, and the Niteline Confidential helpline add a peer support aspect to the care tha t is available for distressed students.

An onl ine counsel l ing service a n d d i s c u s s i o n b o a r d h a s recently been launched a t www. $rinitgmentalhealth.com and this has allowed those students, who may previously have found i t difficult to present themselves to the services, to access an on-line facility as a first point of contact.

In 2008, College launched the Student Mental Health Policy and Guidelines, www.tcd.ie/Student~Counselling/ Student Mental Health Policy & Guidelines.pdf which outl ined information on mental health and mental illness and described the Academic a n d Adminis t ra t ive Procedures t h a t a r e in place to facilitate students completing their academic requirements , despite mental health problems. In addition Guidelines were issued for staff and students to assist them in helping students with mental health issues. In particular, guidance was issued on the maintenance of confidentiality and the workings of The Mental Act 2001, as i t pertains in the College setting.

In summary, if you need help, please ask for help, if you see a colleague, who you think may need help, please encourage them to seek help, either through face to face contact with the many available services, or initially through the on-line counselling service. The services a re in place to support you and to assist you to progress through your academic career in spi te of mental heath problems.

Dr David McGrath

Director College Health Service

Trinity College

1 M'c~ev i t t C Morgan M, Illness doesn't belong to us, JR Soc Med 1997; 90:491-5

2 Health in Practice Programme Irish College of General Practitioners

3 Systematic reviews of depression, anxietv. and other indicators of psvchological distress among U.S. and Canadian medical-students,

Dyrbye LN, Thomas MR, Shanafelt TD.

Acad Med. 2006 Apr;81(4):354-73. Review

4 Acad M d 2002 Sep;77(9):918-21

Depressed medical students' use of mental health services and barriers to use.

Givens JL, m. 5 Compr Psvchiatrv. 2001 J a n - Feb;42(1): 1-15.

Perceptions of academic vulnerabi l i ty associated with personal illness: a s tudy of 1,027 s tuden t s a t nine medical schools. Col labora t ive Resea rch Group on Medical Student Health.

Roberta LW, Warner TD, Lvketsos C, Frank Ganzini L, Carter. 6 doi: 10.4065/80.12.1613 Mayo Clinic Proceedings December 2005 vol. 80 no. 12 1613-1622

SCHOOL OF MEDICINE m - - - - - - -

'4

Clinical Skills: the TCD experience b

"Talking to patients seems so basic, but the development of professionally it is so difficult when you come to do it, competent graduates. Clinical Skills the clinical skills course made this so courses and patient contact are in much easiern Year 2 Medical Student. place in all years of the TCD course and Knowledge, Skills and Attitudes. These are facilitated through governmental three learning domains constitute the curriculum development funding. learning basis of the undergraduate These monies have allowed investment

300 YEARS OF EXCELLENCE

-d A -- curriculum in Medicine. Over the years, knowledge became the dominant focus of most medical curricula which often proved detrimental to the other components of professional education. Why? There are a number of reasons which caused the development of clinical skills to decline over the years. For instance, the explosion of knowledge in biomedical science, the increased service demands, the cost of delivering and assessing clinical skills, and patients' perceptions of appropriate treatment all contributed. Less emphasis was placed on the practical elements of the course and more on the theoretical aspects. This trend was responded to through an international emphasis on outcome-based education which focuses attention on what knowledge, skills and attitudes the doctor should possess upon graduation. There have been many descriptions of what competencies are important. TRe General Medical Council's Tomorrow's Doctors, the Scottish Doctor and the more recent European TUNING project have all produced lists of competencies required.

The tide has changed. It is evident that there is a renewed emphasis on

in essential staff, equipment, room refurbishment, development of curricula, assessment practices and evaluations. In addition, there has been major investment in facilities at both major teaching hospitals., AMNCH and SJH.

Trinity students today enjoy patient interaction from Year 1 where they are introduced to a family with a newborn child and they can establish a professional relationship, whilst concentrating on concepts of normality, normal development and normal communication. In Year 2 one day per week is dedicated to clinical teaching and learning. Students are hospital based and develop skills such as: vital signs, basic suturing, IV cannulation, point of care testing, basic life support (adult) and a comprehensive range of physical examinations and communication skills such as history taking, consent, breaking bad news. The course continues in Year 3 as part of the six months clinical attachments students undertake where the skills are further practised on the wards. Skills will include: arterial blood gas, suturing, basic life support (child & infant), urinary catheter

insertion, phlebotomy, critical care - primary assessment and respiratory adjuncts. This is all topped off with an end of year examination which assesses students' ability to perform a selection of skills from the year. Students receive feedback regarding areas of weaknesses that require improvement and those who do not perform to a satisfactory standard are required to repeat the examination and occasionally tk year in order to progress. The aim of the final phase of the curriculum is to allow students become clinically competent. The courses are more flexible and students can avail of teaching were they wish to

I c improve skills in addition to learning

new skills appropriate to the area they are attached to. The clinical examinations have been altered to reflect the emphasis being placed on competence.

The innovations have been perceived positively both by students and clinical colleagues. As one student so honestly

I describes the experience: "Meeting real patients so early is cool .... that's what being a dodor is all about. It's great to practice skills with fiends in the classroom and make the mistakes on them before being let loose on sick people".

The old adage of see one, do one, teach one is now redundant. Instead, there is a more fitting quote of how clinical expertise (or indeed any expertise) is acquired: "How do I get ta Carnegie Hall? Practice. Practice. Practice." (Saadi)

Dr. Aileen Patterson Lecturer in Medical education

Erasmus Medics

U N I V E R S I T E FtANCOIS - RABELAlS T O U I J -

In the lead-up to the tercentenary of Medical School in Dublin University it is fitting to highlight a very successful GaelidGallic collaboration for well over a decade between the Schools of Medicine in Dublin University and the Faculty of Medicine i n Francois Rabelais University, Tours. This exchange programme h a s been available for students in their 3rd year of the medicine course and was established in 1994 under the direction of Professors Conor Keane (Pr of Microbiology, Trinity College Dublin) and P r Gerard Lorette (Pr of Dermatology in Tours). Between three to six students m a s the channel each year on an integrated structured funded programme. While Tours has been the only exchange partner with TCD on the Medical circuit, Tours enjoys a healthy cultural academic exchange with 29 of their medical students actively placed on Erasmus exchanges th roughou t Europe including Germany, UK, Belgium, Greece, Hungary, Italy, Romania and Spain; this dissipates any notion that the French were reluctant travellers! TCD has plans to expand the Medical Erasmus programme in the near future.

The ERASMUS, or European Region Action Scheme for t h e Mobility of University Students , was established in 1987 and was formerly part of the SOCRATES I/ I1 programmes unt i l 2007 and was then enveloped within the European Union's Lifelong Learning Programme 2007-2013. ERASMUS,. stemming from Desiderius Erasmus Roterodamus (or Desiderius Erasmus of Rotterdam, see photo above), c. 14661146, a Dutch Renaissance humanist and a Catholic Christian theologian worked extensively in a number of European locations and incites Desire for knowledge

(stemming from both his forename a n d surname) . The ERASMUS programme h a s a number of objectives: improve the quality and increase the volume of student and teaching staff mobility throughout Europe, so as to achieve a t least 3 million s tuden t and teacher exchanges by 2012; improve the quality and increase the amount of multilateral cooperation between higher education institutions in Europe; improve a n d increase cooperation between higher education institutions and enterprises; and spread innovation and new pedagogic practice and suppor ts between universities in Europe. Student mobility, the most visible "iconic* element in the programme is hoped to provide the foundations required to foster links a t various levels between international institutions.

On a more individual level t h e programme provides many Ewopans a structured way of their lst time living and studying abroad - L'Auberge Tourangelle- springs to mind. The programme fosters not only learning and understanding of the host country, but also a sense of community among s tuden t s from different countries. Following interviews with current and past Irish and French students their ERASMUS experience was considered both a time for learning a s well a s a chance to socialize. Tours is an attractive city located on the lower reaches of the river h i r e , between Orl6ans and the Atlantic coast. The Touraine, region around Tours, is known for its wines (whites are largely more handsome than reds and include Vouvray, sauvignons of the Touraine, Chenins blancs of Saumur and Anjou), its perfection of its local spoken French, and for the numerous and varied styled Chateaux dotting le fleuve from

Orl& to Nantes - a unique stretch of moving water and sandbanks gaining UNESCO recognition in 2000. The vibrant University City has received excellent reports from former TCD exchange students.

The programme is open to all students however, a working knowledge of the host institution language is necessary. Integration within the 3d medical years has been facilitated by t h g Medical Schools educational committees and quality dove-tailing has been established to avoid redundancy and ensure that Irish and French studenta reintegrate without difficulties into the following medical year upon their return fkom the host countries. TCD has provided a specific introdudory course in some subiects to ensure

Curriculum Vitae is important" and the French trainees are actively encouraged to achieve fluency in the universal medical tongue - English, Trinity College and Francois Rabelais Tours encompass the positive spirit tha t the ERASMUS programme was designed for. In 201012011 we endeavour to involve French and Irish Medical colleagues (teachers and former students) in a Tercentenai-y reunion - for an exchange under the one roof.

For practical information: contact the TCD Medical School website ( h t t p : / / w w w . m e d i c i n e . t c d . i e ) , the International Office in TCD (international@tcd.ie) or the Francois Rabelais University Tours website (www.univ-toUrs.fk1.

- -- .,---- -- ------ that our French col leagues a n d guests commence the academic year on a level footing with their Irish c o u n t e r p a r t s ; this was greatly a p p r e c i a t e d . N o n e t h e l e s s , students of both n a t i o n a l i t i e s are required to follow t h e host institutions' 3"' year programme and they do this with gusto - as attested to by the number of excellent achievers from the French s t u d e n t s t h i s year. The French students vouch for the "possibility of living abroad while not having the expense of studying outside the European Union" as the grant available to ERASMUS students are not available to those opting to leave the continent to study. Some of the Irish students have equally impressed - many French medical studenb in Tours will remember one of our Irish students from the North of Ireland achieving not only academic brilliance at the year's end but he also managed to direct and stage a play in French "un spectacle 6tonnantn according to a number of his French co-students (feat that Francois Rabelais would have been truly proud). Apart from the curiosity aspect and cultural exposure, competitiveness also applies "simply having ERASMUS on one's

More Wine? i No matter what one might think about the evils of alcohol it seems that moderate wine drinking (whatever that is) has some protective effects on health. One of the difficulties in carrying research in this area is the veracity of the data collected. I am told that if you take a history from gentlemen of a 'certain age' and ask them about alcohol consumption and sexual activity they will lie, halving the amount of alcohol consumed and doubling their sexual activity! I cannot say anything about women as I would never ask such questions and I am sure that answers would be equdly untrustworthy.

Kew-Kim Chew writing recently in the International Society for Sexual Medicine's journal reported on a research project enquiring about the drinking, smoking and sexual habits of 1,580 men between the ages of 20 and 80 years. He and his colleagues

Francois Rabelais (approx. c. 1494 - April 9, 1553), a major Renaissance writer, a doctor and a Humanist, was born probably close to Chinon. He had a large influence on French language a t that time (employing loan-words, double-entendre, metaphors . . .) and famously authored Gargantua and Pantagruel, telling the story of two giants - a father, Gargantua, and his son, Pantagruel - and t h e 3 adventures and feastings, written in an amusing, extravagant, and satirical style.

Dermot O'Toole Senior Lecturer

Consultant Gastroenterologist

reported that men with a standard alcohol intake (defined as up to 4 drinks a day for not more than 5

days per week) have less erectile dysfunction than non-drinkers. While this may be true, it did not go so h.r as to claim that 'alcohol' improves male sexual performance. Which don't think the author's of this study were trying to say.

In the last newsletter I mentioned the possible benefit of 'resveratrol' on health, cardiovascular health in particular. According to Mitch Frank and Jacob Gaffney in the 'Wine

Spectator' in April 2009 a family

doctor, Philip Norrie in Australia, was

so impressed with the 'resveratrol'

story that he established a vineyard

and released wine with enhanced

resveratrol under the label 'The

Wine Doctor'. He achieved this by

extracting more resveratrol from

the grape skins and adding it to the

wine. Whether it-will prolong the

consumer's health or not, only time

will tell.

Bacteria and fungi play important

roles in oenology and medicine.

Many of us in hospital medicine have

recourse to platelet transfusions in

- diverse clinical situations. This is

particularly true of Haematologists

who t rea t leukaemia and related

diseases. Platelets are separated from

whole blood at the time of collection

and after leukodepletion (depletion of

contaminating white cells). Platelets

are then stored on an agitator for

up to 5 days and therefore bacterial

contamination becomes a possibility.

The frequency of contamination

causing clinical

p r o b l e m ?

i s d e b a t e t

h o w e v e r :

n u m b e r of

s t r a t e g i e s

h a v e b e e n investigated to

try to eliminate

bacteria from

stored platelet

concentrates.

O n e s u c h s t r a t e g y i ,

the treatment

of p l a t e l e t

concent ra tes

with long-wave

u l t r a v i o l e t

l i g h t a n d a

photo-ac t ive

c o m p o u n d ,

a m o t o s a l e n .

This treatment

and variations

on i t inactivate a broad spectrum of

bacteria providing the possibility of

preventing transfusion-associated

bacteraemia. A Swiss firm h a s

apparently jumped on the band wagon

and developed a similar strategy

for treating wine to inactivate any

bacteria present . Tradit ional ly

sulphites, actually sulphur dioxide

(SO21 have been used to kill bacteria

in wine an idea originally propagated

by Roman winemakers in widespread

use today. You will frequently see

the phrase 'contains sulphites' on the

label of wines. Now, a new technology called "Surepure" may dramatically

reduce the amount of sulfites used by

winemakers by using ultraviolet light

instead. About the size of a couple of

refrigerators, Surepure can process

over 5,000 bottles worth of wine

per hour. The wine is pumped in, is

exposed to specialized UV rays, and

is pumped back out. Whether photo-

active compounds are used or not I do

know. The manufacturer claims that

this does away with the necessity for

filtration which can replace sulphite

use but may also strip the wine of

its flavour. So once again there is

a connection between wine and

medicine other than drinking!

What is happening to wine making

and drinking in the recession? Early

in the spring of 2009 the Comite

Interprofessionnel des Vins de

Champagne (CIVC) reported tha t

volume sales decreased by 4.8% in

2008 to 322.5m bottles. Sales in

France, which represents 50% of the

Champagne market, fell by 3.6%,

while exports to EU countries and

non-EU countries declined by 6.5%

and 6.2% respectively. While this is

bad news for oenologists i t may not

be bad for the consumer. Wine 'sales'

abound and if you look carefully you

will undoubtedly find bargains.

Happy drinking.

Giovanni Morelli.

Interview with Professor Rose Anne Kenny Head of Department of Medical Gerontology, Trinity College,Dublin

Consultant Physycian in Geriatric Medicine, St. James's Hospital Dublin

At what point did you get a feeling that academic medicine - was going to be a big part of your life?

.r During my junior medical rotation a t the Royal Postgraduate Medical School in London, 1did an attachment in Geriatric Medicine and worked

with the then Professor of Geriatric Medicine, Professor Malcolm Hodkinson. His background was in clinical biochemistry and he had pioneered the field of clinical biochemistry in ageing and constantly emphasised how l i t t le research was being carried out a t that time on older persons, despite the major demographic changes which would take place in western cultures. This impressed me hugely. I thoroughly enjoyed my attachment in Geriatric Medicine and realised t h a t t he mul t id isc ip l inary approach t o medicine, the dearth of academic research in ageing at the time offered an opportunity in the field tha t I knew I would enjoy.

Certainly Malcolm Hodkinson was an early role model. Similarly I had encountered geriatricians in Ireland whose work and altruism I hugely respected - Professor Cillian Twomey and Professor Michael Hyland in Cork and Professor Davis Coakley in Dublin.

I was supervised during my Research Fellowship by Professor Richard Sutton then of Westminster Hospital and the Royal Brompton and together we developed a very active clinical research programme i n syncope and cardiac pacing devices. When I worked a s a Consul tan t and Senior Lecturer in Newcastle upon Tyne, Professor J i m Edwardson and Professor Oliver James - with whom I co-founded the Institute for Ageing and Health - were hugely inspirational.

Do you think it's easier for a medical trainee to get engaged in research now compared to when you were a student?

When we were students and junior medical doctors there were little or no structured research pathways. I t was very much up to the individual to carve a research niche and develop their own training programme. There is no question that today training programmes in research are much more structured. I do believe that there is not as much emphasis placed on the importance of spending a significant period of time in research training today as there was when we were competing for research in clinicd posts.

You are having a busy year, with your inaugural lecture and the Graves Lecture. It's clear from them, that you are passionate about improving our understanding of neurovascular instability, especially in the older patient. What take home messages do you have for physicians dealing with illnesses?

Neurocardiovascular instability is a phrase that our group coined some 20 years ago which encapsulates t he impor tant interdependency of brain and cardiac function. Age related changes in these organs are vital to common clinical syndromes and increased susceptibility to these disorders a s people age. Atypic~l presenta t ions a r e par t icu lar ly common and traditional clear cut symptomatology becomes more blurred in the context of co-morbidity

and ageing. Neurocardiovascular instability is of course not unique to older persons. I t is the commonest cause of syncope in the young and the commonest cause of epilepsy which is resistant to treatment.

More recently Dr. Joe Harbison and I have begun to explore the role of neurocardiovascular ins tabi l i ty in established stroke and transient ischaemic episodes. This offers a unique opportunity to combine our joint research interests and explore a new paradigm for cerebral profusion.

From being a physician and researcher, you have now also had to become an administrator of an academic program. Do you like that challenge, and what is most rewarding about it?

I t is a privilege to work with colleagues from other disciplines inc luding social sciences and economics and to embrace new knowledge i n t h e s e domains - which is in fact very pertinent to neurocardiovascular stability and clinical health in ageing. TILDA (The Irish Longitudinal Study of Ageing) has been a huge challenge and one of the core objectives of TILDA is to engage in tangible multidisciplinary research i n order to understand the ageing process. I really believe that this will place Ireland firmly in a leadership role in ageing research internationally.

Engaging with these disciplines has been challenging whilst a very rich learning process. I t is remarkable how many individual groups are doing worthy work in the field of age related research in Ireland and haven't until recently collaborated in an active way. Part of the advantage of administering this new academic programme is encouraging groups within Ireland to work together as one.

You have plans for a Centre of Excellence for Successful Ageing. What is that project going to be about?

The Cen t r e of Excellence for Successful Ageing is an initiative

which will improve the quality of acute hospital and community care delivered to older persons in Ireland. It will challenge models of care delivery and again work with disciplines including health service, research and policy makers to ensure quality care for older persons, but also affordable care given the demographic changes which Ireland will face and the pressures that this will inevitably impose on the health care service.

i

The Centre for Excellence has four principle domains; one i s clinical research, second is clinical service delivery both in hospital and in the community, the third is creativity in ageing and the fourth is training and education. Therefore we plan to a t t rac t medical scient is ts of international reputation to the centre. The research activity will build on extant capacity both within the field of ageing, but also with other colleagues in St. James's Hospital e.g. colleagues in cancer, respiratory, neuroimaging, cardiology and colleagues in Trinity College with whom we are already engaged in active research e.g. social care, social policy and economics.

Can you please tell me how your family is coping with you being so busy?

My 12 year old son is sitting beside me as I am preparing this piece and he chose to answer this question for me - in brief "not very well" he says. I t is a challenge being a working mother. You balance many different domains in life and it's not always easy.

Do you have outside interests? What are you reading at the moment?

I have virtually no outside interests. At the moment I am reading RF Foster's History of Ireland.

And I hear that you are also writing .... ?

I am wr i t i ng a book on self management of health a s we get older. The proposed title (although this has not been confirmed as yet) is "Don't die young and be alive when you do". Let's hope that we can all achieve that.

20 August 2009

Con Feighery- Our man on the Pitch

College Park, 1990. My first return to the rugby field in many years. In the past I had fought many a memorable ba t t le on t h e same ground. Competing with the College 'Freshers'. Later playing for a combined TCD-UCD fifteen against an Oxford-Cambridge team in the late 1960s, we played on an ice-hard pitch: I can still hear the resounding clatter of steel studs on the unyielding surface. What was I doing on this famous ground in 1990. I did ask myself this question on several occasions during this Wednesday aRernoon. So did the 30 or so players on the pitch. The teams consisted of first year medical students f?om UCD and Trinity, engaged in a typically ferocious battle to gain supremacy. I had been inveigled to act as the referee, since I had "something to do with rugby" in the past. This turned out to be an unwise choice. I had made the decision beforehand, that unlike many rugby officials, I was going to allow the game to flow. This turned out to be a recipe for unbridled mayhem. Like many referees, I earned the displeasure of both teams. My son, Eoin, then aged 15, came along to watch this spectacle and his wry comments showed he was not impressed with my skills - and correctly so.

My first opportunity to score a try came when I was aged 8, as I raced down the centre of a small, uneven pitch in Gonzaga College. The ball was held in both hands, although I had no intention of passing. My run was accompanied by screams and cries from my companions on the pitch. I finally understood what the fuss was about, when it was pointed out t ha t I was running towards my own try line. Fortunately, my Gonzaga rugby career survived this and I was even appointed a s place kicker a t one juncture. The next stop was Castleknock College, then a force in Leinster schools' rugby. Because of my then small stature, I moved around to various positions, centre, wingforward, even scrumhalf. Desperate to get on the junior cup team, my opportunity came when our hooker, well established on the team, developed viral hepatitis. I i n s t an t ly honed my hooking

skills and thereafter played all my schools' rugby in that position. As I later became a lineout jumper, this conflict in positions became apparent, especially when I trialled for schoolboy interprovincial status.

Competition for a place on the Fresher's team in UCD proved quite a challenge for this hookerllineout specialist. My initial appearances on the Fresher's A team (the second s t r ing side) were soon followed by demotion to the B side - I had made the injudicious decision to take a weekend off and attend the Wexford Opera festival. Somehow or other, by the end of the season, I had managed a few appearances on the Fresher team proper, a position I retained the following year. During my second year in university, I was approached to play in the Dublin Hospitals' cup by a member of the St . Vincent's Hospital's team. I played i n a few earl ier round games, and put in several rather indifferent performances. In the final, we played a strong Mater Hospital side. Spurred on by a sense of embarrassment a t my earlier efforts, I managed to make a useful contribution to our team's performance and we won the match comfortably. I have always believed that this game was a turning point in my rugby career - I developed a sense of self-belief which I was to rely on in future years.

In the following years in UCD, I was chosen to play on the first team and played in 5 colours matches against Trini ty, with the spoils evenly divided. University rugby was blessed during those years with a plentiful supply of current or future International players. During my seven years playing with UCD, as many as 8 or 10 players were capped. These included Fergus Slattery, Barry Bresnihan, Tom Grace, Shay Deering, Kevin Mays, Aidan Brady, A1 Moroney, John Murray, Jamsie Crowe and my brother Tom. Surrounded by such talent, i t was much easier to make an impression and I was selected to play for Leinster in 1969. I remember well being more than awe struck, playing in one my first interprovincial matches against an

Ulster side which included a set of famed players such a s Willie John McBride, Mike Gibson and Ken Kennedy - all members of the current International side.

In those years, the Ireland side was chosen by a group of selectors, called the "big fiven. These selectors cons is ted of f ive ind iv idua l s representing the provinces. They were the frequent recipients of lengthy analysig and some abuse from the media and the general public, especially if Ireland were not performing well at the time. Each year, shortly &r Christmas, a game called the "Final Trialn was played in Lansdowne Road. In this game, a team consisting of most of the current international players, termed

the "Probables" lined out against a hopeful XV, the "Possibles". I t all sounds wonderfully quaint now. For international hopefuls, the all important step was to try and get named as a final trialist. The media spent acres of ink guessing who would make it to the final trial and in some instances strongly promoting the case of individual players - sometimes to that player's detriment.

Once in the final trial, anything could happen. And in my case did. I played in the final trial in 1971 and again in 1972. In 1972, my partner in the second row was an Ulster lock and together we won more than our fair share of lineout possession. I got word later from one of the selectors that my name was in the mix. By lunchtime on Sunday, to my utter delight, disbelief and astonishment,

I got word that I was selected to play for Ireland against France in Paris a t the end of the month. My second row partner was none other than Willie John.

Four further 'new caps' were selected to face the French. We approached the match full of hope but also knowledge tha t Ireland had failed to win in Paris for the previous 20 years. What were the chances that this experimental Irish side with five new caps could prevail? We trained in Paris on the Thursday a n d F r iday before t h e match under to close eye of coach Ronnie Dawson (a previous Irish captain of the Lions) and headed to Stade Colombes on the Saturday. The pre- match tension is clearly visible in the team photograph taken some 10 minutes before kick-off. We started the match in an uncompromising fashion, matching the physicality of the French. We scored two tries, one by new cap Johnnie Moloney and the second by seasoned prop-forward Ray McLaughlin. The result - a clearcut victory for Ireland, 14 points to 9.

A few days later, t he same team was again selected to play against England in Twickenham. However, in the intervening period, momentous historic events took place in Ireland. In Derry a peace march was fired on by the British army leaving 13 dead, an event referred to as Bloody Sunday. Two days later, an angry crowd assembled a t t he Bri t ish embassy in Merrion Square in Dublin, set fire to the building, which was gutted in the process. When we ran onto the Twickenham pitch 2 weeks later, several protestors ran onto the pitch and had to be physically removed. A tight match ensued and with minutes to go, England led by a two points, 12-10. Then Ireland won the ball from a scrum some 20 metres from the England line and a popped pass to Kevin Flynn allowed him to cut inside and score close to the posts. The conversion sealed our victory, 16 points to 12. So, two away Internationals played and twa victories. Roll on the rest of the season. However, a shock was in stqre for us all.

The next game was against Scotland in Lansdowne Road. Again, t he same team was selected. Then came the astounding news, that Scotland refused to travel to Dublin for the

game. The explanation given was tha t t he safety of their team and supporters was a t risk. Attempts to persuade their officials otherwise proved f ru i t less . Wales t hen adopted a similar line and the fourth international of the season was also lost. The Irish Rugby Football Union then persuaded France to travel to Dublin, to play a second international and so give home rugby supporters something to cheer on. This match was duly played a t the end of April and Ireland again were victorious, 24 points to 14.

Sadly, t he second match against France concluded my international rugby career. I continued to play Leinster rugby for the following seasons, including a match against a visiting All Blacks side, to whom we lost narrowly. However, due to a combination of factors, including a busy job as a medical registrar in the Mater Hospital, I failed to make the same impression in the final trial of the following season. My position was taken by Kevin Mays, my Leinster and former UCD second-row partner. Kevin's physical advantages, some 5 inches in height and 3 stone in weight were sufficiently persuasive to give him a n opportunity in the engine room of the scrum.

A few seasons later, I tore the anterior cruciate ligament in my left knee and this ended my rugby career. Diagnostic tests for this ligament tear were poor at this time and so it was 12 years later and after several cartilage tears in my unstable knee, that the diagnosis was made.

Rugby has continued to fascinate me, now in the role of a supporter. This can act as a useful counter-balance to the beguiling molecules of the immune system. In a key game, I can get as excited as any spectator on the sideline and can offer a torrent of biased opinions to the referee, should he wish to listen. However, my only continuing involvement with competitive rugby is in helping to run the Dublin Hospitals' Cup competition. I also act as an alickadoo for the Trinity Hospitals' rugby side and remain ever hopeful that we may some day bring home the cup to the Trinity sideboard.

Professor Con Feighery Immunology