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TRANSCRIPT
In this issue
WorkingThrough theNight in a“Satellite” Laboratory –Jessica Explains
Ian BarnesDoes Qualityin Histology
HCPC Looking forChair andMore
EducationCommitteeCourses intothe Future
Choice 2 Reminder forYour Pension
The Association for Clinical Biochemistry & Laboratory Medicine | Issue 623 | March 2015
ACBNews
About ACB NewsThe 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: 07792-912163/0121-507-5353Fax: 0121-507-5290Email: [email protected]
Associate Editors Mrs Sophie BarnesDepartment of Clinical Biochemistry12th Floor, Lab BlockCharing Cross HospitalFulham Palace RoadLondon W6 8RFEmail: [email protected]
Mr Ian HanningDepartment of Clinical BiochemistryHull Royal InfirmaryAnlaby RoadHull HU3 2JZEmail: [email protected]
Dr Derren Ready Microbial DiseasesEastman Dental Hospital University College London Hospitals (UCLH) 256 Gray’s Inn Road London WC1X 8LD Email: [email protected]
Mrs Louise TilbrookDepartment of Clinical BiochemistryBroomfield HospitalChelmsfordEssex CM1 5ETEmail: [email protected]
Situations Vacant AdvertisingPlease contact the ACB Office:Tel: 0207-403-8001 Fax: 0207-403-8006Email: [email protected]
Display Advertising & InsertsPRC Associates Ltd1st Floor Offices115 Roebuck RoadChessingtonSurrey KT9 1JZTel: 0208-337-3749 Fax: 0208-337-7346Email: [email protected]
ACB Administrative OfficeAssociation for Clinical Biochemistry & Laboratory Medicine130-132 Tooley StreetLondon SE1 2TUTel: 0207-403-8001 Fax: 0207-403-8006Email: [email protected]
ACB PresidentProfessor Eric KilpatrickTel: 01482-607-708Email: [email protected]: @ACBPresident
ACB Home Pagehttp://www.acb.org.uk
Printed by Swan Print Ltd, BedfordISSN 1461 0337© Association for Clinical Biochemistry &Laboratory Medicine 2015
ACBNewsGeneral News page 4
Microbiology News page 12
FRCPath Exam page 13
Practice FRCPath Style Calculations page 14
Federation News page 16
Current Topics page 18
Scientific News page 20
Training Matters page 21
Education Committee page 23
Obituary page 25
ACB News Crossword page 27
Issue 623 • March 2015
The monthly magazine for clinical science
Issue 623 |March 2015 | ACB News
Front cover: Jessica Patel at theend of a 9 hour shift in a“satellite” clinical biochemistrylaboratory
HCPC Seeks ClinicalScientists for PanelThe Health and Care Professions Council (HCPC) is seekingtwo HCPC registered clinical scientists to become panelmembers to participate in a range of independent panelsto consider allegations of impairment of fitness to practisefor individual registrants. They will provide professionalexpertise and can be involved in deciding whether acomplaint should be referred to HCPC’s Conduct andCompetence Committee or Health Committee. They canalso take part in final hearings, listen to evidence andmake decisions about a registrant’s fitness to practise andwhat action to take.HCPC has 660 partners from a wide range of
backgrounds and levels of experience including the NHS,clinical management, the private sector and academia.Panel members are paid £180 per day as well as travel,accommodation and subsistence expenses. Thecommitment for this role is in the region of 10 to 20working days each year. All partners have to completecompulsory training.Hayley Graham, HCPC’s Partner Manager commented:
“This role gives people the opportunity to work on a widerange of issues and get involved with an independentregulator to safeguard the health and care of peopleusing our registrant’s services. Potential candidates can readmore about the role and download an application form(http://www.hcpc-uk.org/aboutus/ partners/panelmembers).Applications close on 29th March 2015. �
4 | General News
ACB News | Issue 623 |March 2015
Sudoku This month’spuzzle
Last month’s solution
POCT Ltd BuyAnaloxPoint Of Care Testing Ltd, (POCTLtd) has acquired 100% of theshares of Analox Instruments Ltd,(Analox) a UK based instrumentand reagent manufacturingcompany. Ian Cowie, ManagingDirector and CEO of POCT Ltd,commented, “Throughout a longand successful period ofdistributing Point of Care products,we now take over the additionalmanufacturing and distributionresponsibilities of AnaloxInstruments by completing thisacquisition”. POCT Ltd wasfounded in 2002 and distributes arange of high quality Point of Careportable blood and urine analysissystems. Analox Instruments wasfounded in 1973 and produces highquality analyser systems for themeasurement of a wide variety ofanalytes. Products are used in over65 countries world-wide. Further information may beobtained from Ian Cowie atemail: [email protected] �
ACB News | Issue 623 |March 2015
6 | General News
In the third video of the Barnes PathologyQuality Review series Dr Ian Barnes looks atfundamental issues pointing to three key NHSfoundations of quality of services beingeffective, safe and providing a positive patientexperience as possible. Ian points to reliability,robustness and responsiveness as centralcomponents we all must address.
KPIs and Potential for Misuse
Building on the previous video where helooked at pre-analytical factors such asphlebotomy and transport, Ian points to ISO 15189 as the key foundation for theclinical laboratory. Dr David Burnett sees ISO 15189 as a total change in approach toimplementation of quality standards. The useof Key Performance Indicators is consideredand Ian feels strong professional leadershipand roles of professional bodies as veryimportant. David however, while seeing KPIsas important points to the “huge potential formisuse” and advocates the use of the Sigma95% Confidence Calculator which can bedownloaded from the ACB website (downloadhere if reading electronic copy).Ian turned his attention to innovation in
Histopathology and talks with ConsultantHistopathologist Navid Momtahan about theimplementation of high resolution digital
imaging. Navid believes these techniques canimprove efficiency of patient care and sayingthat, yet again, the hurdle to implementationis “the cost is in the laboratory but the savingis somewhere else in the hospital”.
Please Email on to Histopathologists
This third video is now live on YouTube andcan be viewed by clicking on the image abovefor the electronic version of ACB News. For the printed copy simply put the title intoyour search engine to go straight to the video.Please do forward on this ACB News to yourHistopathologists and others who areinterested in quality issues in yourlaboratories. �
Foundations of a Quality Service
Biomedical Scientists for Key Regulatory RolesThe Health and CareProfessions Council (HCPC) isseeking two HCPC registeredBiomedical Scientists tobecome visitors. Visitors visit and assess
existing and proposededucation and trainingprogrammes delivered byeducation providers, usingestablished monitoring
processes. They also providerecommendations to theHCPC’s Education and TrainingCommittee regarding theapproval or ongoing approvalof the programmes. Visitors will be paid £190
per day and a £75 fee forpostal submissions togetherwith expenses. Thecommitment for this role is
around 5 to 10 working dayseach year. All partners have to complete compulsorytraining. Potential candidates can
read more about the role and download an application form here: http://www.hcpc-uk.org/aboutus/partners/visitors �
Click on image to view this video or put the title intoyour search engine
8 | General News
ACB News | Issue 623 |March 2015
The ACB are seeking support from anenthusiastic member who would like to takeon the role of webmaster and support thedevelopment of the ACB website along withthe ACB office staff. This role supports the maintenance of the
ACB website, keeping it refreshed and up todate. In addition, the successful applicant willhave shared responsibility to develop thewebsite for our users, working strategically tocontinue the evolution of the site for the aimsof the association and its membership.For further details please contact
Paul Newland, Director of Publications &Communications, by Email:[email protected] or Tel: 0151 2525 486. Closing date for expressions of interest is
Friday 10th April 2015. �
ACB Webmaster Position
HCPC Seeks New LeaderThe Health and Care Professions Council (HCPC) is recruiting anew Chair to its Council. Potential candidates applying forthe role must be on the HCPC Register or be an existingmember of the Council.The Chair leads the Council and contributes to the strategic
direction of the organisation and is the primary ambassadorfor the HCPC, representing the interests of statutoryregulation to outside bodies and the organisation atconferences, meetings and other events. Potential candidateswill have experience of providing strong leadership, be ableto uphold the HCPCs principles of transparency,accountability and will inspire confidence in the organisationand promote the HCPC’s central commitment to publicprotection.The appointee would be expected to start on 1st July 2015
and the initial term will be four years. The successfulcandidate will be required to remain registered with the HCPC for the duration of their term. The Chair is paid anattendance allowance of £320 + expenses a day, and the rolerequires 120-150 days per year, divided between the Counciland external meetings held throughout the UK and overseas.Potential candidates can find out more about the role and
how to apply from the HCPC website: http://www.hcpc-uk.org/aboutus/recruitment/councilApplications close on Monday 23rd March 2015. �
John FenwickACB News is sad to report thedeath of John Fenwick on 10thFebruary. John retired in 2004after many years in the ClinicalBiochemistry Department atBurton General Hospital andbefore that worked at Selly OakHospital in Birmingham. �
Focus onDeadlines . . .If you are intending to come toFocus 2015 in Cardiff then doremember that you get a discount if you book early. Early booking for ACB Members is£380 and £425 for ACB TemporaryMembers. You need to book by 13th April
to get this rate for the fullconference package whichincludes the conference dinner. �
General News | 9
Issue 623 |March 2015 | ACB News
Association of Clinical Pathologists
29th ACP Management CourseHardwick Hall Hotel, Sedgefield, County DurhamWednesday 2nd – Friday 4th September 2015
A wide ranging, residential, 3 day course introducing management issues relevant to therunning of a modern pathology service. It is intended for Specialist Registrars and Trainees intheir final year of training, Clinical Scientists and those who have held their first Consultant postfor less than 2 years. The course will address the following subject areas:
� The NHS Reforms � Funding and Structure of the NHS � Clinical Governance � Role of PCTs, SHAs� Financial Management � Business Planning� Demand Management � Managing Staff� Appraisal, Job Panning & Revalidation� Self Management � Future Organisation of Pathology Services in the UK
Course fee: £595.00 for ACP Members, £620.00 for non-Members. Includes a pre-course folder, course information handbook, en-suite accommodation,
all meals, refreshments and course dinner. Full details from: Paulene Horrocks, Association of Clinical Pathology.
Tel: 01273 775700. Email: [email protected] Application form: www.pathologists.org.uk
10 | General News
ACB News | Issue 623 |March 2015
ACB Scotland is delighted toextend a warm welcome toProfessor Alan Wu who isvisiting Scotland and haskindly volunteered to speak at our Spring Meeting. Alan is internationally
renowned for his work inclinical chemistry, toxicology,cardiac biomarkers andpharmacogenomics. He is Director of Chemistryand Toxicology at San Francisco General Hospitaland Professor of Laboratory
Medicine at the University ofCalifornia, San Francisco.
Since 1999, he has beenEditor-in-Chief of ClinicaChimica Acta. Professor Wu has written
over 500 publications,including several booksshowing the value of clinicallaboratory tests. He is IFCC lead for the
“Labs are Vital” programme,and will focus in his talk on how clinical laboratoryscience can be promoted. �
Professor Wu Speaks at Kirkaldy Meeting
ACB Scotland Regional Scientific Meeting
Point of Care TestingDunnikier House Hotel, Kirkcaldy15th April 2015
10:00 Coffee and Registration
Point of Care TestingChair: Dr Joy Johnstone, Kirkcaldy10:30 POCT Lactate and Potassium in the ITU Setting
Mrs Judith Strachan, Tayside11:00 Lessons from a POCT CPA Accredited Laboratory
Mr Tony Cambridge, Plymouth11:30 Scottish Point of Care Testing Survey
Mr Jim Allison, Grampian12:00 POCT Ketone Measurement in Paediatrics
Dr Gemma Gallacher, Lanarkshire12:30-13:30 Lunch 13:30 AGM
Point of Care Testing and Plenary Lecture Chair: Dr Michael Murphy, Tayside14:00 POCT in Keepwell Projects
Mrs Shona Hyman, Tayside14:30 POCT in Remote and Rural Areas
Dr Anne Pollock, Highland15:00 Plenary Lecture
Professor Alan Wu, UCLA16:00 Tea
To register please email [email protected] by Friday 27th March 2015. The meeting is free to attend but registration is required for catering purposes.
General News | 11
Issue 623 |March 2015 | ACB News
The full audited accounts of the ACB are now completed and as in previous years areavailable in the Annual Report provided tomembers at the AGM and on the website. The ACB does not hold a political fund nor wasany salary paid to, or benefits provided by, theunion to, or in respect of, any member of theExecutive, the President and the GeneralSecretary. That document provides for you:
� The total income and total expenditure ofthe union for the period to December last.
� The amount of the union’s total income forthat period that consisted of payments inrespect of membership.
� The name and address of the auditor whoaudited the accounts contained within theannual return and the full audit report.
A member who is concerned that someirregularity may be occurring, or have
occurred, in the conduct of the financial affairsof the union may take steps with a view toinvestigating further, obtaining clarificationand, if necessary, securing regularisation ofthat conduct. The member may raise any suchconcern with such one or more of thefollowing as it seems appropriate to raise itwith: the officials of the union, the trustees ofthe property of the union, the auditor orauditors of the union, the Certification Officer(who is an independent officer appointed bythe Secretary of State) and the police.Where a member believes that the financial
affairs of the union have been or are beingconducted in breach of the law or in breach of the rules of the union and contemplatesbringing civil proceedings against it the union or responsible officials or trustees, he should consider obtaining independentlegal advice. �
Trade Union StatementStatement to Members issued in connection with the
Union’s Annual Return for period ended 31st December 2014 as required bySection 32A of Trade Union and Labour Relations (Consolidation) Act 1992
12 | Microbiology News
ACB News | Issue 623 |March 2015
Despite a decrease in the number of cases of Clostridium Difficile Infection (CDI), it continues to be the major cause of hospital-acquired diarrhoea, causingsignificant morbidity, mortality and financialcosts to healthcare. The treatment for CDI in Europe and
North America is still based around theadministration of antibiotics includingmetronidazole, vancomycin and fidaxomicin. A major disadvantage of treating withantibiotics is the high risk of recurrent disease,especially in those who are elderly, takingother antibiotics and in patients with a historyof reoccurrence. Recurrent CDI can be defined as a relapse of
infection with the same strain causing theprevious episode or re-infection with a newstrain of C.Difficile. It is estimated thatreoccurrence occurs in ~20% of patientstreated initially with either metronidazole orvancomycin, and after one reoccurrence, the risk of a further reoccurrence increases to40% rising to 60-70% after more than tworeoccurrences. Although there are newoptions for treating CDI such as fidaxomicin (a novel narrow-spectrum macrocyclicantibiotic), there is pressing need for adifferent approach; treating antibiotic-associated diarrhoea with antibiotics doesn’tseem theoretically sensible.
Gut Microbiota
The indigenous gut microbiota refers to thebacterial population that reside in theintestine, and a ‘healthy’ gut microbiotaconsists of a dense and diverse microbialcommunity. A typical gut microbiota isdominated by obligate anaerobes;Bacteriodetes, Firmicutes and Actinobacteriaand facultative anaerobes of theProteobacteria group. Interestingly, one thirdof our human gut microbiota is common tomost people, while two thirds are specific toeach one of us. It has been stated that yourgut microbiota is like an individual identity
card! As well as aiding digestion and playing amajor role in immunity, a healthy gutmicrobiota is essential for colonisationresistance against infections such as CDI.Where the gut microbiota is disrupted thisresults in dysbiosis and it is this that is themajor risk factor for developing CDI.
Faecal Transplant
The concept of ‘Faecal Transplantation’ alsoknown as faecal microbiota transplantation,faecal biotherapy and bacteriotherapy, wasfirst described as a treatment of foodpoisoning or severe diarrhoea and recorded in Chinese literature from the 4th and 16th century. It was referred to as ‘yellowsoup’. It is a treatment strategy with the much
needed different approach by restoring thediversity of the gut microbiota and reversingdysbiosis. The modern method involves ablended and filtered faecal suspensionprepared from a fresh donor stool which isadministered to the patient via the upper orlower gastrointestinal tract bynasogastric/duodenal tube, colonoscopy orenema. Numerous studies have concluded that
faecal transplantation holds great promise as atherapy for recurrent CDI but large,randomised double-blinded studies areneeded for its routine widespread use and theconcept of a customised microbiota pill for thetreatment of CDI would be most welcome I’msure! �
Further Reading1 Zain Kassam MD. Faecal Microbiota Transplantation for
Clostridium difficile infection: Systematic Review and Meta-Analysis. Am J Gastroenterol 2013; 108: 500-508.
2 Tu Anh N Pham and Trevor D Lawley. Emerging insights on intestinal dysbiosis during bacterial infections. Curr Opin Microbiol. Feb 2014; 17 (100): 67-74.
3 Blessing O Adamu and Trevor D Lawley. Bacteriotherapy for thetreatment of intestinal dysbiosis caused by Clostridium difficileinfection. Curr Opin Microbiol. Oct 2013; 16 (5): 596-601.
4 Jessica Hamzelou. Healing by faeces: Rise of the DIY gut-bugswap. New Scientist Issue 2958.
5 Els van Nood, M.D. et al. Duodenal Infusion of Donor Faeces for Recurrent Clostridium difficile. NEJM. 2013 Vol: 368 Issue 5.
C.Diff Faecal TransplantationMichelle Cairns, The Public Health Laboratory, London
FRCPath Exam | 13
Issue 623 |March 2015 | ACB News
The FRCPath Practical paper is designed to testcandidates’ skills in designing and performinga laboratory experiment and interpreting theresults. The examination is split into threesections which reflect this. During the first,which typically lasts an hour, candidates arepresented with a problem and asked to designan experiment to investigate this. During therest of the examination, candidates are askedto perform an experiment and describe theirfindings, and also to comment on a set of datawith which they are provided. The wholeexamination lasts 3 hours, and each of thethree sections attracts an equal share of themarks.The practical paper in September 2014
followed this broad structure, although with a change on order. During the first hour,candidates were presented with two sets ofdata, one from 1999 and the other from 2009.Each set contained results from 40 patients,showing age, gender, total and HDLcholesterol. Candidates were asked tosummarise and comment on the two datasets.The question stated that measurement of HDL-cholesterol is challenging, and this wasintended to direct attention towards anydifferences in HDL results between the twodatasets.After answers to this had been collected,
candidates were asked to design experimentsto investigate any effects of a change inmethod for measuring HDL cholesterol (fromprecipitation to homogenous assays) onresults. They were also provided with serumsamples which had been stored in severaldifferent ways, and asked to assess the effectsof different storage conditions on total andHDL cholesterol results.The overall pass rate was 77%.
The examiners found some candidates’handwriting difficult to read, and a fewcandidates may have lost marks as a result.
Data InterpretationSixteen of twenty-two (73%) candidatessatisfied the examiners in this section.Successful candidates provided descriptivestatistics for the cholesterol and HDLconcentrations in the two datasets, and usedan appropriate statistical test to compare thetwo time periods. Some candidates lost marksby splitting the datasets according to patients’gender (thus losing statistical power), throughmathematical errors or through failing todiscuss the results.
Experimental DesignSeventeen candidates (77%) passed thissection. Successful candidates showed a clearunderstanding of method comparison. Manyfailed to comment on the confounding effectof demographic change in cohort studies; butby itself this was not taken as a reason to failcandidates. Some candidates lost marks byconcentrating on some areas of methodcomparison to the exclusion of others.
Laboratory BenchworkFifteen candidates (68%) passed this section.Those who did badly wasted time describinghow they would perform the experiment(rather than actually performing it), or byperforming a multi-point calibration where aone-point calibration would have sufficed.Other candidates failed to determineconcentrations, or calculated these incorrectly– one candidate obtained an implausibly highHDL concentration, and failed to recognise itas such. A few candidates based a response tothe underlying question (about the effect ofstorage conditions on results) on theabsorbance values they obtained, and weregiven some credit for doing so. Somecandidates performed the practical task well,but could have expanded more on the reasonsfor the results they obtained, and theirimplications. �
Practical Paper Feedback:Performance in Autumn 2014
14 | Practice FRCPath Style Calculations
ACB News | Issue 623 |March 2015
A patient is found to have a serum digoxin concentration of 3.8 µg/L. Digoxin was stopped.Assuming a half life of digoxin in the serum of 40 hours, how long would it take for the serumdigoxin concentration to fall to 2.0 ug/L?
FRCPath, Spring 2014
First calculate the elimination rate constant (kd) from the half life (t1/2):
t1/2 = 0.693kd
40 = 0.693kd
kd = 0.693 = 0.0173 h-1
40
Using the natural logarithmic form of the integrated first order rate equation:
ln Cpt = ln Cp0 - kd.t
where Cp0 = initial concentration = 3.8 µg/L
Cpt = final concentration = 2.0 µg/L
t = time for concentration to fall from 3.8 µg/L to 2.0 µg/L = ?
Substitute these values and solve for t:
ln 2.0 = ln 3.8 - 0.0173t
0.693 = 1.335 - 0.0173t
0.0173t = 1.335 - 0.693 = 0.642
t = 0.642 = 37 h (to 2 sig figs)0.0173
Alternative forms of the integrated rate equation can be used:
1. Cpt = Cp0 x e-kd.t
Deacon’s Challenge No 166 - Answer
Practice FRCPath Style Calculations | 15
Issue 623 |March 2015 | ACB News
2.0 = 3.8 x e-0.0173t
2.0 = e-0.0173t
3.8
0.526 = e-0.0173t
ln0.526 = -0.0173t
-0.642 = -0.0173t
t = -0.642 = 37h-0.0173
2. log10CR = -0.30N
where CR = concentration ratio = Cpt/Cp0 and N = number of half-lives
log10 (2.0/3.8) = -0.30N
log10 0.526 = -0.30N
-0.279 = -0.30N
N = -0.279 = 0.93-0.30
t = 0.93 half-lives = 0.93 x 40 = 37h
Question 167Current NICE guidelines for the use of newer agents in the treatment of Type 2 Diabetesrecommend that GLP-1 agonists (e.g. exenatide) should only be continued after 6 months ifthe HbA1c concentration has fallen by at least 9 mmol/mol compared to baseline. If thebiological within-subject variance is 5 mmol2/mol2, what analytical precision must the assayachieve in order to be able to detect a true fall of 9 mmol/mol with greater than 95%certainty?
Two tailed z-distribution:
P(%) 10 5 2 1 0.2 0.1z 1.65 1.96 2.33 2.58 3.09 3.29
FRCPath, Spring 2014
16 | Federation News
ACB News | Issue 623 |March 2015
As we move into the last few weeks before the2015 scheme comes into place the pace ofactivity is really gathering for unions, thePensions Agency (NHSBSA), NHS Employersand the Department of Health alike:
1. The consultation on the detailed draftlegislation and regulations for the 2015Scheme and associated transitionarrangements has closed and these aremaking their way through the formalparliamentary processes which mustconclude before Parliament rises on 30th March.
2. The Pensions Agency, in partnership withNHS Employers and NHS unions, hasreleased additional communications, bothwritten and videos, to help schememembers (and employers) understand thechanges. These can be accessed via thePensions Agency website athttp://www.nhsbsa.nhs.uk/Pensions.aspxand follow the link to the Members Hub.
3. Members should have or will shortly bereceiving a pay slip leaflet with a Choice 2reminder and further information. This can also be downloaded from:http://www.nhsbsa.nhs.uk/Documents/Pensions/Payslip_Leaflet_2015_(V1)_online_22.12.2014.pdf
A Choice 2 Decision Tree has also beenposted to indicate what you should bethinking about: http://www.nhsbsa.nhs.uk/Documents/Pensions/decision_tree_-_choice_and_tapering_(V0.8)_-_Formatted.pdf
4. Again, in partnership NHSBSA, NHSEmployers and unions have been running aseries of 4 webinars to brief employingauthorities on the new scheme and whatthey have to do in readiness. The contentof these can be accessed via the NHS
Employers website at: http://www.nhsemployers. org/events/2015/03/new-2015-nhs-pension-scheme-arrangements
They have been increasingly popular andwe might suggest that local employers andtheir union representatives could benefitby viewing them together. The last one ison 3rd March 2015.
5. NHSBSA have recently published anupdated (v13) Guide to the 1995 & 2008Schemes and now a separate (v0.1) Guideto the 2015 Scheme. These can bedownloaded from: http://www.nhsbsa.nhs.uk/Documents/Pensions/SD_Guide_(V13)_(website)_11.2014.pdf and:http://www.nhsbsa.nhs.uk/Documents/Pensions/SD_Guide_(V0.1)_Published_01.2015.pdf
6. Scheme identifier logos. Although it mayseem trivial the communications team areseeking to use every device to helpmembers follow the information for theschemes relevant to them. The colour codeof orange for 1995, blue for 2008 andviolet for 2015 will be used in all theirliterature.
Choice 2 Reminder
If you are eligible for Choice 2 but have notyet made your deliberate decision now is thetime to dig the letter and information fromthe bottom of your “to do” pile, consider theissues for you and make your consideredchoice. DO NOT DELAY further! The closingdate is 16th March 2015 (except for relevantstaff in Public Health England (PHE) where it is29th May 2015 due to late inclusion in theexercise). In the absence of an expression toopt into the 2008 scheme with its NormalPension Age (NPA) more closely aligned to thenew 2015 scheme the “default” choice is that
NHS Pensions . . . Choice 2 ReminderGeoff Lester, NHS Staff Council & Pensions Scheme Advisory Board Representative
Federation News | 17
Issue 623 |March 2015 | ACB News
you will stay in the 1995 scheme. The key issuethen is that to take your 1995 final salarybenefit at the 1995 NPA of 60 you will not beable to accrue further pension in the 2015scheme.The Choice 2 Decision Tree on the NHSBSA
website has useful prompts to help you makeyour decision.
Choice 2 for Public Health EnglandStaff
The Choice 2 decision for PHE members ismore complicated. The underlying rationalefor Choice 2 is the same: Your original PensionsChoice decision to stay in the 1995 schemewould have been made on the assumption ofan enduring NPA of 60. Transfer (at somepoint on or after 1st April 2015) to a newscheme with a later NPA means that thisassumption is no longer valid.Choice 2 in PHE will only affect how your
previously accrued NHS benefit is calculated.PHE members have the additional complexityof a compulsory transfer to equivalent CivilService Schemes – final salary based for thosewith full or tapered protections and a CARE-based scheme for those who would otherwisehave transferred to the NHS 2015 scheme. The original DH presumption had been that
PHE members will take an offer of a bulktransfer of their preserved pension rights fromthe NHS 1995 or 2008 schemes into the CivilService schemes. However the details of theterms of that transfer are not yet known. It islikely that the bulk transfer will be beneficialfor many members as it will preserve thepension’s final salary link until your eventual
retirement. However, some may wish to preserve their
previous accrual in the NHS scheme (albeit asdeferred members, losing the final salary link).This will be a very personal decision based onyour own career and pay circumstances andretirement plans. Members who may benefitfrom becoming NHS deferred members arelikely to be those already at the peak of theircareer expectation and on maximum paypoints. Choice 2 would let you choose themost beneficial option for such a deferredpension. As PHE staff were originally excluded from
the Choice 2 exercise they have a later decisiondate of 29th May. Hopefully the Bulk TransferTerms will be known by then. For you this is adecision that needs to be made even morecarefully.
OTGUP & ERRBO
These acronyms may sound like minorcharacters in Harry Potter but refer to twonew provisions arising from the 2015 scheme.OTGUP is “Option to Give Up Protection”
and will apply to a relatively small number ofmembers with protection in the 2008 schemefor whom the 2015 option maybe better.ERRBO is “Early Retirement Reduction Buy
Out” and will let anyone in the 2015 scheme,with its NPA the same as State Pension Age(SPA), pay extra into the scheme to retireearlier than SPA without actuarial reduction.
� More on these two concepts in the nextbriefing. You will not need to make anydecisions about them just yet. �
18 | Current Topics
ACB News | Issue 623 |March 2015
If you had told me just 12 months ago that Iwould be working through the night in aClinical Biochemistry department as a BankWorker, AfC Band 4 I would have beensurprised. I had just finished my MSc inBiomedical Science and was looking for atrainee position as a Biomedical Scientist,which is not easy without some experience.After searching around local hospitals forvolunteer work I came across a lab that waslooking for Bank Staff and after an interview Istarted work in the specialist Vitaminslaboratory. However, there was an acuteshortage of out of hour’s staff developing as anumber of the trained BMS staff were retiringor moving on. After my first few weeks I wasselected to be trained as an AfC 4 BankWorker that would work through the night.
Training as a Band 4 Night Worker
We have a “hub and spoke” laboratory systemwith an out of hour’s service at both ourhospitals, which are about five miles apart.Our two acute hospitals both have ITU andEmergency Departments. I was being preparedto work on the overnight shift at the “spoke”laboratory. The shift pattern is from midnightuntil 9 am. I was trained in a list of duties,suitable for AfC Band 4 to be able to keep the“spoke” laboratory working with help fromthe Biomedical Scientist at the “hub”.
The duties include:
� Booking in samples and preparing them for analysis.
� Adding samples to the biochemistryanalysers.
� Maintenance of our clinical biochemistryanalysers including changing bulk solutions.
� Taking a variety of phone calls.� Correct ways of packaging samples and
interacting with transport services.� Understanding key tests that might come
in during the night including CSF,Microbiology and calls from otherlaboratories around the country forspecialist toxicology tests such as ethyleneglycol and how they should be dealt with.
After a month of daytime training includingworking the Blood Sciences call centre, I did ashort period of shadowing night work, thenset off on my first single-handed night shift.
How it Works
I interact with the Biomedical Scientistworking through the night at our hublaboratory in West Bromwich. We are a “twoman team”, separated by five miles of theBlack Country, with my spoke City Hospital labbeing close to central Birmingham. There isalso a Band 6 Biomedical Scientist working inHaematology sharing the spoke laboratorywith me. My role is to prepare samples andplace them on the analysers. I do not authorisethe work or give out unauthorised results fromour laboratory computer system, as this is theresponsibility of the Band 6 at the largerlaboratory.Having undertaken this role now for
approaching six months here are some keyreflections:On a quiet night when things work as
expected, I prepare 50-60 samples includingbooking in most of the work for Biochemistryand Haematology and placing them on the
Running a Spoke Throughthe NightJessica Patel, AfC 4 Bank Worker
Click photo to hear Jessica explain more
Current Topics | 19
Issue 623 |March 2015 | ACB News
analyser. I maintain the analysers as requiredbut do not undertake the full dailymaintenance through the night and neitherhave I been trained to load on reagents. This can be an issue as sometimes reagents runout and it does appear that with appropriatetraining I could load, calibrate and QC areagent pack. The bleep goes perhaps 5-10times a night and usually I can handle thequeries myself. For example, most resultenquiries are for work that has already beenauthorised by the BMS 6 at the hub laboratoryand I can give these out. Occasionally I have torefer the call onto my colleague if the resultsare still “hanging” on the computerunauthorised. Of course if we keep up withthe work then the results are available onscreen around the hospital. The bleep activityreally reflects how on top of the work we areand sometimes the perceived convenience ofphoning the lab rather than looking up thingson ward terminals.Sometimes things happen which are
unexpected and this can lead to someinteresting situations, which can be quitestressful. For example, the piece of softwarelinking our Biochemistry analysers to the mainlaboratory system can occasionally fail. Whenthis happens ones pulse rate increases fast!However, I have learnt that there are alwaysways round difficult situations. In thisparticular case, which has only happened once,we had to enlist the help of the Consultant on-call – someone who is surprisingly friendlywhen woken at 3 am. We arranged to put ataxi service in place and instead of meanalysing samples, the results of which wouldnot be seen at the hub, I interacted withfriendly Birmingham minicab drivers to getsamples over to my colleague. As well ashelping to put in this ad hoc alternative systemI talked to a number of users and explainedthe situation. Junior doctors are surprisinglynice when they are kept politely informed.
Unpredictable Nature of Night Work
One thing I have learnt over the last fewmonths is that while much is predictable, thereare elements of the service that are not andthis is a difficult management issue.
For example, a seemingly normal night canbecome exceptionally difficult when ouranalysers decide to malfunction. There are alsotimes when there really is very little to do andduring these periods, it would be good tohave something tangible to get on with.Having worked night shifts, including up to
five consecutive nine-hour nights, with acouple of days off before working nightsagain, for eight weeks it has certainly beeninteresting to try and adapt. Living a“nocturnal” lifestyle can have a major impacton both home and social life as it feels asthough you are living in a different time zoneto people most close to you. Although onemay think it is something you can get used to,coping with shift working is not asstraightforward. Perhaps laboratories need tohave a little more understanding of shiftworking and the impact on worker efficiency. I believe this is looked at in more detail inother working environments where shiftworking is a key component. It is interesting toobserve how other staff around me copes withshift patterns. Some people get really activethrough the night as a way of coping, whileothers appear to be worn out through thenight. Certainly, one thing this experience hastaught me is that greater understanding ofhow to work effectively at night would bereally useful in the clinical laboratory.
Excitement of Responsibility
Looking back a few months ago when I did myfirst night shift I still remember how nervous I was. Thoughts about security during out ofhours and my ability to tackle the requiredresponsibilities ran through my mind, but I’mglad I had the determination to do it. There isa real sense of excitement and fulfilment inrealising you are being trusted to haveresponsibility for a key hospital area throughthe night, albeit with a colleague a few milesaway in the “mother ship” to fall back onwhen things go wrong. My personalaspirations are to gain a trainee post as aBiomedical Scientist, but in the meantime I know that I am doing a valuable job, which ishelping to sustain our busy NHS laboratoryand giving me great experience. �
20 | Scientific News
ACB News | Issue 623 |March 2015
A survey conducted by WEQAS in 2012 showed a diverse practice in the reporting ofethanol units. The majority, (64%) oflaboratories in the UK reported their bloodethanol units as mg/dl (or mg% or mg/100 ml)compared with 28% that reported as mg/L, 8%reporting in mmol/L and one laboratory thatreported in g/L.In August 2014, following the publication of
the Guidelines for laboratory analyses forpoisoned patients in the United Kingdom; Ann Clin Biochem 2014 51: 312, WEQAS issueda statement to all its participants that mg/Lshould be used as the standard unit forreporting ethanol concentration. A referenceto this document was included in the report toall participants.
Current Position
Analysis of the most recent WEQAS data showsa reversal of the 2012 data with 68% ofparticipants now reporting their ethanolresults as mg/L, however 28% are stillreporting in mg/dL and one laboratoryreporting in mmol/L and one in g/L.
Recommendation
To achieve harmonisation of units in line withthe Guidelines for laboratory analyses forpoisoned patients in the United Kingdom, it isrecommended that laboratories report ethanolin mg/L for all clinical samples. Alternativelocal arrangements of reporting may be usedfor forensic analysis. �
Position Statement onReporting Blood EthanolAnnette Thomas on behalf of the ACB Scientific Committee
Reporting Units for Ethanol – 2012 Survey of UK Laboratories
Reporting Units for Ethanol – 2014 WEQAS Survey
Training Matters | 21
Issue 623 |March 2015 | ACB News
The first National STP Elective PresentationDay Meeting was held at the ACB Offices,London, on 17th December 2014. The meetingprovided an opportunity for first and secondyear STP trainees to gain inspiration and ideasfor planning their own elective. Shortpresentations, given by Life Sciences STPtrainees who had completed or finalised theirelective placement, highlighted the widevariety of exciting, challenging and rewardingoptions available to current trainees. The first presentation of the day was
delivered by Angela Ballantyne (Luton & Dunstable Hospital) who described her four-week elective to Gilbert Bain Hospital,Shetland. During her visit Angela undertookan extensive laboratory comparison (qualitycontrol systems, business continuity),participated in tutorial sessions and attendedmultidisciplinary ward rounds. Angela’spresentation provided an excellent insight intothe logistical and practical challenges faced bya small hospital situated in a remote location. Amie Thompson, King’s College Hospital,
London, presented her challenging andrewarding four-week visit to Manipal TeachingHospital in Pokhara, Nepal, and described thepractice of healthcare, in medical laboratorysciences, in one of the poorest countries in theworld. The talk was particularly useful for STPtrainees considering a similar elective, asdetails on how to arrange this placementthrough a company which specialises inhealthcare electives overseas was provided.
Vellore Comparisons
Jenny Lake, Southend Hospital, made atwenty-six hour journey from Southend toChristian Medical College (CMC) hospital inVellore Town (India) for her elective. Duringher visit Jenny undertook a methodcomparison (sweat analysis), clinical audit(Troponin T) and observed several analytical
methods not previously seen during hertraining in the UK. Her talk also describeddifferences in healthcare structure at CMCcompared to a UK hospital; patients travelfrom afar for treatment and therefore bloodtests are not repeated, tests are paid for inadvance so no reflex testing can be offeredand as CMC is a charity hospital which treatsvery poor patients, where possible proceduresare used to save the patients money. In addition to this, the talk provided usefulinformation regarding the practicalities oforganising an elective outside of the UK. Following these presentations Chloe Eaton,
John Radcliffe Hospital, Oxford, gave a highlytopical talk on her four-week visit to KerryTown, Sierra Leone, in order to setup adiagnostic laboratory for Ebola screening; theaudience was given a detailed insight into thistask by way of a photographic guided tour ofthe treatment centre and diagnosticlaboratory facilities.
World Views Continue
Further talks given during the afternoonsession described electives which included:rotations in clinical neurophysiology, vascularscience and microbiology, and how thesespecialisms overlap and integrate with clinicalbiochemistry (Rachel Lopez-Real, NottinghamUniversity Hospital and Alexandra Thurston-Postle, Nottingham City Hospital);pursuing a research interest by visiting alaboratory undertaking research intobiomarker discovery and validation indementia (Stuart Bennett, Royal LondonHospital); and going to the Wellingtonregional genetics service laboratory in New Zealand and comparing differences inpractice between New Zealand and UK geneticlaboratories (Jennie Dring, BirminghamWomen’s Hospital). The final talk of theafternoon by Liz Palmer (Prince Charles
Around the World in STPElectivesStuart Bennett, Royal London Hospital
22 | Training Matters
ACB News | Issue 623 |March 2015
Hospital, Merthyr Tydfil) gave a very thoroughand interesting overview of the WelshEmerging Drugs and Identification of NovelSubstances project. Setup in Wales in 2011, the project identifies emerging drugs with theaim of reducing harm to individuals and localcommunities.
Huge Range of Electives ProvideExciting Opportunities
Aside from providing an insight into the widerange of elective options available to trainees,the speakers also offered invaluableinformation regarding the planning stages forthe elective; considerations for the aims and
scope of the elective learning framework andmapping elective objectives to good scientificpractice were discussed, as well as makinginitial contact with a prospective hostinstitution. Overall the meeting was a hugesuccess and feedback from those in attendancewas positive. As a second year STP Trainee, the day highlighted that the scope of theelective is huge and really does provide anexciting opportunity to pursue a wider area ofhealthcare science outside of your routinetraining. It provides a great opportunity tolearn new skills and continue your professionaldevelopment as a Healthcare Scientist, whichadds significant benefit to the STP. �
Education Committee | 23
Issue 623 |March 2015 | ACB News
The shape of ACB Training Courses haschanged over the past few years as a result ofthe implementation of Modernising ScientificCareers, the expansion of the Association toinclude all laboratory medicine professionalsand cost pressures. The Education Committeehas a proven track record of organising highquality meetings providing a training day atFocus, supporting the management trainingcourse and in the past organise two residentialcourses per year. With the change inassociation membership we have also workedacross the disciplines to provide relevantmultidisciplinary meetings where required.
Focus 2015For the past two years the EducationCommittee have run a multidisciplinary sessionand organised discipline specific sessions. This year Dr Rachel Carling is co-ordinating our multidisciplinary session entitled ‘Theimportance of the multidisciplinary team
approach – Expanded Newborn Screening’.Starting with an overview of the process, the morning will review the role of thenewborn screening and inherited metabolicdisease laboratories, the confirmatory testingrequired and look at roles of non-laboratoryprofessionals within the pathway. Quality, key performance indicators and audit within ascreening laboratory will also be discussed.For the Clinical Biochemistry discipline
specific session we like to focus on the FRCPathexamination. This year will be no different andit is the turn of the practical to be put underthe spotlight. While we won’t be able to run amock practical, Dr Chris Chaloner is going toreview some example questions, summarisesome of the mathematical tools that you needto know to interpret data and provide tips forsurviving the process. At the request of thetrainees we have also invited Tim James totackle troubleshooting within the laboratory.
Courses on Offer in 2015
Trainees at a Focus Training Day having fun with A4 paper!
24 | Education Committee
ACB News | Issue 623 |March 2015
Tim previously led a very successful session atone of the residential courses and will covertopics including how to tackle lot to lotreagent variation, antibody interference andassay fliers.The Immunology Professional Committee
and Microbiology Committee have beeninvolved in the discussions but it has beendecided that there will be no discipline specificsections at Focus 2015 due to other meetingsthat are on offer.
Residential Course 2015With training budgets being cut, theEducation Committee with representationfrom the Trainees’ Committee has reviewedwhat we can offer and decided that in 2015we will run one two day residential coursebetween the 5th and 7th of October. This willbe held in the Conference Centre facilities ofthe University of Birmingham, which has goodtransport links and is a central location makingit accessible to all Trainees. Dr Rachel Webster,West Midlands Regional Tutor, will beorganising this course which will focus ontopics not covered well in text books to ensure
that the time spent on these courses is wellutilised. A programme will be published onthe ACB website and circulated to all Traineesin due course. Topics will include EQAinterpretation, Fluid and CSF analysis andinterpretation, discussion of Duty Biochemistscenarios and specialist techniquespresentations/workshops.
Management Training Course 2015Sally Benton is again co-ordinating the highlysuccessful CB management course. The coursewill take place at the University of Surreybetween the 12th and 17th of July and willhave sessions discussing R&D and innovation in the NHS, managed service contract andprocurement, clinical leadership, finance andHR. Places are limited so we advise you tobook early. Details will be published in theACB News and circulated via the ACB Office toall Trainees. The Education Committee hopes that the
courses organised meet the requirements ofthe membership but if you have any suggestionsplease contact Hazel Borthwick, Email:[email protected] �
Trainees also get time to relax and network, and friendships made can last the rest of your career
Obituary | 25
Issue 623 |March 2015 | ACB News
Clinical Biochemistry, as we know it, is arelatively young discipline and the time hascome to remember one of its forefathers. Paul Trinder, or PT as he was known fondly byhis scientific associates, was a warmunassuming man who came, via anunorthodox route, to have a considerableimpact. On leaving school, he began his careeras an analyst in a commercial laboratoryworking largely with coal, before being calledup as a Private into the Royal Army MedicalCorp. Trained at a multidisciplinary laboratory,he was then sent off to India to work in twoother laboratories – the last studying theaetiology of tropical sprue. Returning to thecommercial lab in 1946, he furthered his newambition to become the Head of aBiochemistry Department by completing anexternal BSc in Chemistry from LondonUniversity. He started work in the BiochemistryDepartment at Sunderland Hospitals as atechnician for one month, a senior technicianfor four months before being appointed asBiochemist in 1949. This was the first of severalappointments of a Clinical Biochemist in theNorth East – all of whom were Chemists,rather than Biochemists. Rising through thenewly developing gradings to be a Top GradeBiochemist, he never felt the need to workelsewhere.
Innovation and Methods Poured Out
Having joined a Pathology Department thatencouraged research and publications, PT began to develop his real forte ofinnovation methodological development. His first paper in 1951 looking at rapiddetermination of sodium in serum, yieldedresults in minutes rather than hours and was,like all of his methods, intended to enhancethe service offered by his department.
Unfortunately, it was to be eclipsed veryquickly by the introduction of the flamephotometer but that did not hold back hiscreativity. Methods followed for potassium,cholesterol, salicylate, iron, calcium,carboxyhaemoglobin, SGOT/SGPT, aspartateamino-transferase, uric acid, glucose, xylose,phenylalanine, and HDL-cholesterol. Thesewere only the ones that were published –with many others being developed to supportthe interests of clinician colleagues. His PhDwas no extra effort, such was the amount oforiginal work he was completing to choosefrom.
Ubiquitous Trinder Salicylate Method
Most in Clinical Biochemistry of a certain agewill have measured salicylate using Trinder’sreagent. When a health scare suggested thatthe two most popular chromogens being usedin glucose-oxidase-peroxidase methods mightbe carcinogenic, Paul rapidly publishedalternatives. The first used adrenaline,
Giant of MethodologicalDevelopment Remained aTrue MackemDr Paul Trinder, 1919-2015
26 | Obituary
ACB News | Issue 623 |March 2015
and then, almost immediately afterwards, 4 aminophenazone as an alternative oxygenacceptor. It was this method, epitomised as theTrinder Reaction, which has had the mostwidespread impact and remains the mostcited article in the Annals. Pretty good for anarticle from 1969. Interestingly the parallelneed to change the reagents for occult bloodswas sorted and applied within the departmentwithin a couple of days.A local lad, always happiest amongst his
test-tubes, Paul was not one for theconference circuit but would be amused whenpathologist colleagues returned frommeetings as far away as Moscow complainingthat no one had known where Sunderland wasbut they had heard of Paul Trinder and wereusing his methods. Staff had to contend withtaking phone calls from luminaries such asNorbert Tietz ringing from the States just tocheck something with him before putting itinto their books.
Analytical Rigour
Undeterred by early automation such as theTechnicon AutoAnalyser, Paul set to adaptingmany of his methods to cope with the rapidexpansion of the department. Due to theactivities of organisations such as BoehringerMannheim, many of his methods – particularlycholesterol and glucose – becameinternational standards on the big pieces ofautomation which became the norm. This shiftto automation also finally led to Paulregretfully having to accept that he was no
longer able to perform all of the work in thedepartment but he remained central. In hisown words, his management style was that ofa benign dictator but his own personalexperience made him passionate aboutdeveloping others. Everyone in thedepartment enjoyed his encouragement, theireasy access to his encyclopaedic knowledgeand the adventure of being involved inapplying new methods and equipment as partof their own professional development. They were also ‘brought up’ in the analyticalrigour which PT had always applied and thatexperience served them well at the time and inlater appointments. Paul’s broadercontribution was also recognised as an earlyrecipient of the ACB’s Wellcome Prize forsignificant contribution to the quality oflaboratory practice and Fellowship of thefledgling Royal College of Pathologists.His retirement in 1985 was fittingly marked
by a scientific symposium at which somenotable speakers explored topics where hiswork had made significant impact yetremained the focus of continuingdevelopment. Throughout his long retirementhe maintained his sharp intellect by keepingup with developments and the progresscolleagues were continuing to make in hisbeloved biochemistry. Such was his humilitythat his family did not appreciate hiscontribution outside Sunderland and haveonly just come to understand his impactprofessionally. �
PW
Crossword | 27
Issue 623 |March 2015 | ACB News
Last month’s solutionAcross 9 Toe party line with gen about
possible capacity for work (9,6)
10 More intoxicated (primarilyexcess spirit drunk) (7)
12 Cover novel arrangement inold gramophone record (7)
13/29 Fix old alcoholic cherry dyemixture for vitamin product (24)
14 Musical group without webaccess? (5)
15 Adult group retains NorthWest backing (7)
18 Eccentric sect say conversion is bliss (7)
21 Adenoidal order of 7 doesn’t irk (5)
23 Their usual mathematicaldesignation sounds wise (9)
25 Blood products – ingredients ofbroth in meal starters (7)
26 Distressing carbon monoxidedeath of conductor (7)
29 See 13
Down1 Spy location (4)2 Tread stage (4)3 Mistake denied, point out
bun not ordered (8)
4 Potential pathogen: applybromine between six and ten (6)
5 Stevenson character going aftercorrupt deal for chemical (8)
6 Unbalanced rough (6)7 South Asian republic lacks rain:
production a lot less (3,5)8 See 1711 More biting returns concerning
former British chemical company (5)
15 Cites informal informationabout the study of traits (8)
16 Role is to synthesise hormone(8)
17/8 Professional team polymathmay misconstrue a symptom of 13/29 lack (8,8)
19 Injured city fans free of guilt (8)20 Rate drugs that include 18 (5)22 Refuse saddle (6)24 Two short months to extract
by boiling (6)27 French bear belongs to us (4)28 Tailors sell old textile
measures (4)
ACB News CrosswordSet by RugosaPostcard is Born . . . Now Use this Tool!Last month the concept of the Innovation & User Feedback postcard was born. We thought it was original, but a quick Google search showed us Surrey Pathology Services have already produced one! Anyway, that aside, we designed and printed the thing in just two weeksbut of course this is the tool not an end in itself. Our concept is now written up as a controlled policy for usingthe postcard as part of our quality system. The policy details how we will distribute, and also when they comepouring back, how the comments will enter into our quality system. Next month we will let you know how weare getting on, our first entry is from five healthcare staff at Birmingham Jail!
