30430 Issue 491 March 2004 · ACBNews The Association of Clinical Biochemists ¥ Issue 491 ¥ 20th March 2004 Modernisation Report LabTests Online Uk Style Colorectal Cancer Screening

ACBNewsACBNewsThe Association of Clinical Biochemists • Issue 491 • 20th March 2004

Modernisation

Report

LabTests

Online Uk Style

Colorectal

Cancer

Screening

Part I MRCPath

Practical &

Theory

Modernisation

Report

LabTests

Online UK Style

Colorectal

Cancer

Screening

Part I MRCPath

Practical &

Theory

THE

LATEST

ARRIVAL

® Registered trademarks referenced are owned by Dade Behring Inc. or its affiliated companies and registered in the U.S. Patent & Trademark Office.

TM Trademarks referenced are owned by Dade Behring Inc. or its affiliated companies.

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Family values to appreciate in theclinical laboratory.

About ACB News

The monthly magazine

for Clinical Science

The Editor is responsible for the finalcontent. Views expressed are not necessarily those of the ACB. EditorDr Jonathan BergDepartment of Clinical BiochemistryCity HospitalDudley RoadBirmingham B18 7QHTel: 07973-379050/0121-507-5353Fax: 0121-765-4224Email: [email protected]

Associate EditorsMiss Sophie BarnesDepartment of Chemical PathologySt Thomas’ HospitalLondon SE1 7EHEmail: [email protected]

Mrs Louise TilbrookDepartment of Clinical BiochemistryBroomfield HospitalChelmsfordEssex CM1 5ETEmail: [email protected]

Mr Ian HanningDepartment of Clinical BiochemistryHull Royal InfirmaryAnlaby RoadHull HU3 2JZEmail: [email protected]

Focus Handbook EditorDr Richard SpoonerDepartment of Biochemistry Gartnavel General HospitalGlasgow G12 0YNEmail: [email protected]

Situations Vacant AdvertisingPlease contact the ACB Office:Tel: 0207-403-8001 Fax: 0207-403-8006Email: [email protected]

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ACB ChairmanMiss Janet SmithDepartment of Clinical BiochemistryUniversity Hospital Birmingham NHS TrustBirmingham B29 6JDTel: 0121-627-8449 Fax: 0121-414-0078Email: [email protected]

ACB Home Pagehttp://www.acb.org.uk

Printed by Piggott Printers Ltd, CambridgeISSN 1461 0337© Association of Clinical Biochemists 2004

March 2004 • ACB News Issue 491 • 3

Front cover: Ron Parker, Jean McHale and Steve Smith outside the impressive new Biological Sciences buildingat Walsgrave Hospital in Coventry

ƒocus2004ICC • BIRMINGHAM • 18-20 MAYThe Association of Clinical

Biochemists National Meeting

ICC, Birmingham Tel: 01223 404830 Fax: 01223 404841

Email: [email protected] Web: www.focus-acb.org

ACBNewsNumber 491 • March 2004

Editorial 4

General News 6

Disposable Laboratory Tips 13

LabTests Online 14

IT Links 15

MRCPath Short Questions 16

RCPath Exam 18

MRCPath Exam 24

Meeting Reports 28

Promoting Our Science 32

Situations Vacant 36

Editorial Editorial Editorial Editorial Editorial Editorial Editorial

4 • ACB News Issue 491 • March 2004

Produced by pathology professionals the Department of Healthreport, “Modernising Pathology Services” is a powerfuldocument that is going to impact on our working lives in the

months and years ahead. At just 35 pages, the report is welcominglyconcise and differs from the draft guidance in being much moresingle-minded. Networking of clinical laboratories is the wayforward. The report is very clear about that and backs it withconsiderable finance and infrastructure.

How you receive the report depends on where you are down thenetworking experience. For many the work involved appearsdaunting, while for networking pioneers there will be a smile thateveryone is now to take forward the networking dream. We allknow examples of those who have grasped networking as a modeland also some notable “black holes”, where people have ignored thewhole thing and hoped it will go away.

Accreditation . . . Now MandatoryThe clear statements in the report on CPA accreditation are worthstudy, as they impact both on laboratories who have not applied foraccreditation and, I believe, on the CPA set-up itself.

The report points out that until recently accreditation wasvoluntary with the exception of cervical cytology laboratories. Thenew guidance is that “All NHS trusts should ensure that pathologyservices are accredited or seeking accreditation”. It goes on to statethat any laboratories that are not already accredited, or in theprocess of becoming accredited should complete applications assoon as practicable.

This clear statement is going to have a profound effect on thosethat have chosen to ignore the accreditation process. Accreditation ata local level is a story of gradually getting up to speed with evolvingquality standards. Some who have decided not to participate inaccreditation may now find the work involved daunting. Certainlywhere bricks and mortar are involved to achieve the requiredstandards, and local funding is not forthcoming, the options arebleak. For those that rise to the challenge there is the consolationthat CPA are so swamped with registration forms that inspectiondates will be in the distant future. Merger with those that have theinfrastructure to help achieve accredited status is a pragmatic wayforward for some and this could help drive networking in suchsituations.

Active professionals who take on the work of a CPA inspector arelikely to be the same “busy”people who are now called upon toimplement networking solutions. For the CPA the task of findingwilling voluntary inspectors to undertake ever more work is in myview unsustainable. I believe that CPA will eventually conclude that a

Networking Solutions By Dr Jonathan Berg, Editor

The ModernisingPathology

Services reportwas published on

17th February.Here the ACBNews Editoroffers his

personal view.

Editorial Editorial Editorial Editorial Editorial Editorial Editorial


for Allteam of full-time professional inspectors is the only practicable way forward.The sooner CPA grasp this the better as they should have an increasinglycentral and important role to play in UK Pathology.

The Leadership VoidDriving change forward requires dedicated and single-minded individualswith the ability to motivate rather than demoralise. We need leaders whounderstand the change process, can take the pressure and overcome manyhurdles and setbacks. Change always threatens, and the real fear is that manysenior people in the profession will decide to take an early retirement ratherthan be part of an uncertain future. We simply cannot allow this to happenfor we are thin on the ground as it is.

The report has clearly recognised that the need for leadership includes aninfrastructure at the centre. The Modernisation Agency has already appointeda national clinical lead for pathology. A national programme lead will also beappointed in April 2004. There is money set aside to develop “local leaders,network managers and clinical champions” as well as to put in place somenational co-ordination with an “implementation oversight group”.

Each Strategic Health Authority is to be given £100,000 of revenue fundingfor project management to help drive local networking solutions but SHAshave little infrastructure or expertise to take on this work. I would suggestthat the professions have an ideal opportunity to take the lead. OncePathology Directors from local trusts have had their first meeting it needs tobe straight down to the SHA with an offer to set up a professionally ledreview committee to drive things forward.

It’s About People . . .This is about the whole of pathology and it will be interesting to see howdifferent pathology disciplines react. Success will be about people prepared towork hard to make networking happen. Investment in equipment and IT isvital but people are the key. Local leaders will need to be acceptable to thewhole of pathology and discipline specific leaders need to be chosen withcare.

The timescale inherent but not explicit in the report appears tight, with thefunding starting this April and carrying on for two years. The Department ofHealth investment is significant but it is now up to pathology locally to usethe report to argue for greater resources as part of the networking challenge.

The pathology professions now need to take control rather than waiting forsomeone from the local SHA to come banging on the door. Alternatively, youcan sit around for a few more months and then have the unpleasantexperience of things being imposed on you. ■


General News General News General News General News General News

Here is the Executive Summary of the much awaited Department ofHealth Report on pathology services that was published on 17thFebruary 2004.

Executive Summary

i The Department of Health launched a PathologyModernisation Programme in 1999, with the keygoals of improving the quality and efficiency ofNHS pathology services and encouraging theintroduction of new technologies and practices todeliver high quality care for patients. Between1999/00 and 2002/03, capital funding of £28million was invested in 39 demonstration projectsacross England.

ii A consultation paper Pathology – The EssentialService – Draft Guidance on ModernisingPathology Services 1 proposed future principles,goals and objectives for NHS pathology. The keychange proposed was the introduction of managedpathology networks across NHS trusts as a modelof service delivery to address the workforce andtechnology challenges facing the NHS. Thisdocument builds on the responses received. It setsout steps that can be taken locally to developpathology modernisation strategies and describesaction which will be taken nationally to supportdevelopments.

Next Steps Locally

iii The steps proposed in this document will help theNHS build capacity to develop better pathologyservices as well as putting in place basic buildingblocks to support clinical services to meet keypriorities and targets by:• setting up a managed pathology network, or

similarly robust mechanism, identifying localleaders, appointing and resourcing networkmanagers and clinical champions

• reviewing local pathology services andestablishing and promulgating implementationarrangements to achieve change and supportlocal clinical and health protection

requirements• participating in audit of delivery and continuous

quality improvement• undertaking a workforce review and skill mix

profile of the staff required to deliver improvedservices, linked to a training needs analysis to

facilitate engagement with the workforcedevelopment arm of the SHA.

iv The key focus is redesigning services to buildpathology capacity to support delivery of targetsset out in Improvement, Expansion and Reform:the next 3 years.2 Advice on best practice forimplementing change is described for both NHSand Foundation Trusts.

Modernising Strategies

v It is recognised that managed pathology networkscan provide a wider strategic context forpathology services planning. Modernisationstrategies which will support service developmentare outlined including:

• integrating pathology into wider service developments

• redesigning systems• decreasing inappropriate variation• making effective use of IT and new technologies• improving information management.

Next Steps Nationally

iii As part of a national focus to increase diagnosticcapacity and support the NHS to implementchange in pathology services, the Department ofHealth will set up an implementation oversightgroup. They will:

• disseminate key messages on modernising pathology

• advise the Department of Health on using funding resources for success

• support sharing of good practice in pathologyacross the NHS

• network with the Modernisation Agency andother key stakeholders to re-design pathology services

• work with the diagnostics industry to support theuptake of new technology, new ways of workingand effective point of care testing services

• review progress after the first year.

vii A total of £9.1 million revenue and £54 millioncapital funding will be available to support thiswork over the period 2003/04 – 2005/06.

continued on page 8

Modernising Pathology Services

■ Blood gas systems such as the Omni S can be totally managed from the central laboratory

allowing staff to monitor reagent levels, update user security, perform troubleshooting and

assess quality control performance of all remote analysers.

■ Professional blood glucose meters like the Accu-chek Inform can offer strip lot tracking, quality

control enforcement, user proficiency management and meter tracking.

■ The Cardiac Reader with point of care D-Dimer and Troponin T assays can be integrated into a

24 hour pathology service whilst allowing management and visibility of all results by patient.

One sample One process One set of results

Innovative IT Solutions for the integration of Roche point of care

systems into hospital and laboratory information systems allowing

the security and confidence to conform with EPR guidelines.

Tel: +44 (0)1273 484788 Bell Lane, Lewes, BN7 1LG

Innovative solutions for IT integration



Integrator Wanted for

Research ProjectDo you have an old self-contained integrator tuckedaway in a drawer? If so, then Julian Waldron is keen tohear from you so he can put it to good use. In particular, Julian is looking for a machine such as theHP 3392A integrator, to replace one that has given upthe ghost. These were a great workhorse in the 1980sbut you have probably replaced yours with a PC-basedintegrator system now. Perhaps instead of throwing itout you have tucked the HP in a drawer – if so thenJulian can help by taking it off your hands. Pleasecontact Julian on email at [email protected] give him a call on Tel: 0121 507 5352. ■

As part of this funding, in 2005/06 each SHA will receive £100,000 revenue funding for projectmanagement to support pathology networkdevelopment locally. In addition, during 2004/05and 2005/06 the Department of Health and theModernisation Agency will fund a programmemanager to lead a project on pathology serviceredesign and modernisation. In 2005/06 theDepartment of Health will provide £325,000 toroll that work out nationally.

viii This document has been developed with theadvice of a Working Group, chaired by theDepartment of Health’s Pathology ModernisationAdviser, Dr Ian Barnes. Its membership is set out atAnnex 2. We are very grateful to the group for thetime they gave to developing this document. Weare also very grateful to all who contributed todeveloping the consultation paper and to thosewho responded to it (names atwww.dh.gov.uk/pathologymodernisation/commsdoc318june.pdf).

ix Any comments or queries on this documentshould be addressed to:Pathology Modernisation TeamDepartment of HealthArea 423Wellington House133-155 Waterloo RoadLondon SE1 8UGEmail: [email protected]

1 Department of Health. Pathology - the Essential Service -Draft Guidance on Modernising PathologyServices. London: Department of Health 2002

2 Department of Health. Improvement, Expansion andReform:the next 3 years. Priorities and Planning Framework2003-2006. Available atwww.dh.gove.uk/planning2003-2006/index.htm

3 Further information on allocations to SHAs andTrusts is at www.dh.gov.uk/nhsfinance.htm ■

Modernising Pathology

Services continued

Focus 2004

Internet Café

Located in the Exhibition Hall

Free of Charge

Keep in-touch with your department

Check your emails each day



Ethics in Coventry

The front cover this month shows three speakers at therecent meeting on ethics and screening at WalsgraveHospital in Coventry. The meeting looked at the issuessurrounding informed consent and also updated dele-gates on the evidence for colorectal cancer screeningfollowing on from the two-centre study recently carriedout in Coventry and Fife. ■

Mr Ron Parker, Professor Jean McHale and Dr Steve Smith outside the

Biological Sciences building at Walsgrave Hospital in Coventry.

Is your HPC Registration

Up to Date?

A Note from FCS

The Federation has recently learnt of a case where aclinical scientist received a letter giving a short periodof notice that registration would be terminated becauseof non-payment of the appropriate fee.

It appears that there had been a problem with thedirect debit mandate, but our member was notinformed of this until the letter saying that registrationwould soon lapse.

In view of the implications for employment it is vitalto maintain continuity of registration. Therefore itwould be worth a couple of minutes checking yourpayment records to confirm that membership is up-to-date and checking your register entry, especiallyif you have set up an automatic payment mandate inthe last 12 months. Your registration dates can bechecked on line at:http://register.hpc-uk.org/lisa/RegistrantSearchInitial.jsp

If you are not sure that payment has been made, theHPC Registration Department can be contacted on Tel: 0845 300 4472 or Email: [email protected] Website: www.hpc-uk.org

The FCS would like to be kept informed if there areany problems with registration. ■

Quality Assurance in

Genetic Testing

NCCLS is seeking input and volunteers from the molecular diagnostics field. NCCLS is evaluating, “Use of External RNA Controls for the Quality of GeneExpression Measurements with Microarrays and byReal-Time PCR (RT-PCR)”, a new project proposed fordevelopment through the NCCLS consensus process.NCCLS volunteers are experts in the medical testingcommunity who share and enhance their technicalexpertise. They work together to write reliable andpractical consensus standards and guidelines toimprove the efficiency and effectiveness of clinicallaboratory practices and medical testing.

The newsletter “NCCLS eNews”, gives informationabout recent documents, guidelines and best practiceand can be found at www.enews.nccls.org ■

Practice MRCPath

City Hospital, Birmingham

Saturday 27th March 2004

There are several places left on a practice MRPath practical exam. If you are taking the exam in the nearfuture and would like to put yourself through unnecessary torture then you will be very welcome tocome along. The proceedings will commence at 9 amand will finish by 5 pm. Convenient Bed and Breakfastaccommodation can be arranged. There may be a smallcharge to cover the cost of sitting the exam.

If you are interested please contact Dr Jonathan Bergby email on [email protected] to discuss. ■

Focus 2004The Clinical Laboratory

Exhibition of 2004

Pathology Modernisation

New Technologies

New Developments



Paediatric

Biochemistry

Meeting 2004CSB main Lecture Theatre

St James’s Hospital

Wednesday May 26th

Morning Session:

Neonatal ScreeningChair: Prof Carol Dezateux10.30 Recent developments in newborn

screening in the UKProf Carol Dezateux, London

11.00 HaemoglobinopathyDr Sally Kinsey, Leeds

11.20 Cystic fibrosisProf Rodney Pollitt, Sheffield

11.40 MCADDDr Mick Henderson, Leeds

12.00 Group discussion

12.30 Lunch

Afternoon Session:

Paediatric HaematologyChair: Dr Maggie Fitzpatrick14.00 The laboratory investigation of

iron deficiencyMr Rod Hinchliffe, Sheffield

14.40 Thrombophilia screening in children, is it indicated?Dr Mike Richards, Leeds

15.20 Haemochromatosis: from neonate to centenarianProf Mark Worwood, Cardiff

Registration£20 per delegate to include lunch (non-LTHTStaff); £10 for members of staff at LeedsTeaching Hospitals Trust.

Please make cheques payable to ‘LTHT(Leeds Teaching Hospitals Trust)’ and forward to: Ms E Kelshaw, Department ofClinical Biochemistry & Immunology, St James’s University Hospital, LeedsLS9 7TF.For further information contact Dr MickHenderson on Tel: 0113 2066861. Fax: 0113 2065971. Email: [email protected]

Vincent Leads Poster

Ward Rounds

During lunchtime at Focus 2004 there will be posterward round sessions. Professor Vincent Marks haskindly agreed to facilitate these. Vincent will be reviewing the posters each morning and then taking hisposse of interested delegates on a tour of his favouriteposters. He will introduce poster authors to his rovingband of nomad scientists and this is bound to lead toconsiderable intereaction. We predict this will be a funand memorable part of the meeting. Focus 2004 is ameeting of minds and it will be fun as well! ■

Breakfast Workshop Choices

The Focus website has now got short résumés of thecontent of the breakfast workshops. So, as you will besending in your registration form in the next few daysto ensure you do not pay the late booking fee this is the ideal time to visit the Focus website www.focus-acb.org/2004 to check out which workshops you will show up at. ■

New Street Pick Up for

Focus Delegates

This year the Focus committee have organised courtesymini-buses to pick you up from the front of NewStreet station and take you to the conference hotels.Two, 21-seater minibuses will operate from 12pm to6pm on Monday 17th May and will run every 15minutes. When you come out of New Street stationyou need to head for the front entrance where the taxirank is. The mini-buses will be clearly signed.Normally we would not dare to suggest that delegatesshould try and get picked up at New Street – this yearis different! ■

Don’t be an April Fool!

Register for Focus

by 1st April 2004

and avoid the late booking fee of £50

(applicable for all registrations

received after 1st April)



Chinese Banquet Tasting

On the Tuesday evening at Focus there are a number ofsocial events to entertain you. Two of these will endwith dinner at the Big Wok Chinese restaurant inBirmingham’s Chinatown. The Rock Climbers willdescend on this very different restaurant, no doubt torecount to anyone who cares to listen the excitement oftheir expeditions. At the same time the city walkers willbe able to tell of their adventures on terra firma. Thewalking tour starts at the International ConventionCentre and stops by some interesting public art andarchitecture on the way to Chinatown. There will evenbe time to venture in to the amazing Selfridges buildingand of course to rub the nose of the Birmingham Bull.This may not be the Lake District, but walking can befun in this rejuvenated city landscape! ■

Kate Hall and Pippa Goddard of Birmingham Children’s Hospital meet Brianat the Big Wok restaurant

Focus Exhibition Tickets

and Day-Tripping

Focus 2004 exhibitionvisitor tickets are nowavailable. Do contact theFocus office if you needsupplies. We wouldencourage you to send asmany of your staff as youcan to the exhibition. TheICC has plenty of reasonably priced car-parking for thosecoming fromsurrounding cities andthere are excellent raillinks from all directions.

Airfares from major UKcities are often amazingvalue. It is easy toconsider day trips fromplaces such asEdinburgh, Glasgow, Belfast, Dublin and many otherairports with return fares often being around £50.Check out airline websites such as www.flybe.com,www.mytravelite.com and www.ryanair.com.

The commitment of commerce to Focus has beenimpressive with the exhibition totally sold out. Withthis huge support for our profession it is vital that delegates and exhibition visitors come along and lookat all that is on offer. ■

Trent, Northern and Yorkshire Region Summer Meeting

The Trent, Northern and Yorkshire Region will hold a scientific meeting on Thursday 1st July 2004 atRingwood Hall Hotel, Chesterfield. The meeting will celebrate the career of Dr Howard Worth.

Speakers include:• A word here and a word there Dr J G Lines• Reflections, renal medicine and reference values Dr C G Fraser• Protecting the patient; registration, why and what for? Professor C P Price • A physician’s view from the coal face Dr R Lloyd Mostyn • The development of instrumentation in Clinical Biochemistry: a personal view Dr H G J Worth

The meeting will be followed by a dinner in the evening and preferential rates will be available for accommodation at the hotel. Further details will be available in due course. To register your interest, pleasecontact Mr Ian Hanning, Department of Clinical Biochemistry, Hull Royal Infirmary, Anlaby Road, Hull HU32JZ. Tel: 01482 607716. Email: [email protected]



Association of Clinical Biochemists (N.I. Region)

and Association of Clinical Biochemists

in Ireland

Scientific Meeting

Friday 26th March 2004

Postgraduate Lecture Theatre

Belfast City Hospital

10.15 Registration and Coffee10.55 Opening Remarks

Mr Peter Auld, Chairperson, N.I. Region ACB

11.00 HypercalcaemiaDr Steven Hunter, Royal Group of Hospitals, Belfast

11.35 Folate, Homocysteine and Cardiovascular DiseaseDr Jayne Woodside, Department of Medicine

12.10 Point of Care Testing in Northern IrelandDr Margaret McDonnell, Belfast City Hospital

12.45 Lunch

14.00 Porphyria RevisitedDr Mike Badminton, University Hospital of Wales, Cardiff

14.35 Mucopolysaccharidoses: Clinical Presentation and TreatmentDr Ed Wraith, Royal Manchester Children’s Hospital

15.10 Oestrogen Replacement Therapy: Benefits and RisksDr Joanne McManus, Royal Maternity Hospital, Belfast

15.45 HbA1c Assays: Moving from Alignment to StandardisationDr Ned Barrett, Mid-Western Regional Hospital, Limerick

16.20 Discussion

16.30 Close of meeting and Coffee

Further information available from:Dr Peter Sharpe, Department of Clinical Biochemistry,

Craigavon Area Hospital, Craigavon BT63 5QQTel: O28 38612657. Email: [email protected]

or Dr Martin Healy, St James Hospital, DublinTel: 01 4537941 ext. 2024. Email: [email protected]

Tips Disposable Laboratory Tips Disposable Laboratory Tips


LabTests Online LabTests Online LabTests Online LabTests Online


The excitement is mounting as the finalpreparations are underway to launch LabTestsOnline. Yes, for all those members of the

public who have been punching laboratory tests into“ask Jeeves”, the Association of Clinical Biochemists now has the answer!

The LabTests Online team, consisting of MikeHallworth, Stephen Halloran, Jonathan Kay, SteveSmith, James McGuire and Ian Godber, is almostready to launch the LabTests Online UK website.

LabTests Online is designed to give the patient abetter understanding of the many clinical laboratorytest that are part of routine health care, as well asinformation on the diagnosis and treatment of awide range of conditions and diseases. It is based ona successful AACC initiative, but has been completelyrewritten to be relevant to UK practice. Based on theUS experience, patients will use the information onLabTests Online to be better informed about theirown health care.

Help Us Now Please!The LabTests Online team is on schedule to launchthe UK site to the public just after Focus 2004. Thiswill include a campaign with national and regionalmedia coverage.

However before this stage the medicalprofessionals, especially GPs and Practice Nurses,need to be informed about our new service.

This is where YOUR help is needed. Posters andpublicity materials need to be distributed to GPsprior to the launch. Every laboratory has excellentlinks with its GP network, and this well establishednetwork needs to be used.

If you would like to play a pivotal role in thisexciting service, please volunteer to be a keycoordinator – one from each UK laboratory isurgently needed.

The Co-ordinator’s RoleThis key person will be required to be the

facilitator between LabTests Online and the GPsurgery, ensuring all the relevant posters and leafletsare distributed to every GP surgery the laboratoryserves. It will also be important to ensure the GPsurgeries are kept fully stocked with the necessarypatient information leaflets.

There will be a special meeting during Focus2004, when all coordinators will be fully briefed and updated on all developments.

If you would like to be one of the keycoordinators, please email Mike Hallworth [email protected] for more information. ■

Move Over Jeeves . . .By Maggie Throup

Lab Tests Online

will provide

• Detailed test descriptions

• Illness descriptions cross-

referenced to related tests

• Latest news on advances in

testing that may directlyaffect the patient

• In-depth articles explaining the

meaning of reference rangesand the types of kits that areavailable for self-testing

• Links to helpful, free internet

services that will answer questions about test resultsand provide a range of additional information

IT Links IT Links IT Links IT Links IT LInks IT Links IT Links IT LInks


Website of the Month: ACB Regional Websites -

ACB West Midlands RegionBy Dr Ian Godber, Wishaw General Hospital

http://www.acbwm.org.uk

This site was set up last year by the West Midlands Region ACB, and funded by a grantfrom the Robert Gaddie Memorial Fund. Its aim was to provide a source of informationon ACB issues at a more local level than the National site. The success of the site has led

the ACB to approve the set-up of further sites for each ACB region, and I will be leading thisinitiative, which will hopefully see more regional sites go live later this year.

Information provided on the site includes contact details for each of the laboratories in theregion. If they have their own websites or online handbooks, links can be added to access thisinformation quickly and easily. The site also provides information on meetings, as well as beingan area where the results of audit projects carried out within the region can be made available.Visit the ACB West Midlands site, and if you have any ideas as to what information you wouldlike on your regional site, contact your ACB regional secretary who will put you in touch withthe individual within your region who has volunteered to help on this project.

• Don’t forget, links to all past and present ‘Websites of the Month’ are available from the ACBwebsite (www.acb.org.uk). If you wish to suggest a site for the ‘Website of the Month’,please submit a short review (150-200 words) to Ian Godber at Wishaw General Hospital([email protected]). ■

MRCPath Short Questions MRCPath Short Questions MRCPath Short


Question No. 37The analytical imprecision (Cva) of serum iron in your laboratory is 10%. Iron was measured onseveral occasions in healthy volunteers, and the within-subject coefficient of variation of the mea-sured iron results was found to be 15% (calculated using nested ANOVA).

Estimate the true biological coefficient of variation in serum iron.

Calculate the expected coefficient of variation of the results in these volunteers if the analytical pro-cedure is performed in duplicate (on a single sample per patient with results expressed as the meanof the duplicate determinations) instead of singlicate.

MRCPath, November 2003

Deacon’s ChallengeNo. 36 AnswerThe incidence of the Gilbert genotype is common in the US and Europe. If the incidence ofthe variant bilirubin-UGT (UGT1A1) promoter associated with Gilbert’s in a population is9%, what proportion of the population carry at least one copy of the variant promoter?(Assume Hardy-Weinberg equilibrium applies).

MRCPath, November 2003

Gilbert’s follows an autosomal recessive mode of inheritance. If the normal promoter, A, has an incidence p and the variant promoter, a, has an incidence q, then according to theHardy-Weinberg equilibrium, the distribution of the genotypes AA, Aa and aa will be p2, 2pq and q2 respectively.

The incidence of the Gilbert genotype, aa, is q2 which we are told is 9% (0.09).

Therefore, q = √0.09 = 0.3

and since p + q = 1, it follows that p = 1 - q , i.e. p = 1 - 0.3 = 0.7

The genotype AA (incidence p2) is the only one without at least one copy of the variant promoter

p2 = 0.72 = 0.49

Therefore the proportion of the population with at least one copy of the variant promoter

(i.e. q2 + 2pq) = 1.0 - 0.49 = 0.51 (51% )

Topics will include:

• GI Tract

Liver, pancreas, gut function

• Nutrition

Vitamins, trace elements, antioxidants

• Immunology

Autoimmune disease, Ig-subclasses, allergy

• Histology/Cytology

Liquid-based cytology

• Techniques

AA, ICP-MS, spectrophotometry

• Management

Finance, budget management, what not to do!!

• Case Reports

Poster Presentations Skills

ACB Training Course18th-23rd April 2004

The social programme will include a quiz, a night at the dogs and a Chinese banquet

For further details please contact: Stephen Halloran, Clinical Laboratory, Royal Surrey County Hospital, Surrey GU2 7XX

Tel: 01483 464121 Fax: 01483 464072Email: [email protected]

ACB website: http://www.acb.org.uk

For an application form please contact the ACB Office: [email protected]


RCPath Exam RCPath Exam RCPath Exam RCPath Exam RCPath


This is the first time that we have reproduced the College Part I practicalexamination along with handy comments for interested parties. Allfeedback is welcome.

Paper 321st November 2003: 1300-1600

• Note that the examiners attach considerable importance to the legibilityand orderly presentation of the results of practical work. Marks can onlybe given for legible written work presented at the end of the examination.

• Analytical results should be presented in tabular form whenever possible.A tabular summary of results should be provided on a separate page at theend of the script.

• Calculators and textbooks may be used if desired.• Candidates are advised to read through the whole exercise before starting

any practical work.

QuestionDrug A is routinely used in the treatment of patients with rheumatoid arthritis.

It is metabolised in vivo to its active metabolite B by the enzyme PP.The possibility of introducing drug C into the treatment regimen is being

investigated and there are some concerns that drug C may inhibit the metabo-lism of drug A.

Investigate the effect of drug C on the metabolism of drug A. Determine thetype of inhibition and discuss the effect of adding drug C into the treatmentregimen.

Method for Measuring Metabolite B0.4 mL substrate1 mL Reagent 12 mL Reagent 2

Make up to final volume of 4 mL with buffer.Reaction takes place at room temperature.Measure absorbance at 505 nm.

Reagent 1 contains enzyme PPReagent 2 contains a second enzyme that converts B into a coloured end-product (molar extinction coefficient at 505 nm is 5500). The concentration of B produced from A is equimolar.

Part I PracticalExamination inChemical PathologyReported by Dr Gwyn McCreanor, MRCPath Examiner

Exam RCPath Exam RCPath Exam RCPath Exam RCPath Exam


You are provided with: 30 mL of a solution of drug A (3 mmol/L)30 mL of a solution of drug C (30 mmol/L) 50 mL of Reagent 1100 mL of Reagent 2 50 mL of buffer

Note: Drug A is not particularly soluble – ensure it is properly mixed beforepipetting. Further supplies of reagents are not available.

The Examiner’s Comments The wet practical was a very simple enzyme assay where candidates were asked toinvestigate possible inhibition of the activity The question was based on Drug Awhich is routinely used in patient treatment.

This drug is metabolised in vivo to its active metabolite B by the enzyme PP.The possibility of introducing drug C into the treatment regimen is being

investigated and there are some concerns that drug C may inhibit the metabolism ofdrug A.

Candidates were asked to investigate the effect of drug C on the metabolism ofdrug A, and then to determine the type of inhibition and discuss the effect ofadding drug C into the treatment regimen.

The assay method was very simple ie 0.4 mL substrate plus 1 mL Reagent 1and 2mL Reagent 2. Make up to final volume of 4 mL with buffer. Reaction takes place atroom temperature and measure absorbance at 505 nm.

The idea of this practical was simply to see whether the candidates could measureenzyme activity, whether they could differentiate the types of enzyme inhibition andhad an understanding of the effect of adding a second drug in the clinical scenariopresented.

The main points that the examiners were looking for included:

• Understanding that measurement of enzyme activity is a rate measurement notend point. So candidates were expected to measure rate of enzyme activity overtime rather than carry out a single end point measurement

• Measurement of the rate of enzyme activity at different substrate concentrations– plot substrate against rate

• Construction of Lineweaver Burk plot to determine Km – give some idea ofenzyme-substrate affinity

• Measurement of enzyme activity adding a range of inhibitor concentrations • Identification of type of inhibition • Discussion of effect on patient of using both drugs.

Comments about the Answer Papers:This was an open book exam and Teitz contains details on how to investigateenzyme inhibition.

Very few measurements were actually required to complete the points above, sothe practical was not technically demanding but required some thought andplanning.

Most candidates presented the theory of enzyme activity correctly and then didnot put this theory into practice.

The enzyme reaction was complete in four minutes so measurements taken after

Manage the Process - Control the Direction

RCPath Exam RCPath Exam RCPath Exam RCPath Exam RCPath


that time were not useful and resulted in a linear correlation betweensubstrate concentration and the absorbance.

Many of the candidates did not measure rate but did a single endpoint measurement (timing not usually considered) and then used themolar extinction coefficient to calculate a value, which they then plottedagainst substrate concentration. One candidate noted that the readingshad increased when re-read ten minutes later and decided that this wasdue to the colour ‘deteriorating’.

No-one looked at the time scale of the activity to see when thereaction finished – in fact, at the concentration of enzyme used, itshowed classical enzyme kinetics as the enzyme concentration was lowenough that you could see the reaction happen but high enough to get asignal of sufficient amplitude to detect the rate of change in such a shorttime scale.

Several candidates simply added inhibitor to the reaction mixture andcalculated the percentage enzyme activity remaining.

Most candidates had problems with the axes on the graphs. Theycould not convert absorbance units into enzyme activity.

Those candidates who plotted Lineweaver Burk plots did them verywell and managed to get really good data and were able to answerwhich type of inhibition was present.

Most students understood the clinical effect of adding the inhibitor tothe drug regimen and this part of the question was well answered. ■

Gary Barker

For further information: email [email protected]

A THOROUGH EVALUATION OF THE PROCESS MADE A HUGE IMPACT ON EFFICIENCY

ÒWe know that we can justify the purchase by

the fact that the systemwill pay for itself within

three to five yearsÓ

With budgetary constraints a major factor in the implementation of a processplan, changes to workflow may be depen-dent on changes in cash-flow.Therefore, it is essential that the processmanagement procedure can plan tomaximise efficiency in the long term aswell as the short term. As such, theOLA2500 has been highlighted as apotentially invaluable future addition tothe lab.

To give Gary the last word, ÒBarcodeidentification of any given sample at anystage can quickly tell us where the sam-ple has been and any tests that remainoutstanding. This can make a hugeimpact on improving efficiency for theentire passage of a sample through thelab, irrespective of tests to be performedor on which analyser.

By automating the sample handlingprocess, we will be able to free up labpersonnel while improving the quality ofservice by getting rid of human error.Ó

Receiving 400,000 samples per yearon which 2.3 million tests are performed,efficiency at the Clinical BiochemistryDepartment of York Hospital is key.

Gary Barker, Head BMS, identified themaintenance of a steady through-flow ofsample processing as fundamental toimprovement. The avoidance of proce-dural bottlenecks would positively impacton both patient care and working condi-tions for the lab personnel.

He stated, ÒThe lab has benefited enormously from the installation of two Olympus AU2700s. This twinnedclinical chemistry system is ideal for highvolume laboratories where workstationconsolidation and high throughput are required.

Apart from being miles faster than ourprevious systems, there is much largercapacity for onboard chemistries andmany more reagent shots per pack -overall it makes far more economicsense.

However, one of the biggest factors forus was its small footprint at no loss offire-power. It saves valuable lab spacewhich is always going to be at a premiumat York.Ó

MRCPath Exam MRCPath Exam MRCPath Exam MRCPath Exam


Theory September2003First Paper

Question 1

Discuss the role of risk management in laboratory quality procedures. What practicalsteps can be taken in the laboratory to minimise risk?

This question was answered by all candidates. Surprising omissions by candidates included the contribution ofCPA accreditation, external and internal quality assurance, and the contribution of COSSH to the process.Those candidates who had reviewed the latest guides on laboratory accreditation and looked at total qualityassurance reviewed risk best.

Question 2

Discuss the use of computerised decision support in a clinical chemistry laboratory.What are the advantages and disadvantages to using such computer assistance?

16 of 18 candidates answered this question. The most outstanding area in which the candidates did notcomment was the use of decision support in deciding when tests are necessary. Relatively few of the candidatesgrasped the need for liaison between the laboratory staff and medical personnel as a prerequisite for the produc-tion of suitable algorithms for decision support systems. Additionally relatively few of the candidates gavegood examples of areas where simple decision support testing could be of value in deciding whether or notfurther investigation or clinical treatment could be undertaken.

Question 3

Describe the methods for the assessment of cerebrospinal fluid xanthochromia. Whatare the indications for its measurement and precautions that need to be preserved ininterpreting the results?

16 of 18 candidates answered this question. Given the fact that there has been a recent review on xan-thochromia testing it was obvious which candidates had read the review and those who had not. The mostnotable omission by candidates who did not do well was the complete absence of any view of what wavelengthswere used in spectroscopy. These candidates also tended to be unsure of the way in which CSF scanning wasundertaken.

Question 4

Describe the metabolic products of tyrosine. Outline the clinical disorders associatedwith defects of the associated metabolic pathways.

4 of the 18 candidates answered this question. Given that this is a very defined metabolic area from which anumber of key metabolites are formed, those individuals who answered this question were either very good orvery bad in their views. With this question there is no substitute for relatively small amounts of knowledgeabout metabolism. Candidates would do well to review key areas of metabolism where defects in one area cancause multiple clinical problems.



Question 5

Outline the physiology behind the following tests and briefly indicate their use inclinical medicine.

Short synacthen testGlucose tolerance testWater deprivation test

17 of 18 candidates answered this question and provided reasonable answers overall. An over-riding pointhowever was the poor answers provided for the glucose tolerance test. Of all the tests in the clinicalbiochemistry laboratory which are used to diagnose a very common condition, it is surprising to havefound so many candidates being rather "woolly" in their knowledge of this test. It is perhaps moreunderstandable with short synacthen tests and water deprivation tests, of which individuals may be lessaware, but the lack of knowledge of the physiology of glucose tolerance tests was disappointing. In some cases some individuals knew more about the short synacthen test than they did about the glucosetolerance test!

Second Paper

Question 1a

Describe the clinical and biochemical consequences of ingestion of ethylene glycol.How can the laboratory assist in the management of case of poisoning withethylene glycol?

9 of 16 answered this question. Some individuals did not mention the osmolar gap and in one caseconfused the use of the anion gap and osmol gap. Most of the candidates managed to mention acidosis andthe renal problems that ensued but others were sketchier on oxalate metabolism and rhabdomyolysis.

Question 1b

Discuss critically the methods available for the detection and estimation of ethanoland body fluids.

2 candidates answered this question. The crucial point in answering this question is that there should bean overview of all methods, including direct and indirect measurements of ethanol. The opportunity todiscuss Point of Care Testing was also implicit.

Question 2

Discuss critically the biochemical tests available for the detection and monitoring ofpancreatic disease.

17 of 18 candidates answered this question. The question specifically notes pancreatic disease.Surprisingly, therefore, a number of candidates failed to provide any detail on the endocrine function of thepancreatic gland. Additionally pancreatic disease encompasses not only failure of the exocrine and theendocrine secretions but also of the possibility of tumours arising. It is therefore of some significance thatno discussion of tumour markers was found in a number of the answers. One candidate failed to mentionthe fact that amylase is one of the tests which is most frequently requested in monitoring pancreaticdisease. The standard of answers was highly variable and was dependent on how lateral a view was takenof the scope of pancreatic disease. Suffice to say in some cases there was no discussion about glucosemetabolism or other endocrine functions, nor of breath testing or sweat tests. In all, this question wasbadly answered by a majority of candidates.



Question 3

Discuss the pathophysiology of the biochemical abnormalities encountered in cardiacfailure. How can the laboratory assist in the detection and monitoring of patients withthis condition?

The lead in to this question implicitly regarded this as an area in which there should be discussion on the func-tions of BNP in cardiac failure. The majority of people who talked about BNP and its use also did extremelywell in describing the physiology of congestive cardiac failure. Many others, however, were limited in theirviews of the physiology and could not logically discuss the role of the renin-angiotensin-aldosterone system. Insome cases there was no good description of renal function nor of the investigations that could be undertaken toassist in assessing overall renal activity.

Question 4

Describe the clinical syndromes associated with deficiency of water soluble vitamins.What are the indications for measurement of plasma concentrations of these vitamins?

9 out of 16 answered this question. Despite the question specifying water soluble vitamins, some individualschose to include fat soluble vitamins in their answers. Although B12 and folate were well described in many ofthe answers, the contributions on riboflavin and pantothenic acid was often very poor and the clinical syn-dromes either confused or poorly described.

Question 5

Outline the principal determinates of biological variability and analytes. How can thecontribution of this to total variation in analyte concentration be minimised?

17 of 18 answered this question. This was a reasonably well answered question. There were no outstandinglypoor answers and poor marks were awarded either for rambling essays with few good examples or a shortanswer that was probably due to lack of time. In general the rest of the answers gave good overviews of the bio-logical variability found, which include the simple and well known facts such as the diurnal variation ofcortisol, the contribution of recent meals to glucose and triglyceride measurement and variability dependent onseason, e.g. cholesterol measurement from winter to summer. ■

Future SupportVisit www.dpcweb.com or call 01286 871872 for more details.

Diagnostic Products Corporation - UK, Glyn Rhonwy, Llanberis, Gwynedd, LL55 4EL

Meeting Reports Meeting Reports Meeting Reports Meeting Reports


Ethics and the clinical laboratory has been a hot topic in recentyears with lots of media attention. Years ago when we had anidea for a new test we went to the laboratory fridge for some

patient samples. Indeed, my PhD was based almost entirely on thatapproach and I hardly went near an ethics committee. Today we need tothink much more carefully about the ethical issues regarding use ofblood and tissue from patients once we have received it and also ensurethat it has been collected with due regard to any ethical issues.

Coming from a legal background, Professor Jean McHale, Professor ofLaw at Leicester University, explored various issues regarding ethics andin particular the consent process. Jean pointed out that there was amixture of UK and European Law as well as an element of selfdetermination which often crosses legalistic boundaries. The Human Rights Act has been applied relatively late in the UK and it is within Article 8 of the act, that the interpretation of informedconsent falls.

Clearly for a surgical procedure informed consent is required, butsimply touching a patient without consent can be deemed unlawful. Inrecent years high profile cases such as those in Liverpool and Bristolhave put much greater emphasis on informed consent. The process ofconsent itself needs to have evidence based information, which isunderstandable to the patient. In some cases a tape recording of theconsent process may even be considered.

Leftover Tissue and SamplesSo, do we need to ask permission before we take left over materials inour laboratory and use them for purposes other than that in which theywere supplied? Jean pointed out that consent as an ethical imperative isnot an absolute. However, we must not deceive or coerce patients intosupplying a sample or entering a procedure but rather they must begiven enough information to choose. There is a tendency to givepatients a large amount of information but do they really understandwhat they are given?

With regard to informed consent prior to PSA testing, it has beenshown that patients are less likely to take the test when they have beenfully informed. The responsibility is with the requesting clinician ratherthan the laboratory to ensure that informed consent has been gained.

It was Jean’s premise that if we are not careful we drive towards theprovision of ever-more information with a tendency towards totallydefensive clinical practice. Consent should relate to trust and we needmore trust and less litigation. One was left with more questions thananswers and a feeling that the law and informal research in abiochemistry department are becoming increasingly incompatible!Further more getting a straight answer from a lawyer is a nearimpossibility!

Screening for HealthReported by Dr Jonathan Berg, Editor , ACB News

The WestMidlands Regionvisited the new

Clinical SciencesLaboratory at

WalsgraveHospital to

consider theethics of

consent andscreening

for colorectalcancer



Colorectal Cancer Screening Pilot

There have been two arms to the National Screening Committee pilot forcolorectal cancer screening based on faecal occult blood testing withcolonoscopy follow-up. The Scottish arm of the pilot was based atNinewells Hospital in Dundee and the English arm at Walsgrave Hospital inCoventry. Mr Ron Parker, Director of the Colorectal Cancer Sreening pilotin Coventry, spoke of the results that had been obtained.

The present pilots followed a trial in Nottingham where 150,000 peoplewere screened using faecal occult blood followed by colonoscopy of thosewith positive results. Colorectal cancer is a major cause of death with17,000 patients per year dying in the UK. Cancer of the colon is not anovernight process and it can take about 5 years from a polyp growing to thesize of 1 cm where it is likely to contain malignant cells, then a further 5years might elapse before clinical signs bring the patient to hospital.

The trials started in 2000 and included people between the ages of 50and 69 years. A test kit was posted to their home and positive results werefollowed up by a colonoscopy at their nearest hospital. Overall uptake was57% with a FOB positive rate of 1.7% in Coventry and 2.2% in Dundee;similar figures to those found in the earlier Nottingham study. Uptake ofscreening was found to be lower in younger patients, worse in men thanwomen and also lower in areas of deprivation and high ethnicity.

In the UK study a total of 4,480 colonoscopies were undertaken and 90%were completed successfully. There were a total of 25 adverse events due tocolonoscopy including 23 admissions to hospital.

Ron Parker demonstrates the use of the colonoscopeon Eddie Legg, West Midlands Regional Tutor!



The results of the colonoscopy were as follows:

However, the important message is that in the screening pilot patients tend to presentearlier in the clinical course of the disease.

Ron pointed out that the screening programme had meant patients were identified andtreated at much earlier stages therefore benefiting from a better prognosis.

Boy from the Brown StuffDr Steve Smith, Head of Biochemistry at Coventry Hospitals looked at the way the screen-ing service had been set up. Faecal Occult Blood (FOB) may be measured by one of twotests. The chemical test is based on the pseudoperoxidase activity of haem where guaiacacid is converted to a blue colour in the presence of hydrogen peroxide. The alternativeimmunological test detects the presence of the human globin part of haemoglobin.

Tests based on guaiac acid are widely used, cheap and simple and also not oversensitive.However, they can suffer from false positives if dietary restriction is not implemented,chemical interference from substances such as ascorbate and aspirin and may be positivewith upper gastrointestinal bleeding, such as from bleeding gums. The immunologicaltests are more specific and sensitive and do not require dietary restriction. As the globinpart of haemoglobin is degraded, they do not detect upper GI bleeds. Some would say thatthe immunological tests are too sensitive, expensive and unproven.

The pilot sites used the Hemascreen test device. Two samples are applied from three consecutive daily motions to the test card, which is then put into a prepaid envelope andreturned to the laboratory. The Coventry screening laboratory is headed by an MLSO2,with about 6 support workers. The laboratory is largely computerized and support workerswere trained both by the NHS and the company supplying the devices. Support workersdo not need laboratory experience, but one should ensure they are not colour blind.Support workers were involved in distribution of the devices as well as unpacking andreading those that came in the post.

The results for the screen were classified as follows:

Total 4480

Carcinoma 14.6%

Adenoma 35.9%

Normal 49.5%

Dukes CRC Normal Presentation in

Staging Presentation Screening Programme

A 8% 48%B 33% 25%C 34% 27%

Result Action

Negative No further workWeak Positive Patient retestedPositive ColonoscopySpoilt RetestTechnical Failure Retest



There are a total of six windows to report on a returned card and if 5 ofthese 6 showed positive then the patient proceeded directly to acolonoscopy. A weak positive result was where 1-4 windows showedpositive and a negative result was where all 6 windows were negative.Weak positive results were repeated after dietary restriction.

Before starting ‘live’ tests each day operators ran quality controlmaterials, produced using “All Bran and blood” and staff undertook nomore than 75 tests a day. The concurrence between readers was greaterthan 90%.

The possible move from a pilot project to a project encompassing thewhole country will depend on political decisions as well as putting inplace an infrastructure in both Primary and Secondary care that cancope with the additional clinical work involved.

It was speculated that the number of referral laboratories required to undertake a national screening programme was estimated at around6-8.

Overall this was an interesting afternoon meeting of the WestMidlands Region, which attracted a number of members from otherregions. One learning point was that unfortunately the meeting conflicted with a scientific meeting in the Yorkshire Trent region. Nowthe relevant meeting organisers in the neighbouring regions are gettingtheir heads together to make sure this does not happen again. ■

Promoting Our Science Promoting Our Science Promoting Our Science


These are challenging questions but they’re increasingly being askedin the Department of Health, within the ACB, across the diagnosticsindustry, and other professional organisations. Doing something

about them is perhaps the unifying challenge for us all in the comingyears. This ACB News article reports on thoughts and ideas that have beenexpressed across tables, in corridors and lifts, backs of cars (and a fewother places) by a variety of individuals from different backgrounds inrecent times. A selection of these individuals (listed at the end) has met onfour occasions over the last six months to try to galvanise some of thisthinking. A wider participation at every level in science and industry is nowneeded, not only to develop these ideas but also to help implement them.This article invites further discussion and represents the start of a project inwhich wide participation will be engaged.

Background DiscussionUK investment in diagnostics is the second lowest amongst our EC partnercountries (see adjoining chart). ‘Pathology’ has a poor image and is fre-quently perceived as nothing more than a hospital cost centre, its profes-sionals/practitioners as ‘backroom staff’. More often than not new servicedevelopment can only take place as a re-organisation of existing resources.New investment is often difficult to obtain even though business cases candemonstrate potential longer-term healthcare benefits if initial pumppriming can be achieved. The diagnostics industry argues that low invest-ment affects their ability/confidence to invest in new technologies. Therisks are high for what is argued to be a low profitability industry. Thus, a‘vicious circle’ exists in which the patient may not be receiving maximumbenefit from laboratory medicine.

It is debateable how many of the ongoing problems are due to laboratorymedicine itself or how much is due to the constraints of the healthcareenvironments in which we work. Some would argue that a recognition ofshared blame is important to achieving any change and that a number of

PromotingLaboratory MedicineBy Gilbert Wieringa, Manchester

Why should we bother about raising awareness of laboratory medicine?

Why try to raise the profile of health care scientists?

Does laboratory medicine make a valued contribution to healthcare

delivery?

Is there an appropriate investment in laboratory medicine in this

country?



issues need to be tackled:1 Ensuring laboratory medicine presents clearer measures and markers of its impact

on clinical and financial outcomes2 Ensuring the tax payer has a greater understanding of the contribution of

laboratory medicine to healthcare delivery 3 Increasing awareness amongst health service ‘managers’ of an under-utilised

resource.4 Educating ourselves (science and industry) in how to sell our message (PR,

marketing, communication skills)

Overnight success in tackling these issues is unlikely. They vary in their complexity andtackling some of them go beyond what laboratory medicine can achieve by itself.Others, however, can begin to be tackled with initiatives that can take laboratorymedicine closer to the general public.

Proposed initiatives for 2004/2005 • LabTests Online UK. To be launched with national publicity in May/June, this web

site will contain information for patients about why laboratory tests are requestedand what they can tell doctors about a patient’s condition.

• Compilation of databases relevant to the general public on topics/diseases thathighlight the contribution of laboratory medicine to healthcare delivery e.g.diabetes, cardiovascular disease, cancer. To include questions/answers, demographic information e.g. incidence/prevalence, NSFs, NICE guidelines andappraisals, literature-sourced evidence bases, contacts to relevant support organisations

• Establish a case study based portfolio highlighting examples of laboratorymedicine’s potential to affect clinical and financial outcomes. Case studies mightinclude examples of innovative practice, impact of adoption of new technologieson clinical practice, individual patient cases. The studies would be widely distributed to press/media and be available for individuals involved in promotinglaboratory medicine’s value.

• Establish database of contacts in national media and specialist press.• Establish database of ‘expert members’ able to respond to healthcare issues

involving laboratory medicine as they arise in broadcast media/specialistpress/DOH releases. Set up a ‘watching brief’ for relevant issues.

• Instigate skills workshops for ACB members in public relations (PR), effectivecommunication, media liaison.

• Establish a website for promoting laboratory medicine. Potentially developed byand linked to existing parliamentary-based web sites, the new site would includeelectronic versions of information databases/case studies, press briefings/releases,named ‘experts in the field’/spokespeople, hyperlinks to other sites (e.g. LabTestsOnline, NICE guidelines, patient organisations), diaries of events.

• Appoint an ACB ‘government officer’. This individual to liaise with governmentdepartments and provide early warning of government initiatives.

• Provide articles for general and specialist press on topics that highlight the value oflaboratory medicine e.g. in “pH 7 – the Parliamentary Health Magazine”, theHealth Service Journal.

• Commission studies with partner organisations e.g. Adam Smith Institute, patientgroups, DOH/DTI comparing use and availability of in vitro diagnostic devices ingovernment priority areas e.g. cardiovascular disease, sexual health.



Further Developments

An early realisation has been the project’s potential to act as a catalyst for closer workingbetween science and industry since the aims are of common interest. Clearly, any proposedinitiatives need co-ordinated approaches in their instigation, implementation, outcomesassessment and integration in delivery. From discussions held over the last six months,some issues for future consideration have come to the fore:• The likely need for professional marketing/PR support. Although many of the

strengths and weaknesses in science and industry complement each other, the need foradditional advice, including specialist administrative support, has been recognised.

• The need to embrace professional organisations, healthcare scientists, industries andproviders in other areas of laboratory medicine.

• An assessment of future needs in developing more outward focussed roles beyond thelaboratory and broadening our understanding of the contribution of laboratorymedicine to outcomes.

• The level of contribution of potential stakeholders e.g. ACB committees, the diagnosticsindustry, Focus and other meetings.

Further articles about progress with ongoing projects and development of new projectswill appear in future ACB News issues. New ideas, offers of contributions, and local initia-tives to further develop proposed projects will be warmly welcomed by the ACB office andwill be considered by a newly established seven-person steering group that includes ACBand Industry representatives and the Director-General of BIVDA.

Contributors to DateBill Bartlett (ACB), Colin Brown (Roche Diagnostics), Andy Bufton (Abbott Diagnostics),Brian Fishwick (BIVDA), Clem Fitzgerald (BIVDA), Danielle Freedman (ACB), Judi Jackson(DPC), Peter McCulloch (Kaetu Management Services), Dermot Neely (ACB), MervynNicholas (Chair, ACB corporate members), Chris Price (President, ACB), Janet Smith(Chair, ACB), Steve Smith (Treasurer, ACB), Gilbert Wieringa (ACB), Doris-Ann Williams(Director-General, BIVDA), Phil Wood (IL). ■

The Association of Clinical Biochemists National Meeting Birmingham International Convention Centre, 18th - 20th May 2004

ocus2004ƒ

www.focus-acb.org/2004Focus 2004 PO Box 409, Cambridge CB14QD Tel: 01223 404830 Fax: 01223 404841 email: [email protected]

incorporating UK NEQAS Chemistry

just first class science, the clinicallaboratory exhibition of 2004 and afantastic social programme

nobullat focus!

UK NEQAS

Situations Vacant Situations Vacant Situations Vacant Situations


Southend because......there’s more

We are committed to equality of opportunity and welcome applications from all sections of the community.

The Trust operates a no smoking policy.

Clinical Scientist (Principal Biochemist)Pathology DepartmentGrade B £31,748 - £40,174 p.a.37.5 hours per week (Mon – Fri, 09.00 – 17.30, may be required to provide occasional ad-hoc out of hours cover)The Pathology Department provides analytical, educational, interpretative consultative services on all aspects of Clinical Biochemistry to SouthendHospital NHS Trust, Runwell Hospital and the BUPA Wellesley Hospitals, as well as to local Primary Care services. Southend Hospital is adesignated Cancer Centre, with a wide range of specialist clinical services making for a varied workload. Equipment includes a Roche Modularsystem, E170 and Elecsys analysers, and GC-MS. We offer a full range of allergy and drugs of abuse testing, and a specialist Macroprolactinservice to other hospitals. We are also fortunate in having a well-established Point-of-Care testing team. The department has Conditional CPAaccreditation. There are two other Clinical Biochemists in the department, and we have a full complement of technical and support staff, withvery low staff turnover. Last year, we performed 2.7 million tests and workload is growing at about 8% per annum. We are well-equipped, anew Pathology IT system was introduced last year and the laboratory was recently refurbished. The laboratory has made time in its schedule for aweekly teaching and update session for all scientific staff. Most importantly, we are a happy department in which everyone works together!

You would be expected to participate in the clinical authorisation rota, authorising results, and giving advice to clinicians and support tolaboratory staff. You would also be expected to provide scientific support to an area of the laboratory, depending on previous experience andinterests, and there are opportunities for research and development. We are strongly committed to education, and you would be asked tocontribute to our weekly update sessions and to participate in BMS training and teaching junior doctors. Secretarial support is available, sharedbetween all the Clinical Scientists. There is no contractual out-of-hours commitment.

We would expect you to hold Membership of the Royal College of Pathologists, but would consider someone who is close to taking the finalexamination. Experience in drugs of abuse work would be an advantage, but is not essential. The key attribute is that the appointee is anenthusiastic clinical scientist who wants to be part of a really good team! Ref: 076-2004c.

For informal enquiries/visits, please contact Mrs C. M. Corns, on (01702) 435555 ext. 4058.

For an application form please visit:

www.southend-hospital.co.ukIf you do not have internet access, please send an A4 SAE (stating the Job Ref number)

to the Recruitment team, Southend Hospital NHS Trust, Britannia House, Britannia Business Park, Comet Way, Southend on Sea, Essex SS2 6GE. Closing date: 23rd April 2004.

Vacant Situations Vacant Situations Vacant Situations Vacant


UNIVERSITY OF LONDON

MSc Clinical

Biochemistry

Applications are invited for this two year, part-timeintercollegiate course beginning in September 2004.

Candidates should have a first or second class honoursdegree in chemistry, biochemistry or a related subject, orhold a medical qualification registrable in the UnitedKingdom. Candidates without these qualifications maybe considered providing they have relevant workexperience. Students will usually be expected to have atleast one year’s experience in clinical chemistry, but wellqualified candidates working in a clinical chemistrylaboratory for less than one year will be considered.

Candidates must hold posts in suitable laboratories forthe duration of the course and must be in a position toattend lectures and seminars at a London medical schoolon Wednesday afternoons (2pm-7pm) during theuniversity terms. Students will be registered as internalstudents of the University of London. The degree isawarded on the basis of examinations held at the end ofthe course, a project and assessment of the practical workset throughout the course.

The course provides an excellent grounding for thoseindividuals wishing to progress to the MRCPath inChemical Pathology.

For further details and application forms write to: Dr Gill Rumsby, Clinical Biochemistry, UCL Hospitals, 60 Whitfield Street, London W1T 4EU. Tel: 020 7636 8333 ext. 2955.Fax: 020 7380 9584. Email: [email protected]

Closing date for receipt of applications will be 1st June2004.

The Trust is committed to equality of opportunity.Job shares are considered for all positions.

www.esht.nhs.uk

For details of other vacancies at East Sussex HospitalsNHS Trust, please contact the Human ResourcesDepartment on 01323 414937 or visit our website.

EAST SUSSEX HOSPITALS NHS TRUST aims to provide highquality hospital services for the people of East Sussex and servesa population of approximately 500,000. We employ around 5,000staff and offer an excellent range of staff amenities.

The Trust provides a comprehensive range of general acutehospital services from two main district general hospitals, theConquest Hospital in Hastings and the District General Hospitalin Eastbourne.

Pathology Directorate - East SussexHospitals NHS TrustConsultant Clinical Scientist -Clinical Chemistry DepartmentGrade C (Spine points 23 - 31), £38,628 - £52,867 paFull-time Ref: E239CHApplications are invited from state-registered ClinicalScientists for this replacement post. Membership of theRoyal College of Pathologists (or equivalent) is essential, asis a broad general background and experience at a seniorlevel in clinical chemistry. A special interest in a particulararea of clinical chemistry would be encouraged.East Sussex Hospitals NHS Trust was established on 1stApril 2002 following the merger of Eastbourne Hospitalsand Hastings and Rother Trusts. Although the previouspost-holder was based at Eastbourne, you will be expectedto work across Eastbourne and Hastings sites. The timing ofthis appointment should enable the appointee to have animportant input into the configuration of the merged service.For further information or an informal discussion, pleasecontact Dr Stephen Bangert, Consultant ChemicalPathologist, Eastbourne on 01323 413810, or Mr Phil White,Consultant Biochemist, Hastings on 01424 755 255 ext 8592. For an application form and job description, pleasecontact the Human Resources Department, EastbourneDistrict General Hospital, Kings Drive, Eastbourne, EastSussex BN21 2UD, quoting the reference number oremail recruitment @esht.nhs.ukClosing date: 5.04.04

Situations Vacant Situations Vacant Situations Vacant Situations


To advertise your vacancy contact:ACB Administrative Office, 130-132 Tooley Street, London SE1 2TU

Tel: 0207-403-8001 Fax: 0207-403-8006 Email: [email protected]

Deadline: 26th of the month prior to the month of publicationTraining Posts: When applying for such posts you should ensure that appropriate supervision and training support will be

available to enable you to proceed towards state registration and the MRCPath examinations. For advice, contact your Regional Tutor.

The editor reserves the right to amend or reject advertisements deemed unacceptable to the Association. Advertising rates are available on request

Some immunoassay systems may keep youwaiting, but not the new UniCel DxI 800. It handlesmore tests, more efficiently and more easily, thanother immunoassay analysers.

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© Copyright 2003 Beckman Coulter, Inc.

Beckman Coulter UK Ltd, Oakley Court, Kingsmead Business Park, High Wycombe. HP11 1JU Tel: 01494 441181 Email: [email protected] Fax: 01494 447558

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