news

Inside this issue

ARTICLES - MENINGITIS• EnteroviralmeningitisoutbreakinNSWinthesummerof2012/13

• MeningitisandtheMicrobiologyLaboratory

CASE PRESENTATION• Fatalviralpneumoniapresentingfromthecommunitycausedbymetapneumovirus

PATHOLOGY NORTH • Cytology• Update

Incorporating:• PathologyNewEngland

• NorthernRiversPathology

• MidNorthCoastPathology

• HunterAreaPathology(HAPS)

• PacificLaboratoryMedicineServices(PaLMS)NorthernSydneyandCentralCoast

HAPSHUNTER AREA PATHOLOGY SERVICE

WINTER 2013

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PathologyNorthappreciatesthesupportprovidedbyallofourclinicianclients.Wevaluetheopportunityofprovidingdiagnosticservicestoyourpatients.Wethankyouforyourloyaltyandcustom.

ThedevelopmentswithinthepublicpathologypracticesinNSW,includingPathologyNorth,areacceleratingsincetheestablishmentofNSWHealthPathologyinJune2012.Reviewsofruralserviceprovision,researchandinnovation,servicelevelagreements,pricingandcosting,andprivatepracticeacrossNSWhavebeencompletedandareinformingdecisionsconcerningtheNSWHealthPathologyStrategicPlan.Thisplandevelopmenthascommencedanditwillbediscussed,critiquedandevolvedfollowingextensiveworkshoppingacrossNSWfrominterestedcommittees.

PathologyNorthwelcomesanycontributionstothisplan.Thetimetable

forpresentationanddiscussioncanbeobtainedfromtheofficeofDrSueCarter,Manager

–Planning&Performance,NSWHealthPathologyExecutive,WisteriaHouse,WattStreet,Newcastle.

PathologyNorthalsohasabusyyearofdevelopmentplanned.Lismorelaboratoryredevelopmentisscheduledtocommenceinthenearfuture.Tweedlaboratoryrefurbishmentisnowcomplete.Graftonlaboratoryredevelopmentplansarewelladvanced.CompletionofCoffsHarbourlaboratoryrefurbishmentisplannedforAugust2013.Kempseyhospitalredevelopmentiswelladvanced.FundingforTareeandArmidalelaboratoryrefurbishmentsissecured.

AmajorairconditioningoverhaulattheHAPSbuildinginNewcastlehasbeenapprovedandtenderforworkiscompleting.ThePaLMSgrouphavenowcompletedthemovetothenewAcuteServicesBuildingontheRoyalNorthShoreHospital(RNSH)campus,NorthernSydney.

PathologyNorthhasmajorrefurbishmentanddevelopmentprojectswithinthecommunityalsowithupgradestomanyofourcollectionsitesplanned,funded,begunornearcomplete.Wewillnotifyyouandyourcolleagueswhenthesenewfacilitiesareaccessible.

NewinstrumentplatformsarebeingrolledoutacrossPathologyNorthlaboratories.ThenewAbbottArchitectdeviceshavebeensuccessfullyinstalledatRNSHandassociatedSydneylaboratoriesatMonaVale,Manly,RydeandHornsby.Alongwiththisinstrumentchange,thereisanassociatedautomationprojectincorporatingroboticspecimentrackmovementandcomputeriseddataandspecimenmanagingmiddleware.

ThissameautomatedlaboratorysolutionisscheduledtobeplacedwithintheJohnHunterHospitallaboratoryinNewcastlethroughJulyandAugust.ThedatamanagingmiddlewarewillbeutilisedacrosstheentirePathologyNorthenvironment.ThetrackequipmentandmiddlewarehasonlybeenimplementedinoneotherlaboratoryinAustraliatodate,namelyRoyalPerthHospital,althoughitisusedextensivelyandsuccessfullyacrossmanylaboratoriesinEurope.

ThePathologyprojectisthelargestandmostdispersedservicethroughoutwhichthissolutionhasbeenimplementedandisaveryexcitingdevelopmentinpatientservicedeliveryseeninNSW.Thislargeprojectwillbeanotherexampleof“harmonisation”ofservicedeliveryacrossPathologyNorthandwillbringmetropolitanandruraltestingintogreateralignmentandequality.Afurtherprogramforenhancedservicetoclientsandpatientswillbetheimplementationofacommonlaboratoryinformationsystem(LIS)acrossPathologyNorth.

Theharmonisationofequipmentinstrumentplatformsandstandardisationofoperatingprotocolsacrossalllaboratorieswillbemostmanifestwhenasingle,commonLIScanreapthebenefitsofthismajorreform.TheEOIforinterestedLISprovidershasnowbeenclosedandrespondentsassessed.Theoutcomesofthisfirstbutsignificant,criticalstepinLISselectionwillbepromulgatedsoonandtheintenseprocesstoselectaLISprovidercommenced.EvenwhilstthisLISprojectisunderway,upgradesandenhancementstoourLISsystemscontinue.

Theaimofalloftheendeavorsaboveistoenhancetheservicetoourclientsandpatients,toallowtheseamlessprovisionofcaretopatientsincommunity,facilitiesandbacktocommunity.Weareexpandingandupgradingourservicesinthecommunitysothereismorechoiceforclientsandpatients.Webelievepublicpathologyservicesshouldberecognisedforthevitalpublicassetthatweallknowtheyare.

Thankyouforyourongoingsupport.

Dr Stephen G Braye Network Director Pathology North

FROMTHEDIRECTOR

2 Front Cover: Cytology HAPS

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ARTICLES

3

Enteroviral meningitis outbreak in NSW in the summer of 2012/13InNovember2012,EmergencyDepartmentandPathologyLaboratorysurveillancesystemsindicatedincreasedmeningitisactivityacrossNSW.

Between1November2012and31January2013,theHunterAreaPathologyServiceidentified38casesfromtheHNEhealthareathatwerepositiveforenterovirusbyPCR.Thistestdoesnotdifferentiatebetweenthediversevirusesthatfallwithinthisgroupbutfurthercharacterisationshowed6Echovirustype30,3Echovirustype6and2picornaviruscases.

Itisnotunusualtoseeasummerincreaseinviralmeningitisactivitybutthisyearhasbeenparticularlynoticeable.

Figure 1. Number of Hunter New England enteroviral meningitis case, 2009 – January, 2013

Thedataabove (Figure 1)showsanover-representationofinfants,with36%ofcasesinthepast4yearsfromchildren<1yearofage,andthemajorityofthesewere<3monthsold(Figure 2).

Figure 2. Number of HNE enteroviral meningitis cases, 2009 – January, 2013 by age

InMarch2013,thenumberofmeningitis/encephalitispresentationsfurtherincreased,particularlyinpresentationsamongchildrenagedunder5years,andremainedabovetheusualrangeforthistimeofyear.

TheSydneyChildren’sHospitalRandwickreportedthattherehadbeenatleasttensuspectedorconfirmedcasesofviralmeningitisorencephalitisrelatedtoenterovirusinfectionsadmittedduringthereportingperiodand34casesadmittedthisyearupto31March.

ForNSWasawhole,EmergencyDepartmentsurveillanceindicatesthatthenumberofpatientsassignedadiagnosisofhand,footandmouthdiseasehadpeakedandremainedwellaboveusuallevels.Thesecaseswerepredominantlyintheunder5-year-oldagegroup,andmayinpartbeduetorecentpubliccommunicationsregardingtheriskofneurologicaldiseaseassociatedwithenterovirusinfection.

Viralmeningitisisgenerallylessseverethanbacterialmeningitisandresolveswithoutspecifictreatment.InAustralia,mostviralmeningitiscasesinthesummermonthsarecausedbyenteroviruses.Onlyaverysmallnumberofpeoplewithenterovirusinfectionsdevelopmeningitis,encephalitisorotherseriouscomplications.

Hand,footandmouthdiseaseisgenerallyamildillnesscausedbyenteroviruses,particularlycoxsackieviruses.Itisnotusuallyaseriousillnessandisnotrelatedtothefootandmouthdiseasethataffectsanimals.Itmainlyoccursinchildrenunder10yearsofagebutcanalsooccurinolderchildrenandadults.

Enterovirusesaremostoftenspreadfrompersontopersonthroughfaecalcontamination(suchasbynotwashinghandsproperlyafterusingthetoilet).Enterovirusescanalsobespreadthroughrespiratorysecretions(saliva,sputumornasalmucus)ofaninfectedperson,andpossiblythroughcontaminatedswimmingandwadingpools.

ThePCR(PolymeraseChainReaction)assayusedonCSFinHAPS,PathologyNorthwilldetectanddifferentiatemeningitis/encephalitiscausedbyenterovirus(commonthissummer),Neisseriameningitidis(endemiccasesrecognised)andHerpesvirus(quiterare).Managementisdifferentinall3typesofmeningitis.

Ifapatientwithenterovirusmeningitisneedshospitalisation,attemptsshouldbemadetocollectCSFtoconfirmtheclinicaldiagnosis.Aviralthroatswabornasopharyngealaspirate,fromwhichtheactualvirusmaybegroupedandastoolsampleorviralrectalswabcollected,willhelptoconfirmthediagnosisanddetecttheactualenterovirusresponsible.

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Enteroviral meningitis outbreak in NSW in the summer of 2012/13 (continued)

Forchildrenrequiringadmissiontohospitalduetosuspectedenterovirusinfection,cliniciansareadvisedtocollectthefollowingspecimensforenterovirustesting:

• viralthroatswab(ornasopharyngealaspirate)

• stool(orifunavailable,aviralrectalswab)

• CSF(iflumbarpunctureisperformed)

ThePCRassayisdoneinNewcastlewhiletheviralcultureassaysareperformedatareferencelaboratoryinSydney.

Formoreinformationcontact

Dr Stephen GravesBSc(Hons),MBBS,PhD,FASM,FACTM,FRCPA.DivisionalDirectorDirectorofMicrobiologyPathologyNorth-Hunter,Newcastle

ConjointAssociateProfessor,UniversityofNewcastle

Special InterestsDirectorofAustralianRickettsialReferencelaboratory,AustralianRickettsialdiseases,teaching,sexuallytransmitteddiseaseandpublichealth.

Contact: 02 4921 4420

Meningitis and the Microbiology LaboratoryBacterialmeningitisisaninfectiousdiseasewithasignificantmortalityrateandmanysurvivorsstillhaveseveresequelae.Theearlyadministrationofantibioticscorrelateswithreducedratesofmorbidityandmortality;itisofcrucialimportancetoinitiateappropriatetreatmentassoonaspossible.Morethan95%ofcasesofbacterialmeningitisarecausedbyoneofthefollowingbacteria:Neisseria meningitidis, Streptococcus pneumoniae, Streptococcus agalactiae (Group B streptococcus), Haemophilus influenzae, Listeria monocytogenes, Escherichia coli and Staphylococcus species.TheidentificationofthepathogenfromCerebrospinalFluid(CSF)usuallytakes1to2daysbyculture.Culturefrequentlyremainsnegative,especiallyiftheCSFistakenafterinitiationofantimicrobialtherapy.TheadministrationofantibioticstopatientswithsuspectedmeningitisbeforehospitaladmissionandcollectionofaCSFsamplehavebecomecommonpractice.Thispracticemaycorrespondinglyimpairmicrobiologicaldiagnosisbycultureofbacteriaresponsiblefortheinfection.

Sincetheoutcomeofinfectiondependsonearlyinitiationofeffectiveantimicrobialorantiviraltherapy,rapiddiagnosticmethodsareveryimportantforearlydiagnosis.Previously,bacterialantigendetectionmethodsonCSFhavebeenthemainstayofnon-culturemethods,buttheylackedsensitivityandspecificity.Accordingly,afocusinrecentyearshasbeenonthedevelopmentofalternativebutmoresensitiveandspecificmethods,suchasPCRthatcanbeusedtoobtainanetiologicaldiagnosis.PCRassayshavebeendevelopedfor

thespecificdetectionofbacteriacausingmeningitissuchasN.meningitidis, S.pneumoniae and S.agalactiae.Efficientandsensitivediagnosticmethodsarealsoneededinthemanagementofviralinfectionsinthecentralnervoussystemandmayhelpredefinetheetiologyofcertainconditions.Forexample,Mollaret’smeningitisisaneponymousdescriptionofrecurrentmeningitisforwhichnocauseisfound.Moleculartestsindicatethatasignificantnumberofcasesofrecurrentmeningitis,previouslylabelledasMollaret’smeningitis,arecausedbyHerpessimplexvirus,oftenHSVtype2(HSV2)butalsotype1(HSV1).ThisonlybecameevidentafterHSVPCRonCSFbecamemainstream.

Enterovirusesareresponsibleforapproximately90%ofallmeningitisandencephalitisinchildrenandadults.Enteroviralmeningitismaybedifficulttodifferentiatefrompartially-treatedbacterialmeningitisbecauseCSFpleocytosismayhaveanearlypredominanceofneutrophils.Patientswithenteroviralmeningitismaybehospitalisedandtreatedwithparenteralantibioticsandacycloviruntiltheclinicalpictureimprovesandbacterialculturesofblood,CSFandHSVPCRareallnegative.Ifpatientshavebeenpreviouslytreatedwithantibioticsearlyinthecourseofillness,thenCSFbacterialculturesmaybeunreliableandlongerempiricantibioticcoursesmaybenecessary.WhenenterovirusPCRispositive,typicallyantimicrobialsandantiviralsareceased,providingthereisnothingtosuggestintercurrentbacterialinfection.

CSFviralcultureslacksensitivity,rarelyprovideresultsinaclinicallyrelevanttimeframeandrequirehigh-leveltechnicalexpertisetoperform.PCRtestsforenterovirusRNAinCSFhaveemergedasthenewgoldstandardfordiagnosisofenteroviralmeningitis.Thesetestshavebettersensitivitythanculture,theresultscanbeavailablewithinhoursofspecimencollectionandthecostsaresimilartoviralcultures.

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Currently,awidevarietyofmultiplexPCRtests(thatdetectmanydifferentpathogenswithasingletestrun)areavailableandtheirusewillbecomeroutineinmanyclinicalmicrobiologylaboratories.Unfortunately,atthemoment,apartfromenterovirusPCR,thetechnicalcomplexityofmostmoleculartestsstillrequiresthattheyareruninbatchesandrestrictstheiravailabilitytohigh-complexitylaboratorieswithappropriateexpertiseinnucleicaciddiagnosis.

Fully-automatedPCRplatformswillincreasinglydeliverreliablemoleculardiagnosticresultsforbacterialandviralmeningitisondemand,withouttheneedofspecially-trainedlaboratorystaff,ordedicatedmoleculardiagnosticfacilities.AsPCRbecomesmorewidelyavailable,itsbenefitswillbeincreasinglyappreciated,especiallyastherapidturnaroundtimeforresultsenablesmoretimelyclinicalmanagement.Formanypatients,e.g.thosewithconfirmedpositivetestforenterovirus,suchtestswilllikelyenablereducedtimeinhospital,lessintravenousantibioticsandaccordinglylessriskofnosocomialinfection.

References:

Nolte,F.S. et al.2011.Evaluationofarapidandcompletelyautomatedreal-timereversetranscriptasePCRassayfordiagnosisofenteroviralmeningitis.JCM.p.528-533.

Boving,M.K.et al.2009.Eight-plexPCRandliquid-arraydetectionofbacterialandviralpathogensincerebrospinalfluidfrompatientswithsuspectedmeningitis.JCM.p.908-913.

Poppert,S.P. et al.2005.Rapiddiagnosisofbacterialmeningitisbyreal-timePCRandfluorescenceinsituhybridization.JCM.p.3390-3397.

Tom Karagiannis, SeniorHospitalScientist,PaLMS

TomKaragiannisisaSeniorHospitalScientist(second-in-charge)inthePaLMSMicrobiologyDepartment.HeholdsaResearchMasterofScienceDegree,BachelorofSciencedegreewithspecial

interestsinclinicalbacteriology,molecularbiology,mycobacteriology,mycologyandlaboratorymanagement.HealsoholdsthepositionsoflecturerattheUniversityofTechnologySydneyandTheNationalAssociationofTestingsAuthorities,Australia(NATA)assessorat.

Dr Bernard Hudson MBBSDTPHFACTMFAFPHMFRACPFRCPAMicrobiologist,PaLMS

DrHudsonisaClinicalMicrobiologistandInfectiousDiseasesPhysician.Heholdsspecialistqualificationsinpathology

(microbiology),internalmedicine(infectiousdiseases)andpublichealth.HealsoholdspositionsofClinicalSeniorLecturerinInfectiousDiseasesatSydneyUniversityandAssociateProfessoratJamesCookUniversityTownsville.

Contact at Royal North Shore Hospital: 9926 4366

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CASEPRESENTATIONFatal viral pneumonia presenting from the community caused by metapneumovirus

Take home messages:

• Diagnostictestingwithmolecular(PCR)methodsallowsforrapididentificationofkeyviralpathogensfromsimplerespiratorysamples–e.g.noseandthroatswabs

• Earlyconfirmationofaviralinfectionallowsantibioticstobeceasedearly,avoidingpossibleadverseeffectsfromunnecessaryexposure

• Neutrophiliainearly,severeviralinfectionfrequentlyoccurs.Alowprocalcitoninprovidesstronglysupportiveevidenceagainstabacterialpneumonia.

• Metapneumovirusinfectioncausespaediatricandadultpresentationswithupperand/orlowerrespiratorytractinfection.Severediseasemayoccurandiswell-describedintheelderly.Outbreaksmayoccurinresidentialagedcarefacilities.

Case

Thepatientwasan82-year-oldwomanreferredbyaGeneralPractitioner.Shehadtype-2diabetesandwasanex-smoker(quit40yearsago).Shebecameunwell4dayspriortopresentationwithincreasingdyspnoeaandanon-productivecough.Onpresentation(onthe30thSeptember2012),shehadtachypnoea,oxygensaturationof66%inroomairandHR120.

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Investigation

TheFBCindicatedneutrophiliaandmonocytosis

Procalcitoninwastested–thiswasmoderatelylow:

Type1respiratoryfailurewasindicatedonaninitialarterialbloodgas:(Nonre-breather,FiO2100%)

TheinitialCXRwasconsistentwithmultilobarpneumonia+/-acutepulmonaryoedema

BedsidecardiacECHOshowedwellpreservedLVfunction.Shedevelopedasecondarytroponinleaktoapeakof13byday3,afterinitiallynormallevelsonadmission.

Investigationsforcommunity-acquiredpneumoniawereperformed.UrinaryantigentestforStreptococcuspneumoniaeandLegionella pneumophilaserogroup1werenegative.Bloodcultureswerealsonegative.

AmultiplexPCRforrespiratoryviruseswasperformed:

Thepatientremainedventilatedinintensivecareforninedaysatwhichtimeadecisionwasmadetowithdrawsupportastheprospectofrecoverywasremote.Shewasextubatedanddiedsoonafter.

Diagnosis

Herdiagnosiswasthereforeseverepneumoniaduetoacutemetapneumovirusinfection.

Formoreinformationonthiscase,contact:DrJohnFerguson,Microbiologyon0249214446

Dr John Ferguson MedicalDegree,MBBS(Hons),FRACP,DTMH,FRCPA

BackgroundDrJohnFerguson’sinitialtrainingwasatRoyal

PrinceAlfredHospital,SydneywithperiodsoverseasintheUnitedKingdomandKenya.HetrainedinMicrobiologyatWestmeadHospital,Sydney.

Special InterestsRespiratoryinfection,staphylococcalinfection,healthcare-associatedinfection,hospitalinfectioncontrol,molecularmicrobiologyandantibioticresistance.

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PATHOLOGYNORTHCytologyCytology(orcytopathology)isaspecialistdisciplinethatincludesdiagnosticandscreeningcomponents.Diagnosticcytologyusesnon-invasiveandminimally-invasivetechniquestocollectcellularmaterialtoconfirmorexcludemalignancy.

PathologyNorthprovidesaqualityserviceprocessingbothgynaecologicalandnon-gynaecologicalspecimens.Thesespecimenshaveahighdegreeofcomplexitywithsamplesfromtheoutpatienthospitalclinicsaswellasfromspecialistreferrers.ThePathologyNorthlaboratoriesholdNATAAccreditationforconventionalandliquid-basedgynaecologicalandnon-gynaecologicalcytology,includingfineneedleaspirationbiopsies.

ThetwocoreCytologyUnitsarelocatedatHAPS,JohnHunterHospital,NewcastleandPaLMS,RoyalNorthShoreHospital,NorthernSydneyandaredirectedbyexperiencedCytopathologistsandCytotechnologists.Thelaboratoriesarecommittedtoexcellenceinallareasofcytology(gynaecologicalandnon-gynaecological)includingexfoliativespecimens,e.g.papsmears,fineneedleaspirationbiopsies(FNAB)andfluids,andareunderpinnedbyacomprehensivesystemofcontinuousqualityimprovement.

TheteamofCytopathologistsandCytotechnologistsatPaLMSandHAPSprovidecomprehensivediagnosticservicestothepublichospitals,selectprivatehospitals,GeneralPractitionersandMedicalSpecialists.Thecytologydepartmentsalsoservicegynaecologicalscreeningtothewomen’shealthnursesviathenationalcervicalscreeningprogramforNorthernSydney,Hunter,NorthCoastandGreaterSouthernAreaPathologyServicesinadditiontoprivateandpublicpractitioners.

Specialisedtests,includingmicrobiologicalstudies,flowcytometry(immunecellmarkers)andImmunohistochemistryareperformedoncytologyspecimens,increasingaccuracyandeffectivelytriagingbiopsymaterial.

Other testing includes

• ConventionalglassslidecervicalsmearsandThinPrepcollections

• HighriskHPVtesting(hybridcaptureDNAandPCRassays)performedfromThinPrepcollection

• ClinicalFineNeedleAspirationcytologywhichincludeslipomas,thyroidnodules,lymphnodesandbreastlumps

• FineNeedlebiopsyofdeeporgansites,deepaxillarylymphnodesorimpalpablelesionswithradiologicalguidanceincludingtheadvancedEUSandEBUSprocedures

• Sputumandurinecytology

• GeneralfluidspecimensincludingCSF,effusions,bronchialbrushingsandwashings,cystfluidsetc.

Scientistsattendfineneedleaspirationbiopsyproceduresinclinicsbothintheprivateandpublicsectors.TheseproceduresincludeFNABofbreast,thyroidandimaged-guidedlesionse.g.liver.TheattendanceofaCytotechnologistattheseproceduresallowstheperformingcliniciantohaveanindicationofadequacyatthetimethespecimeniscollected.*Thislessensthenon-diagnosticcollectionrateofFNABprocedures,reducingthecostandlevelofanxietytothepatient.Italsoallowsforsubsequentprocedurestobeperformedifrequiredi.e.ancillarytestingorcorebiopsyifFNABisnotpossible.

Thecytologydepartmentshavesmallteamsofscientistsattendingeachclinic,e.g.privateradiologyroomsandbreastclinics,allowingforthedevelopmentofanenhancedworkingrelationshipbetweencollectingdoctorandscientistandhenceagreaterlevelofexpertise.Afollow-upsystemforbothgynaecologicalandnon-gynaecologicalspecimensallowsforthecorrelationandfeedbacktoscientists,pathologistsandcollectingdoctors.

OurCytopathologistsandscientistsareavailabletoprovideadvicetocliniciansonappropriatetestselection,proceduraltechniques,resultinterpretationandcasemanagement.

FNABproceduresonpalpablelesionsrequirepre-booking,allowingfortimelyresultstoboththepatientandreferringdoctor.

HAPS (Hunter and Newcastle):

Generalenquiriesandradiology-guidedbookings:JHH 4921 3410orMater 4921 1715

Toarrangeforagroupaddress(lunchtimemeetingscanbeorganised)oravisitbyapathologist:

Tracey RichardsonTracey.Richardson@hnehealth.nsw.gov.au

Therese Atkins Therese.Atkins@hnehealth.nsw.gov.au

Sharon Ling Sharon.Ling@hnehealth.nsw.gov.au

PaLMS Northern Sydney:

Generalenquiries:9926 4186

Radiology-guidedbookings:9463 1196

Otherbookings(includingFNAofpalpablemasses)andresultsenquiries:9926 4354

*PaLMSservicesmayvary.Pleasecontactgeneralenquiries.

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Dr Lisa Tan, PaLMSDrLisaTanjoinedPaLMSin1999asahistopathologistandcytopathologist.ShegraduatedfromtheUniversityofSydneyin1992.HertraininginAnatomicalPathologyincluded

trainingatJohnHunterHospitalandICPMR,Westmead.ShehasbeenHeadofCytologyforPaLMSNorthernSydneysince2004.Herareasofinterestincludebreastandfoetal/placentalpathology.ShehasworkedatBreastScreenWesternandhasbeentheDesignatedPathologistforBreastScreenNorthernSydneyCentralCoastsince2000.

Dr Stephen Braye, HAPSDrStephenBrayegraduatedfromtheUniversityofNSWin1976withthedegreeofMBBS,BSc(Med).HewasadmittedasaFellowoftheRoyalCollegeofPathologists(RPCA)in1985andasa

FellowoftheRoyalCollegeofPathologistsofAustralasia(FRCPA)in1986.DrBrayehasworkedasaStaffSpecialistinAnatomicalPathologyinpublicpracticeinAustraliasince1987atPrinceofWalesHospital,ICPMRandHunterAreaPathologyService(HAPS).DuringhistimeatHAPS,StephenhashadapassionateinterestinCytology,supportinganddevelopingthedepartment.Stephenhasaspecialinterestinbreastandthyroidcytologyinparticular,andistheaccreditedpathologistforBreastScreeninNewcastle.DrBrayehasbeenaSeniorStaffSpecialist,AnatomicalPathologyatHAPSsince1990withperiodsasDirectorofAnatomicalPathology.InSeptember2009,withtheformationofPathologyNorth,DrBrayewasappointedtothepositionofAssistantDirectorPathologyNorth–HunteruntilOctober2011whenhewasappointedNetworkDirector,PathologyNorth.

STAFF PROFILES – CYTOLOGY

Dr Yves Steppeler, Mid North CoastDrSteppelerhasbeenwithPathologyNorthsinceFebruary2013andisbasedatCoffsHarbour.HejoinedPNfromWollongong,wherehespentthelastthreeyearsworkinginthe

privatesector.YvesisoriginallyfromtheUK,wherehetrainedinAnatomicalPathologymainlyinLondonandsurrounds.HehasaninterestinavarietyofareasofAnatomicalPathology,inparticularliverpathology,breastpathologyandlymphoreticularpathology.HehastakenonamanagerialroleintheadministrationofpathologyservicesinavarietyoflocationsintheMidNorthCoast.

Dr Erin Morris, Northern RiversDrMorrisholdsanundergraduatedegreeinBiologyfromtheUniversityofCalifornia,SanDiego.HealsoattendedFlindersUniversityMedicalSchoolinSouthAustraliawherehe

graduatedwithaBMBSandfinishedinthetopthirdoftheclass.DrMorrishasheldaninternshipatMaricopaMedicalCentreinPhoenix,Arizonaandhasundertakenanatomicalpathology/clinicalpathologytrainingatTuftsMedicalCentreinBoston,Massachusetts(four-yearprogram).HehassubspecialtytraininginCytopathologyatBrighamandWomen’sHospitalinBoston,Massachusetts(one-yearprogram).DrMorrisfirstpost-trainingappointmentwasatLismoreBaseHospital.

Founding Newcastle Blood Bank Service Director Dr Peter Hendry visits HAPSHAPSwasdelightedtohostDrPeterHendryatitsPathologyForumon‘PerioperativeBloodManagement-theNewcastleexperience’recently.DrHendrywasthefirstClinicalPathologistattheRoyalNewcastleHospitalandestablishedthefirstbloodbankinNewcastle,becomingthefoundationDirectorin1947.Hisfocuswasonupdatingthehospitalbloodtransfusionservicetoaregionalbloodbank.DrHendryhasreceivedmanyawardsandaccoladesduringhislifetimeincludingbecominganOfficeroftheOrderofAustraliain1985.HebecametheLifeGovernoroftheAustralianPostgraduateFederationinMedicinein1987.In1988,hewasawardedDoctorofMedicine,HonorisCausaandwas

PATHOLOGYNORTHUPDATEawardedDoctoroftheUniversity,HonorisCausain1995,bothfromtheUniversityofNewcastle.HAPS (Hunter and Newcastle) Client Satisfaction Survey 2013Overthecomingweeks,youmayreceiveaClientSatisfactionSurveywhichwehavesenttoourreferringmedicalclients.HAPSconductsthissurveyannuallyaspartofareviewofservicestoimproveclientsatisfaction.Toassist,wewouldliketorequestyourtimeincompletingthesurvey.Thesurveycanbefaxedbackto0249214440.Alternatively,anonlinesurveycanbecompletedbyaccessinghttps://www.surveymonkey.com/s/hapsgpsurvey.Wethankyouforyourparticipation.

HAPS Staff Achievement HAPSwouldliketocongratulateKentChapmanforwinningthe2013EberhardMammenYoungInvestigatorAward.Theawardispresentedforbestpresentationataninternationalorregionalmeetingbyayounginvestigatoronatopicrelatedtothefieldsofthrombosisandhaemostasis.KentisoneofsixYoungInvestigatorAwardrecipientswhoarepresentedwiththeawardworldwide.Hewaspresentedwiththeawardforrecognitionofaposterthathepresentedatthe2011AustralianSocietyofThrombosisandHaemostasisnationalscientificmeetingtitled“GettingtheNACforTTP”.

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