Professor John V. Reynolds, Consultant Surgeon, President of IrSPEN
Professor Reynolds is Professor of Clinical Surgery at St. James’s Hospital and Trinity College Dublin. He is the National Lead for oesophageal and gastric cancer. He is Cancer Lead at St. James’s Hospital and the Trinity School of Medicine, and a Principal Investigator in the Trinity Translational Medicine Institute. He has formerly held Fellowship positions with the University of Pennsylvania and Wistar Institute in Philadelphia and at the Memorial Sloan-Kettering Cancer Centre in New York. He was a Senior Lecturer at St. James’s University Hospital in Leeds (1994-6).
Professor Reynolds has obtained numerous research awards and has published widely in cancer research, with over 320 publications and approximately €5m research grant income. His clinical interest is in diseases of the oesophagus and stomach. His research interest is in five areas: (1) pathogenesis of Barrett’s oesophagus and progression; (2) prediction of response and resistance to chemotherapy and radiation therapy; (3) obesity, altered metabolism, and cancer; (4) malnutrition and peri-operative nutrition. (5) exercise and cancer.
Professor Clíona Ní Cheallaigh, Associate Professor in the Department of Clinical Medicine, TCD
Clíona Ní Cheallaigh is an Associate Professor in the Department of Clinical Medicine, TCD and a Consultant in Infectious Diseases and General Medicine in St James’s Hospital, Dublin. She is the Clinical Lead of the Inclusion Health Service in St James’s Hospital dedicated to improving access to specialist hospital care for socially excluded individuals.
Her research seeks to look at the effect of social exclusion on health from a number of perspectives, and includes work on health systems design and evaluation, work funded by the HRB on premature ageing in homeless adults and work on the effect of social exclusion on the immune system funded by the Royal City of Dublin Hospitals Trust. She has a strong interest in ensuring equity of outcomes for socially excluded people living with HIV.
She is also part of the SFI-funded COVID-19 Research Hub in TCD, with a particular interest in looking at why people who are marginalized are more likely to get severe COVID-19.
Understanding COVID 19 – morbidity, mortality and who is most at risk
Details coming soon.
Ms. Carmel O’Hanlon, Clinical Specialist Dietitian, Beaumont Hospital
• Carmel is working as a clinical dietitian for over 25 years, and is a Clinical Specialist Dietitian in Beaumont Hospital General Intensive Care Unit.
• Board member of IrSPEN (Irish Society for Clinical Nutrition and Metabolism) and an Honorary member of INDI (Irish Nutrition and Dietetic Institute).
• Project Lead for NCEC National Clinical Guideline No. 22 on ‘Nutrition screening and use of oral nutrition support for adults in the acute care setting’.
Nutrition in the ICU: what has been learned and how is it changing practice
Details coming soon
Dr. Emma Ridley, Senior Research Fellow (Lead, Nutrition Program), Monash University, Melbourne, Australia
Emma is a Senior Research Fellow, NHMRC Emerging Leadership Fellow and leads the Nutrition Program at the ANZIC-RC. Emma has 15 years of clinical dietetic experience, including as a senior dietitian in the ICU at The Alfred Hospital, Melbourne and over 13 years of research experience. Emma’s research interests include understanding energy requirements including the clinical application of indirect calorimetry, as well as the effect of optimal nutrition delivery on short and long-term outcomes in ICU patients. Emma regularly presents both nationally and internationally, has 63 peer reviewed publications is the CIA on the INTENT trial which is based on findings from her PhD.
Rehabilitating the COVID patient post ICU: insights and implications for practice
Details coming soon.
Dr. Cara Dunne, Consultant Gastroenterologist St James’s Hospital and CHI, IrSPEN Director
• Dr Cara Dunne graduated with an honors degree in Biochemistry from UCD in 1996 and went on to study medicine in the Royal College of Surgeons in Ireland and graduated with honors in 2004.
• She did her early training in Beaumont hospital and through the gastroenterology Spr training scheme went on to work in Beaumont, St Vincent’s, St James’s and the Mater.
• She was awarded her PhD by NUI in 2013 in “Mitochondrial Instability in Stage II Colorectal Cancer Functional Validation of Prognostic markers Involved in Early Staged Colorectal Cancer”
• Since 2017 she has worked as a consultant gastroenterologist at St James’s. Since 2019 she joint appointed to Our Lady’s Hospital Crumlin and St James’s Hospital to develop a transition and adolescent program for young people with chronic intestinal failure on home parenteral nutrition and patients with IBD. Her research interests are inflammatory bowel disease (Ulcerative Colitis and Crohns Disease) and complex nutrition. She is a member of the ISG, ECCO and ESPEN and a director of IrSPEN. She is chair of the nutrition subgroup for the National Program for Gastroenterology and Hepatology.
Home nutrition and intestinal failure in Ireland – how far have we come?
Details Coming Soon.
Dr. David Sawbridge, Consultant Gastroenterologist, Cork University Hospital
David Sawbridge graduated from Christ’s College, Cambridge, with a degree in Anglo-Saxon, Norse and Celtic but, being surprised to find that studies on 8th Century Mercian Kingship did not have immediate real-world application, he undertook his MBChB at Edinburgh University. He completed his specialist training in Gastroenterology in Liverpool and Salford, including fellowships in IBD (inspired by King Alfred of Wessex – clearly a case of IBD) and Clinical Nutrition/Intestinal Failure. He currently works in these areas as a Consultant Gastroenterologist in Cork University Hospital, with research interests in the interaction between IBD, Nutrition and the gut microbiome.
Practical tips for the management of small bowel syndrome in 3 case studies
Short Bowel Syndrome (SBS) is defined as <200cm small intestine remaining in functional use. It is the most common cause of Intestinal Failure and is a major cause of morbidity for those suffering from the condition. Optimal management of SBS requires an MDT approach and is likely to involve a combination of enteral and parenteral support mechanisms, such as Home Parenteral Nutrition. Here, I will use 3 cases to highlight key clinically-relevant points synthesised from international consensus opinion, propose how these may be of relevance to your management of such patients and suggest how they might integrate into the “SNAP” approach to the assessment and management of SBS.
Ms Arún Fenton, Senior Dietitian, St James’s Hospital
Arún graduated from TCD/DIT BSc. Human Nutrition and Dietetics 20 years ago (2001). She has spent the past 14 years working as a medical oncology dietitian at St. James’s hospital. During this time Arún has been involved in discharge planning and managing circa 80 patients with intestinal failure due to malignancy who required home parenteral nutrition. She has also managed numerous patients with similar diagnoses who required home IV fluid and electrolyte replacement therapy. She has been a dietitian representative on various home parenteral nutrition projects at national level.
Optimising the discharge plan and supporting the HPN patient
Details coming soon.
Professor Emanuele Cereda, UOC Dietetica e Nutrizione Clinica, Fondazione IRCCS Policlinico San Matteo
Dr. Cereda graduated as an MD in 2002 and was awarded the specialization degree in Clinical Nutrition in 2006 and PhD in “Clinical and Experimental Nutrition” in 2009. Since 2010, he has worked as a physician and research scientist at the Clinical Nutrition and Dietetics Unit of the Fondazione IRCCS Policlinico “San Matteo” (Pavia, Italy). As lead investigator in many clinical trials, his research activities are substantiated by a large number of publications in highly ranked peer-reviewed international journals and by several chapters in national and international books, mainly dealing with disease-related malnutrition and complications in hospitals and institutions, wound healing, clinical nutrition in oncology, geriatrics and neurodegenerative diseases. Dr. Cereda contributed to last edition of the “ESPEN Guideline Clinical Nutrition in Neurology” and has been the chair of the Nutrition Small Working Group for the “Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline (3rdEdition, 2019)” edited by EPUAP/NPUAP/PPPIA. He is Associate Editor of Clinical Nutrition and serves as an active reviewer for several international peer reviewed journals dedicated to clinical nutrition or focusing on nutritional topics.
The role of muscle targeted interventions in aging and disease
Sarcopenia has been recently recognized as a muscle disease, with significant adverse consequences on health. Recommended treatment is based on individually tailored resistance exercise training program, optimization of protein intake using high-quality protein sources (i.e. whey proteins providing high amounts of essential amino acids such as leucine) and addressing vitamin D deficiency/insufficiency.
Muscle-targeted oral nutritional supplementation (MT-ONS has been extensively tested in clinical trials, mostly using high-quality randomized controlled trial design and demonstrating efficacy in increasing muscle mass and strength as well as physical performance versus iso-caloric placebo or standard practice in older patients with sarcopenia. Consistent results have been observed in various clinical settings (community, rehabilitation centers, care homes), with or without adjunctive physical exercise programs. Furthermore, a positive effect on markers of inflammation have been shown. A muscle protein-sparing effect, with benefits on physical performance and function, has been also demonstrated in patients at risk of losing skeletal muscle mass, such as patients undergoing weight loss programs or intensive rehabilitation programs associated with neurological disability (Parkinson’s disease). Most recently, MT-ONS has demonstrated not only a significant efficacy on clinical variables, but also a positive impact on healthcare resource consumption in the rehabilitation setting (length of stay and duration of rehabilitation programs).
In summary, MT-ONS, alone or in association with an appropriate exercise program, is an effective therapy for older patients with sarcopenia and should be offered as a first-line treatment, not only to improve clinical outcomes but also to reduce healthcare resource consumption, in particular when patients are admitted to a rehabilitation center.
Ms Eilish Joyce, Clinical Specialist Dietitian, St. James’s Hospital
Eilish graduated from TCD/DIT in Feb 1990 with a BSc in Human Nutrition and dietetics. She started working in St. James’s Hospital in May 1990 and began her career in the speciality of Gastroenterology in May 1991.
She was appointed Clinical Specialist Dietitian in Functional Gastro-intestinal Disorders in May 2020 and currently manages the nutritional care of patients attending a dedicated IBS Care-pathway in St James’s.
A dedicated IBS Care-pathway and its impact on endoscopy waiting lists , healthcare costs and patient outcomes ?
A dedicated IBS Care-pathway and its impact on endoscopy waiting lists, healthcare costs and patient outcomes
Irritable Bowel Syndrome (IBS) is a chronic debilitating condition affecting 5-11% of the population, placing a significant burden on health services. Patients with possible IBS commonly undergo extensive endoscopic investigations. Clinical guidelines recommend that a positive diagnosis of IBS is based on presenting symptoms and non-invasive blood and stool tests in patients who satisfy a diagnosis of IBS using Rome IV criteria . Further endoscopic or radiological assessments are not recommended once a diagnosis of IBS has been established.
Following a successful pilot in 2018/2019, an effective evidence-based interdisciplinary IBS care pathway has been rolled out in St James’s Hospital.
Between Sept 2018 and May 2019, all referrals received for endoscopy were triaged by the gastroenterology medical teams. Patients who met specific criteria were diagnosed with IBS and referred for individualised dietetic intervention, following an agreed pathway, and outcomes assessed.
87% of those who completed dietary intervention were discharged without endoscopy , saving up to 153 endoscopy slots and €103,953 (HSE ABF guide, 2019)
Functional gastrointestinal disorders account for approx. 40% of referrals to our gastroenterology service, of which IBS is the most common diagnosis. NICE guidelines for management of IBS centre on dietary education and intervention strategies provided by qualified dietitians
This pilot of an interdisciplinary IBS care pathway demonstrated symptom resolution and improved patient care, reducing unnecessary investigations. This allowed consultant gastroenterologists to re-allocate endoscopy slots and resources, potentially reducing delays in diagnosis of malignant and other organic conditions.
Dr. Peter Collins, Mater Health, Brisbane & Mater Research Institute, University of Queensland
Peter is a UK trained Registered Dietitian and Accredited Practising Dietitian, living and working in Brisbane, Australia. He is a Senior Dietitian (Gastroenterology & General Medicine) at Mater Health where he works clinically across both the public and private hospitals. Peter is also Honorary Senior Fellow at the Mater Research Institute, University of Queensland. Peter completed his PhD in nutrition support in chronic obstructive pulmonary disease (COPD) in the Faculty of Medicine at the University of Southampton, UK and he is an Early Career Faculty member of ESPEN.
New approaches to optimising outcomes of COVID patients post discharge
The COVID-19 global pandemic has resulted in an unprecented demand on health care systems around the world, from intensive care beds and specialist equipment, through to the ability to support patients during their recovery in the community. Whilst much of the focus has been on the life-threatening impact of the disease and the need for specialist life-preserving critical care, the broader impacts of the disease in terms of malnutrition, fraility and prolonged impaired physical function, are only now starting to be realised (‘Long COVID’). Almost a quarter of a million people in Ireland have contracted COVID-19 since the outbreak against a backdrop of approximately 15,000 available beds across Irish hospitals. This pressure on hospital beds means coordinated nutritional care from hospital to home is essential. In addition, early comprehensive nutritional screening and assessment linked to evidence-based nutrition care plans across all points of the health care continuum, and involving all members of multidisciplinary teams, is of crucial importance to prevent nutritional decline and enhance recovery.
Niamh Rice, IrSPEN Director; Executive Director of the European Nutrition for Health Alliance (ENHA)
Niamh Rice is a director and founding member of IrSPEN and an independent consultant specialising in nutrition and medical affairs. In January 2021, she was appointed Executive Director of the European Nutrition for Health Alliance (ENHA), which aims to ensure that all EU citizens at risk of nutritional problems due to ageing or disease benefit from optimal nutritional care. Qualified in Nutrition and Dietetics, Niamh has over 25 years’ experience working in senior scientific, general management and global director positions within nutrition companies in Ireland, UK and Netherlands. Within IrSPEN, Niamh has directed strategy and communications and has actively campaigned for improved standards of nutritional care, applying her knowledge of business strategy and health economics to underpin IrSPEN’s advocacy and campaigning efforts. Her work on developing a national costing for malnutrition was published in 2012, and she has also written or contributed to several clinical papers, expert reports, government submissions, reviews and business case submissions on behalf of non-governmental agencies and professional groups. As chair of IrSPEN’s programmes and communication committee, Niamh has also worked on initiatives aimed at gaining a better understanding of the needs of patients who experience nutritional problems, including patients receiving home nutrition support and patients with cancer. In the last few years, Niamh has served on national advisory committees on nutrition and hydration for both HIQA and the HSE, developing the budget impact analysis to support new clinical guidelines for nutrition screening of patients in acute care settings in Ireland, launched December 2020.
Dr Graham Turner, Belfast Health and Social Care Trust
Dr Graham Turner works as a Consultant Gastroenterologist in Belfast at both the Royal Victoria and Belfast City Hospitals. He is Clinical Lead for Gastroenterology and Endoscopy at the Trust. He has been a consultant since 2006 initially in Altnagelvin Hospital in Derry but moved to Belfast in 2009 where he is part of the Regional Intestinal Failure team for Northern Ireland.
Graham qualified from Queen’s University Belfast in 1996 and completed his training in Northern Ireland and was awarded an MD degree at QUB in 2004. He has completed Fellowships in Perth Australia and then at University College Hospital in London with Prof Alastair Forbes.
His clinical interests are Intestinal Failure, Inflammatory Bowel disease and endoscopy including Bowel Cancer Screening.
The Nutrition Team as a means of ensuring full integration of nutrition into healthcare delivery
Dr Karen Boland, Consultant Gastroenterologist, IrSPEN Director
Karen graduated with an honours degree from the School of Medicine at RCSI in 2007 and is currently appointed as a Consultant Gastroenterologist at Beaumont Hospital with an interest in inflammatory bowel disease and clinical nutrition. She completed an advanced fellowship in microbiome analysis, diet analysis and inflammatory bowel disease at Mount Sinai Hospital Toronto. Her current research interests include therapeutic drug monitoring in IBD, microbiome analysis and the impact of diet and exercise programmes on outcomes in moderate to severe IBD. Karen is a member of the board of IRSPEN and chair of their Scientific Committee.
Taking Nutrition Seriously in Medicine: Findings and Implications of a National Survey of Physicians and Medical Undergraduates
Professor Carel Le Roux, IrSPEN Director
Professor Carel le Roux graduated from medical school in Pretoria South Africa, completed his specialist training in metabolic medicine at St Bartholomew’s Hospitals and the Hammersmith Hospitals. He obtained his PhD from Imperial College London where he later took up a faculty position. He moved to University College Dublin for the Chair in Experimental Pathology and he is now a Director of the Metabolic Medicine Group. He also holds the position of Professor of Metabolic Medicine at Ulster University. He currently coordinates an Innovative Medicine Initiative project on obesity. He previously received a President of Ireland Young Researcher Award, Irish Research Council Laurate Award, Clinician Scientist Award from the National Institute Health Research in the UK, and a Wellcome Trust Clinical Research Fellowship for his work on how the gut talks to the brain.
Dr Shahrad Taheri, Professor of Medicine at Weill Cornell Medicine
Professor Shahrad Taheri is Professor of Medicine at Weill Cornell Medicine. He is also Senior Consultant Physician in Diabetes and Endocrinology and Assistant Chair in Medicine at Hamad Medical Corporation, Qatar. Professor Taheri has been a member of the National Diabetes Strategy Committee in Qatar. He chairs the Research Committee for the Qatar National Diabetes Strategy and also for the Qatar Metabolic Institute. He graduated in Medicine from London University and obtained his PhD from Imperial College London, followed by post-doctoral research training at Stanford University as a Howard Hughes Research Associate. Professor Taheri has extensive experience in leading large multi-disciplinary clinical and research teams. He has over 150 publications and has won several awards for his research. Professor Taheri’s focus is the design and conduct of clinical trials to answer key questions in the management of metabolic diseases and linking these to basic laboratory investigations to understand underlying molecular mechanisms.
Evidence that total meal replacement therapy (TMRT) can be used to place diabetes into remission
Type 2 diabetes is affecting people at an increasingly younger age, particularly in the Middle East and in North Africa (MENA) region. We assessed whether an intensive lifestyle intervention incorporationg a total meal replacement phase followed by gradual food reintroduction would lead to significant weight loss and improved glycaemia in young individuals with early diabetes.
This open-label, parallel-group, randomised controlled trial (DIADEM-I), done in primary care and community settings in Qatar, compared the effects of an intensive lifestyle intervention with usual medical care on weight loss and glycaemic outcomes in individuals with type 2 diabetes, aged 18–50 years, with a short diabetes duration (≤3 years), had a BMI of 27·0 kg/m2 or more, and who were from the MENA region. Participants were randomly allocated (1:1) either to the intensive lifestyle intervention group or the usual medical care control group by a computer-generated sequence and an online randomisation service. The intensive lifestyle intervention comprised a total diet replacement phase, in which participants were given formula low-energy diet meal replacement products followed by gradual food reintroduction combined with physical activity support, and a weight-loss maintenance phase, involving structured lifestyle support. Participants in the control group received usual diabetes care, which was based on clinical guidelines. The primary outcome was weight loss at 12 months after receiving the assigned intervention. Our analysis was based on the intention-to-treat principle. Key secondary outcomes included diabetes control and remission. The trial was registered with the ISRCTN registry, ISRCTN20754766, and ClinicalTrials.gov, NCT03225339.
Between July 16, 2017, and Sept 30, 2018, we enrolled and randomly assigned 158 participants (n=79 in each group) to the study. 147 participants (70 in the intervention group and 77 in the control group) were included in the final intention-to-treat analysis population. Between baseline and 12 months, the mean bodyweight of participants in the intervention group reduced by 11·98 kg compared with 3·98 kg in the control group (adjusted mean difference −6·08 kg, p<0·0001). In the intervention group, 21% of participants achieved more than 15% weight loss between baseline and 12 months compared with 1% of participants in the control group (p<0·0001). Diabetes remission occurred in 61% of participants in the intervention group compared with 12% of those in the control group (p<0·0001). 33% of participants in the intervention group had normoglycaemia compared with 4% of participants in the control group (OR 12·07 [3·43 to 42·45], p<0·0001).
The talk will discuss findings from the DIADEM-I study, factors related to diabetes remission, and translation of findings into clinical care.
Professor Francis Finucane, Consultant Endocrinologist, Galway University Hospitals and NUI Galway
Francis Finucane is a consultant endocrinologist at Galway University Hospitals and NUIG. He was awarded an MD from the University of Dublin (TCD) for research on the mechanistic basis for type 2 diabetes in young people. He completed an MRC-funded post-doctoral career development fellowship at the Institute of Metabolic Science in Cambridge, where he studied the effects of structured lifestyle modification on metabolic risk. In Galway, he established a regional bariatric medical service for patients with severe and complicated obesity and received the inaugural Clinical Research Career Development Award from Saolta in 2019.
How can TMRT be implemented in practice
This talk will examine the evidence base and indications for meal replacement programmes, reflecting some real world challenges and experiences.
John Conneely, Mater Private Hospital, Dublin
Mr. John Conneely, joined the Mater Private as a Consultant General Surgeon specialising in Digestive Diseases.
He graduated from the National University of Ireland, Galway in 2000 and subsequently completed his surgical training under the auspices of the RCSI, completing the Higher Surgical Training Programme in 2011. Following that, Dr. Conneely undertook a fellowship in Minimally-Invasive Surgery and Bariatric Surgery at the University of Toronto, followed by the completion of a two-year Fellowship in Abdominal Transplantation and Hepato-pancreato-biliary Surgical Oncology at Toronto General Hospital, where he subsequently worked as a Consultant. His subspecialty interests encompass the entire spectrum of foregut and hepato-pancreato-biliary surgery, both in the oncology and non-oncology settings.
He is particularly passionate about the value of minimally-invasive surgery in every context and has trained extensively in the field. Dr. Conneely is committed to developing the excellent minimally-invasive surgery services and the development of metabolic and bariatric services.
Dr Alex Miras, Imperial College London
Alex Miras is a Senior Lecturer and Consultant in Endocrinology and Obesity Medicine at Imperial College London. His clinical and research work focus solely on Obesity. He has contributed to the clinical management and research in Obesity over the last 10 years, through his work at a high throughput Obesity Centre. The specialist interests of his research Group are the mechanisms of action of interventions for obesity, focusing on pharmacotherapy, medical devices and obesity surgery. He has delivered invited lectures at national and international meetings, contributed to national clinical guideline development, published his research in high impact factor journals and disseminated his findings to the lay public. He is an active member of the All-Party Parliamentary Group on Obesity that seeks to change policy at the highest level. He is a SCOPE (Specialist Certification of Obesity Professional Education) National Fellow for the UK and associate editor for Surgery for obesity and associated disorders and Obesity Surgery.
Evidence that anti obesity medications (aom) can be used to place diabetes into remission
Dr Karl Neff, Consultant Endocrinologist (he/him), Ireland East Hospital Group
Dr Neff is a Consultant Endocrinologist and Obesity Physician, with a special interest in the use of bariatric and metabolic surgery as a treatment for diabetes and the complications of diabetes.
Following graduation from the National University of Ireland in Galway, Dr Neff completed Higher Specialist Training in Endocrinology and Diabetes in Ireland, and wrote his PhD thesis on the effect of bariatric and metabolic surgery on the complications of diabetes in University College Dublin.
In 2016 he moved to King’s College Hospital in London. During his time in King’s, he took a lead role in the Obesity service, working with the expert multidisciplinary team in King’s to optimise pre-operative assessment and peri-operative management of diabetes.
In 2019, he returned to Dublin to take up a position in the Ireland East Hospital Group and is now a Principal Investigator in the Diabetes Complications Research Centre at the Conway Institute of University College Dublin.
Dr Neff has published widely on the topic of obesity and metabolic disease, and has contributed to several textbooks on bariatric and diabetes care. With colleagues across Europe, he co-authored the first international recommendations on prenatal and antenatal care in bariatric surgery recipients.
How can anti obesity medications (aom) be implemented in practice
Professor Chris Collins, Consultant General & Upper Gastrointestinal Surgeon and Honorary Professor in Surgery at NUI Galway
Chris lectures to students at all levels across the school of medicine, including the MSc in Obesity.
Chris holds a Bachelor of Engineering and degree in Medicine from UCC. Following a PhD in cancer therapy, he worked as a Senior Lecturer with the RCSI and he completed the Higher Surgical Training Scheme in General and Upper Gastrointestinal Surgery along with a Masters in Quality in Healthcare. He then completed a fellowship in Guys and St Thomas’ in London concentrating on oesophago-gastric as well as bariatric surgery. He was subsequently appointed to Addenbrooke’s Hospital, Cambridge as a Consultant Surgeon.
He has published in excess of 50 peer-reviewed papers as well as being involved in the successful awarding of grants from the EU as well as Enterprise Ireland for the development of electroporation devices as well as educational animation software.
He is very involved in clinical research and teaching in Galway University in the areas of patient safety, minimally invasive surgery, upper gastrointestinal surgery and bariatric surgery.
Dr Ricardo Cohen, The Center for Obesity and Diabetes, Oswaldo Cruz German Hospital, São Paulo, Brazil
Director of the Center for Obesity and Diabetes, Oswaldo Cruz German Hospital, Sao Paulo, Brazil.
Past President, Brazilian Society of Bariatric and Metabolic Surgery
Past President, IFSO-Latin American Chapter
Evidence that surgery can be used to place diabetes into remission
T2D is associated with complex metabolic dysfunctions, leading to increased morbidity, mortality. Some strategies to prevent diabetes and obesity are essential. However, people who develop this disease should have access to all effective treatment options.As GLP-1 agonists and SGLT-2 inhibitors, anti-diabetes medications have shown positive effects on renal and cardiovascular outcomes, including decreased mortality. However, a considerable number of patients do not respond adequately to the best medical treatment. The gastrointestinal tract is an essential target for the management of T2D, as it has an essential role in metabolic homeostasis. There is bold evidence from large non-randomized studies and mid/long-term randomized controlled trials that showed that metabolic surgery could achieve glycemic control and reduce cardiovascular risk factors and mortality. Additional studies are needed; however, there is enough evidence, clinical and mechanistic, to support the indication of surgery in people with T2D and obesity that cannot control their diseases after the best medical treatment.
Professor Helen Heneghan, Consultant Bariatric Surgeon at St. Vincent’s University Hospital, Dublin
Professor Helen Heneghan (MB BCh BAO, PhD, FRCS) is a Consultant Bariatric Surgeon at St. Vincent’s University Hospital, Dublin and the Professor of Surgery at University College Dublin. She is a graduate of NUI Galway medical school, was awarded a PhD in the molecular expression of breast cancer and obesity from NUI Galway in 2012. She completed the RCSI Higher Surgical Training scheme in General Surgery in 2016. During her training, she spent two years on Fellowship in the Bariatric & Metabolic Institute in Cleveland Clinic, Ohio. She then completed her training with a Bariatric Fellowship in the UK (Chester & Liverpool). She has co-authored >70 publications in peer-reviewed journals and has written 5 book chapters on the topics of bariatric and endocrine surgery. Her research interests include obesity and cancer, diabetic kidney disease and bariatric surgery mechanisms.
How can surgery be implemented in practice
Colm O’Boyle, Bon Secours Cork
Mr O’Boyle is Chairman of the Division of Surgery and Postgraduate tutor at the Bon Secours Hospital. He is a Senior Clinical Lecturer at University College, Cork. He has been performing bariatric surgery for over 20 years. The IFSO-endorsed Centre of Excellence in Cork is one of the busiest in Ireland. He is an Associate Editor for the journal “Obesity Surgery” and a member for EAC-BS Accreditation Review Committee and the former Council Representative for Ireland on the Association of Laparoscopic Surgeons of GB+I.
Dr Sarah Browne, University College Dublin
Dr. Sarah Browne is a registered dietitian, graduating from DIT/TCD in 2006. She is a part-time assistant professor/lecturer on the MSc in Clinical Nutrition and Dietetics in the School of Public Health, Physiotherapy & Sports Science at UCD and is also a part-time project manager on the ONSPres Malnutrition Project funded by the HRB, with PI Associate Prof. Clare Corish at UCD. Sarah began her career working as a community dietitian with the HSE where she developed and delivered a range of primary care services for chronic disease management and malnutrition among older adults. She went on to run a private practice specialising in individual adult clinics and community and youth health promotion interventions. She completed her doctoral thesis in 2017 at Dublin City University, working with teenagers to understand diet and physical activity behaviours in the secondary school setting in Ireland. Sarah has completed 2 post-doctoral research positions in the areas of clinical health promotion and childhood obesity treatments. Research interests and activities include dietary behaviours, food environments, childhood obesity, malnutrition in older adults, and qualitative and participatory methodologies in diet & nutrition research.
Identification and management of malnutrition in the community: the perspective of the multidisciplinary team and patients
Malnutrition occurs frequently among community-dwelling individuals in developed countries. Once identified, it can be effectively treated in most cases with dietary advice and oral nutritional supplements (ONS). Previous research has reported inadequate screening and treatment of malnutrition in the community.
In the ONSPres Malnutrition study, healthcare professionals (HCPs) working in primary care and community settings and patients with a previous or current prescription for ONS were interviewed to explore their views of malnutrition management and ONS use. This involved face-to-face interviews with general practitioners and patients, and profession-specific focus groups with community and industry dietitians, nurses, pharmacists, physiotherapists, occupational therapists, and speech and language therapists.
A dislike of the term “Malnutrition” was identified among HCPs and patients, with patients clearly misunderstanding and fearful of the condition. HCPs reported gaps in the management of malnutrition and uncertainty about the care pathway. The lack of resources and need for dietetic support was highlighted. Patients relied on friends and family to manage malnutrition, perceived a disconnect between multidisciplinary care team members and reported little dietetic input. HCPs reported a lack of knowledge about how to manage malnutrition and appropriate ONS prescribing and use. Concerns were expressed about perceived costs, poor monitoring and compliance, and inappropriate prescribing in residential care.
HCPs working in the community are overwhelmed and underequipped to manage malnutrition and patients require further support. Clarity around malnutrition management pathways, improved multidisciplinary communication and greater dietetic support for those who are malnourished or at risk of malnutrition in the community is urgently required.
Dr Aisling Geraghty, University College Dublin
Aisling Geraghty is a clinical health researcher with an BSc in Human Nutrition and a PhD in Translational Medicine from University College Dublin. Dr. Geraghty has a keen interest in the area of maternal/child health and nutrition delivery. Currently working as a Clinical Trials Manager in UCD, Dr. Geraghty previously worked as a postdoctoral research fellow with UCD Perinatal Research Centre and in the Royal Children’s Hospital in Melbourne. Dr. Geraghty also collaborates on post-doctoral work on the ONSPres Malnutrition research project developing an online eModule providing nutrition training for healthcare professionals in the UCD School of Public Health.
Development and evaluation of a multidisciplinary education intervention for GPs to improve the identification and management of malnutrition in the community
Fiona Ward, Dietitian Manager, OLCHC
After graduating from University of Ulster in Coleraine in 1997, Fiona worked in the UK. She developed the home enteral tube feed (HETF) service in Camden and Islington NHS Trust in the early 2000’s before moving full time into paediatrics. She has worked in acute paediatrics in Children’s Health Ireland since 2005. She secured project funding and completed 2 reviews in home enteral tube feeding whilst in Temple Street, one of which was published in the Irish Journal of medical science “Parents need support” and she has been leading on database development for HETF patients since she moved to Crumlin.
Home Enteral Feeding in Children in Ireland
Professor Clare Corish, University College Dublin
Clare Corish is a registered dietitian and associate professor in clinical nutrition and dietetics at University College Dublin where she manages a professional graduate programme in clinical nutrition and dietetics, the first such programme in the Republic of Ireland. She has served as President of the Irish Nutrition and Dietetic Institute and Chair of the Nutrition Society Irish Section.
Her research interests are disease-related malnutrition, nutrition in older adults, early childhood and shift workers.