the association of clinical biochemists •issue 455 …...acbnews the association of clinical...

ACBNewsACBNewsThe Association of Clinical Biochemists • Issue 455 • 20th March 2001

Launch of

“Making the

Change”

Strategy

Informatics for

Clinical Science

The www

Grows Up

Recruitment

into Clinical

Scientist Posts

Launch of

“Making the

Change”

Strategy

Informatics for

Clinical Science

The www

Grows Up

Recruitment

into Clinical

Scientist Posts

We’re not made of stone

AIA-21:the answerto your immunoassayworkload

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Reliability Precision

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About ACB NewsThe 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 BiochemistrySandwell District General HospitalWest BromwichWest Midlands B71 4HJTel: 07973-379050/0121-607-3261Fax: 0121-765-4224Email: [email protected]

Associate EditorDr Richard SpoonerBiochemistry Department Gartnavel General HospitalGlasgow G12 0YNTel: 0141-211-3470/3353Fax: 0141-211-3455Email: [email protected]

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

Focus Handbook EditorDr Sandra RainbowCentral Middlesex Hospital

Display Advertising & InsertsPRC AssociatesThe Annexe, Fitznells ManorChessington RoadEwell VillageSurrey KT17 1TFTel: 0208-786-7376 Fax: 0208-786-7262Email: [email protected]

ACB Administrative OfficeAssociation of Clinical Biochemists130-132 Tooley StreetLondon SE1 2TUTel: 0207-403-8001 Fax: 0207-403-8006Email: [email protected]

ACB ChairmanMr Mike HallworthDepartment of Clinical BiochemistryRoyal Shrewsbury HospitalMytton Oak RoadShrewsbury SY3 8XQTel: 01743-261157 Fax: 01743-261159Email: [email protected]

ACB SecretaryDr Peter WoodRegional Endocrine Unit, Level D, South BlockSouthampton General HospitalTremona Road, Southampton SO166YDTel: 02380-796707Fax: 02380-796898

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

Printed by Piggott Printers Ltd, CambridgeISSN 0141 8912© Association of Clinical Biochemists 2001

March 2001 • ACB News Issue 455 • 3

ACBNewsNumber 455 • March 2001

General News 4

Disposable Laboratory Tips 8

Current TopicsMaking the Change Launch 10

MRCPath Short Questions 14

Trainees CommitteeFrom Flipchart to PowerPoint™ 15

Info TechGet Your Medical Informatics Up to Speed 18

Web Sites for Everyone . . . 22

Federation of Clinical ScientistsPay Claim Settlement 26

Current TopicsRecruitment into Clinical Biochemistry 28

Meeting ReportsEndocrinology and Diabetes in Leeds 30

Obituary 33

Letters 34

Forthcoming Meetings 35

Situations Vacant 36

Front cover: Gordon Challand took this photo in Tibet during a recent visit to a Chinese laboratory

ƒocus2001LONDON • APRIL 30 – MAY 4

The Association of ClinicalBiochemists National Meeting

ExCeL, London DocklandsTel: 01223 404830 Fax: 01223 404841

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

4 • ACB News Issue 455 • March 2001

General News General News General News General News General News

Remember that the Focus 2001 meeting is founded onexcellent science. There are many lectures by eminentspeakers this year including:

• Dr R W Hart, USA (AACC Transatlantic Lecture)• Professor T Cox, Cambridge (Flynn Lecture)• Professor D Lo, Hong Kong (Roche Diagnostics Award

Lecture)• Professor D-J Dyek, Guildford (Kohn Memorial Lecture)• Dr H Kuiper, The Netherlands (Konelab Award Lecture)• Professor T J Peters, London (ACB Foundation Award

Lecture)

Symposia at the meeting include:

• Nutritional Aspects of Bone Metabolism• New Tools in Clinical Biochemistry• Testing Outside the Laboratory• Immunology Seminar• Mass Spectrometry in Clinical Biochemistry.• Metabolic & Endocrine Effects of Illness• Endocrinology Seminar• Haematology Seminar

• Nutrition and Chronic Disease• Molecular Genetics Symposium• Purines and Pyrimidines in Clinical Biochemistry• Drugs and Toxicology• Drugs, Nutrition and Sport

All the latest clinical laboratory products will be onshow at the extensive exhibition. As well as a very fullscientific programme and exhibition time, the meetingincludes an excellent social programme.

Still Not Registered for this

Meeting?

Now is the time to act as there is an additional £50booking charge after 1 April. Focus 2001 representsexcellent value with full-week attendance priced atjust £645 to include a single room and social eventsfor the week. Perhaps you are unable to attend thisexcellent event. Not to worry, this is an excellentmeeting to send your colleagues to. They will comeback after a week at Focus 2001 all ‘fired up’ and fullof ideas – you know it makes sense to use some TrustFund money like this! ■

Get into Focus 2001 Now

Young European Prize for

Invention and Discovery

A new biennial prize for invention and discovery willbe awarded to a European person or team of Europeanpeople, over the age of 18 and under the age of 35,who have contributed to “the advancement of mankindthrough invention or discovery.”

The closing date for entrants for the £30,000William Grant and Sons Award is 30th April 2001.Entry forms and conditions are found onwww.bigidea.org.uk

Entrants will be judged at Paisley University by aneminent panel of European Scientists led by the Chairman, Sir James Black OM FRS and NobelLaureate. He will be assisted by Professor James A. Cairns, Professor of Microelectronics, Department of Electronic Engineering and Physics,University of Dundee, Professor Claude Detraz,Scientific Director, CERN, Geneva, Mr Peter Gordon,William Grant & Sons, and Sir William Stuart, Former Chief Scientific Advisor to the BritishGovernment. ■

Royal College of Pathologists

Upcoming Meetings

Human Adverse Drug ReactionsWednesday 30th May 2001

Professional Standards of Pathologists in a ModernNHS Pathology ServiceThursday 7th June 2001

Infectious Hazards of Donated OrgansThursday 28th June 2001

Recent Advances in GeneticsThursday 5th July 2001

All meetings are held at the Royal College of Pathologists,2 Carlton House Terrace, London SW1Y 5AF.

The above meetings are open to members, trainees,retired members, nurses, MLSOs and non-members ofthe College. For further details please contact: AcademicActivities Co-ordinator, The Royal College ofPathologists, 2 Carlton House Terrace, London SW1Y 5AF. Fax: 0207-451-6701. ■



Congratulations to New Personal Chairs

We offer congratulations to two ACB members,

Bill Fraser and Curtis Gemmell who have recently joined the professorial ranks

Most of us in clinical biochemistry,whether medical or scientific,spend some time each week being a‘duty biochemist’. This most fasci-nating and challenging job involvesgoing through several hundredreports containing abnormalitieseach day, and deciding what actionshould be taken on each of them.There are only five basic thingswhich can be done; contact therequesting clinician to discuss thecase; return the report to thedepartment for analytical re-check;add further tests before reporting;let the report go out withoutfurther action (‘no comment’); oradd a brief interpretative or advisorycomment. Choosing the mostappropriate action is an importantway to add value to reports.

For many reports, the ‘goldstandard’ action is to discuss theresults directly with the requestingclinician. But in reality, there is onlyenough time to do this for ahandful of reports each day. For theremaining hundreds, we mustchoose one of the other options.Adding brief comments hasbecome a valuable indirect meansof communication between us andclinicians, particularly GPs.

‘Cases for Comment’, theinternet-based interpretative servicerun on the ACB’s general discussionmailbase since 1997, has proved apopular service. There have been

several hundred participants frommore than 25 countries, and pastcases (available on the ACB’s website) are much in demand for edu-cational purposes. But few caseshave generated a clear consensus‘best comment’; and many haveillustrated extremely wide differ-ences of opinion between us - dif-ferences too wide to be explicablesolely by valid differrences inpersonal opinion. There is a clearclinical governance issue here whichwe, as a profession, need to address.

Now the WorldIn addition, ‘Cases for Comment’has become the victim of its ownsuccess. Internet services are labor-ious, and as the number of partici-pants has grown, managing it byinternet has become increasinglydifficult. Last year, CPA (UK) Ltdrecognised the clinical governanceissue and provided a grant to turn‘Cases for Comment’ into a pilotEQAS. This new scheme hasbecome part of UK NEQAS -‘Interpretative Comments inClinical Chemistry (pilot)’. We feltthe only practicable way forwardwas to use ideas behind ‘Cases forComment’ as a basis, but to turnthis into an interactive web pagewithin the website of UK NEQAS.Staff from UK NEQAS and from theWolfson Computer Laboratory inBirmingham have now designed a

general purpose web interfacewhich can be used for a wide rangeof interpretational exercises, andusing this, the new EQAS should go‘live’ in April this year.

Bound by exactly the same rulesof procedure and confidentiality asother UK NEQAS, the new schemehas one important difference fromother schemes in clinical biochem-istry (but not with cellular pathol-ogy!) - it will be directed towardsindividuals rather than depart-ments. Individuals will have theirown unique identification numberand will be protected by password.Assessment of the appropriatenessof comments will be byanonymised peer review. As with‘Cases for Comment’, the main aimwill be educational and past caseswill be made generally available forteaching and for discussion. But aswith other UK NEQAS, the schemehas to be self-financing, so withoutsufficient participants joining in thefirst year it will not be possible tocontinue the service. Initially, par-ticipation will be on a ‘threemonths’ free trial’ basis.

The scheme will be demonstratedat Focus 2001 and at the UKNEQAS road shows this year. Forfurther information, please contactthe scheme organiser([email protected]) or godirect to the website throughwww.ukneqas.org.uk ■

A New EQAS for Interpretative Comments



Professor Challand (China Hon.)

Articles by Gordon Challand about his visits to Chinahave appeared before in ACB News. Last year hereturned to China and was made Honorary Professor ofLaboratory Medicine in the University of West China.Now he writes:

“I was fortunate enough to be invited back to Chengdu, thecapital of Sichuan Province, last September and spent two weeksgiving a series of lectures in workshops and to Universitystudents. Accreditation and laboratory quality are very much hottopics there, so I found myself giving probably the first lecture inChina on clinical governance, focusing on quality in the post-analytical phase. At a workshop on education, I had to explain indetail our training schemes for clinical biochemists, both medicaland scientific. There was some time to spend exploring Chengdu.The pace of change is enormous and People’s South Road is nowlined with new apartment buildings, shopping malls and interna-tional-style hotels. But some things have still not changed - thesea of bicycles, the compulsive Mah-Jongg players, and the blindfortune tellers on the Jin Jiang bridge.

To say thank you, my hosts took me to Tibet - how did theyknow that my ambition for more than forty years was to visitLhasa? The Dalai Lama’s Potala Palace was breathtaking andmagnificent, even though cheese-scented candles took some gettingused to, and there was certainly SOBOE when climbing steplad-ders 3,500 metres up. The high point literally was travelling viathe old road (mainly cart track) 300 km west to Xigatse. Theroad climbed ever higher through never-ending hairpin bends (in

Mandarin, a sheep intestine road), then along the shores of a vastsalt lake, the Yamzhog Yumco. It eventually took me to the KaraPass, 5,050 metres in space, at the foot of the south face of NoiJing Kang Sang Fen, at 7,191 metre the highest point of theLhagoi Kangri mountains. For me, this was paradise indeed and Icould even see the route first climbed in 1986.I would like to thank my hosts Shi Ying Kang and Li Ping for yetanother unforgettable visit to China.” ■

Focus Fancy Dress Nights

As Focus 2001 is rapidly approaching, time is neededfor preparation of your fancy dress costumes for certainsocial events! The theme for the Corporate Membersevening on Monday 30th April is ‘Carnaby Street in the60s’, so turn out all your 1960s gladrags. There mustbe some closet hippies or Mary Quant look-a-likesamong the membership, so put on your hotpants orflower power shirts and come along to this 60s revivalto dance along to the ACB band.

The Conference Banquet will be a more formal affair. This is to be held at ‘The Brewery’, a venue thathas provided hospitality on the same site since 1749 when Samuel Whitbread started the brewingdynasty which still bears his name. We invite you to dress up in your black tie and posh frocks for this five-course dinner and then dance the night away. ■

Trade Union Statement

A member who is concerned that some irregularity maybe occurring, or has occurred, in the conduct of thefinancial affairs of the union may take steps with a viewto investigating further, obtaining clarification and, ifnecessary, securing regularisation of that conduct.

The member may raise any such concern with oneor more of the following as seems appropriate: theofficials of the union, the trustees of the property ofthe union, the auditor or auditors of the union, theCertification Officer (who is an independent officerappointed by the Secretary of State) and the police.

Where a member believes that the financial affairs ofthe union have been or are being conducted in breachof the law or in breach of rules of the union and con-templates bringing civil proceedings against the unionor responsible officials or trustees, he should considerobtaining independent legal advice. ■



ACB Medical Informatics Training Course No. 1

Worsley Building, Leeds University

Monday 23rd April 2001

This is the first in a series of three one-day MedicalInformatics Training sessions that will take place overthe next three years. The emphasis is on practicalhands-on exercises using the Leeds University MedicalSchool PC Super-clusters. The courses are beingorganised by the ACB Informatics Committee andmembers of this group will be available to assist with thepractical exercises during the afternoon session. The completeprogramme may be found in the article by John O’Connor and James FalconerSmith in this edition of ACB News.

09.30-10.00 Registration and coffee10.00-10.20 Syllabus and short description of the European Computer Driving

LicenceJohn O’Connor and Dr Jonathan Kay

10.20-10.50 Intranets: What Are They and Why Build Them?John O’Connor

10.50-11.20 Pathology IntranetsJonathan Kaye

11.20-11.35 Web Authoring: Languages and ToolsCraig Webster

11.35-11.50 Examples 1: Capsules (Clinical Calculators)Martin Holland

11.20-11.35 Examples 2: ACB WebsiteIan Godber

11.35-12.30 Hands-on Session 1 Computer Laboratory12.30-13.30 Lunch13.30-14.10 Clinical Guidelines

Julian Barth14.10-16.00 Hands-on Session 2 Computer Laboratory16.00-16.30 Summary and General Discussion

Cost: £70 ACB members £80 non-ACB members

Further information from Dr Graham GroomAssociation of Clinical Biochemists, 130-132 Tooley Street, London SE1 2TU

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


Disposable Laboratory Tips Disposable Laboratory Tips Disposable

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Current Topics Current Topics Current Topics Current Topics Current

This important new strategic document was launched at the RoyalSociety, London, by the Health Minister, Lord Philip Hunt. Thelaunch was attended by senior representatives of the thirty or so

professional organisations that come under the new term of“Healthcare Scientist”.

Key aspects of the strategy include:• A new career structure for Healthcare Scientists with opportunities

to combine or move between jobs in practice, education andresearch and better rewards for working in expanded roles.

• Commitment to modernise and reshape education and trainingpathways so that staff receive the highest quality training andongoing development.

• Commitment to develop more flexible career pathways so that highquality staff can be recruited and retrained.

• Development of a National Occupational Standards Framework toenhance public confidence.

• A healthcare scientist workforce review to ensure adequate numbersof profesional staff are available to deliver high quality scientificservices.

Report Launched to the ProfessionsLord Hunt started by putting the new strategy in the context of the NHSplan where “good practice and extra resources will allow us to achieveour aims”. This strategic document “will raise the profile with peopleappreciating the roles and contribution of Healthcare Scientists. I hopethat you (the professions) will agree that it provides a framework to goforward with”, he said.

Lord Hunt emphasised that there was a need to “reduce fragmenta-tion of Healthcare Scientists” and he hoped that “there was widespreadagreement on this, though not always on the ways to achieve this.” Thestrategy should not in any way be seen as moving to the lowestcommon denominator, but rather enabling a workforce that is trainedand fit for the purpose.

Lord Hunt alluded to present recruitment and retention problemssaying that we need people with the right skills and professionalism.The strategy targets not only the manpower need but, also the environ-ment in which we work. The workplace must put greater emphasis ontraining and continuing professional development. It was a challenge toevery professional group to have practitioners who are up-to-date, safeand effective. Lord Hunt pointed out that vocational training willchange and that he was grateful to those already working in this area.The overall aim is to have competent practice throughout.

Come Collectivelyand Soon Please!Reported by Dr Jonathan Berg, Editor

Report on thelaunch of ‘Making

the Change: A Strategy for

the Professions in Healthcare

Science’ published28th February

2001

Dr Ian Barnes, who was asked to organise thelaunch, welcomes Lord Philip Hunt to the RoyalSociety to give his address


Topics Current Topics Current Topics Current Topics Current Topics

Lord Hunt then turned to what he expected of the 30 or so profes-sional groups present at the launch. Healthcare professionals need todevelop a sensitivity to colleagues and would need a “critical mass” tobe able to stand alongside other groups in the Health Service. “Lack ofsuch co-ordination in the past has held you back”, said Lord Hunt whowent on to say that he would be keen to meet with leaders of the pro-fessions personally to take the strategy forward.

Lord Hunt said that, for example, he understood the different roles ofthe Biomedical Scientist and Clinical Scientist. He was impressed withwhat could be achieved and understood the combined pressures ofservice provision and recruitment and retention at the present time.Further, the lack of NHS Trust emphasis on laboratories is a big issueand Lord Hunt had this message for NHS Trusts - “Your laboratoryservices are hidden away and often not seen by Trust Boards.Laboratories have lost out with regard to investment decisions but nolonger can this be the case.” Lord Hunt said that the Trust Board has theresponsibility for laboratory investment and events in recent monthshad driven this home. The responsibility of adequate investment will betackled by Lord Hunt at Chief Executive level in NHS Trusts.

Career StructureLord Hunt pointed to the strategy requiring a career structure availableto all and suggested that “glass walls and ceilings had, until now, heldpeople back. Both vertical and lateral transfer within professional careerstructures were important.

The new strategy runs to 40 pages and is presented in a refreshing easy-to-read style



Regarding professional registration Lord Hunt appreciated that only50% of the scientists represented were presently covered. The HealthProfessionals Council will go through Parliament soon with regulationrather than primary legalisation being the way to move things forwardwithin a reasonable timeframe.

In conclusion Lord Hunt said he hoped the professions would agreethat the new strategy was a significant step forward which heencouraged us to grasp with both hands. Ultimately he felt that theresponsibility was now clearly with the professions. We needed to raisethe profile and to pull the professions together to have a powerful voicewithin our environment.

Dr Ian Barnes, who had organised the event, thanked the Minister forlaunching the Strategy to the professions and pointed to the stronglysupportive message which he encouraged everyone to take forward.

Go Collectively and Go Soon!After the minister left the event to prepare for health questions in theHouse later that afternoon, several short presentations were made. DrPeter Greenaway, Chief Scientific Officer said that it was clear that theGovernment had a commitment to improving working conditions andthe career structure for Healthcare Scientists. He felt that Lord Hunt hadclearly demonstrated a personal commitment to this and said “he willbe hitting me over the head if progress is not made”.

Dr Greenaway felt that the strategy offered a blueprint for the futureand that there “were messages for everyone, sometimes explicit and

Lord Hunt launches the report

Over 30 different professional groups attendedthe launch



sometimes subliminal”. “Every Healthcare Scientist should read thestrategy”, he said. Lord Hunt had pointed to a major weakness in ourmany small groups with conflicting interests. Peter Greenaway felt thatthis must be addressed to be able to proceed. The overriding messagehad been that, in the changing world of the NHS Plan, HealthcareScientists were seen to have a critical role and that the Governmentenvisages an expanded workforce to meet future Health Service needs.This requires adequate investment and resources and NHS Trusts mustbe made aware of this.

In a short question session Dr Greenaway was tackled on how wecould get the message back to our NHS managers. He said that thestrategic document was an important tool that should be used locally aswell as from central Government.

Asked how the professions should take up Lord Hunt’s offer ofpersonal involvement in taking things forward, Peter offered this advice:“Go to see him collectively and go soon!”

Response of the ACBWe hope to carry the views of the Association Chairman & Council onthe Strategy in the April edition of ACB News. We also hope to bringyou an article by Lord Hunt giving his personal view on the strategy,but perhaps we should wait until after the election before publishingthat! Once you have read the strategy, which is a very readable 40 pagedocument, then do consider writing to ACB News with your owncomments. ■

Making The Change: A Strategy for the

Professions in Healthcare Science

Copies are available free of charge from: Department of Health Publications, PO Box 777, London SE1 6XH

Fax: 01623 724524 Email: [email protected]

The document is also available for downloading on the internet at: www.doh.gov.uk/makingthechange

Dr Peter Greenaway, Chief Scientific Officeremphasised the need to go back collectively to speakto Lord Hunt and take things forward


MRCPath Short Qestions MRCPath Short Questions MRCPath Short

a) Calculate the hydrogen ion concentration of blood with a pH of 7.12

pH = log10 1 [H+]

where [H+] = hydrogen ion concentration in mol/L

Substitute pH = 7.12 and solve for [H+]:

7.12 = log10 1 [H+]

antilog 7.12 = 1 [H+]

[H+] = 1 = 1 = 7.6 x 10-8 mol/Lantilog 7.12 1.318 x 107

To convert to the more familiar nmol/L multiply by 109 to give 76 nmol/L.

b) Treatment with barbiturate halves the hydrogen ion concentration, what is the new pH?

New [H+] = 76/2 = 38 nmol/L = 3.8 x 10-8 mol/L

New pH = log10 1 = log10 1 = log10 2.63 x 107 = 7.42[H+] 3.8 x 10-8

Exam tip: Fully familiarise yourself with your calculator beforehand. It is not much fun trying to find out how to doantilogs in the exam!

Deacon’s ChallengeNo. 1 - Answer

Deacon’s Challenge No. 2

During the course of treatment of a patient with diabetic ketoacidosis, 6 litres of physiological saline (0.9%) and 3 litres of dextrose (5%) were infused before thepatient’s urine output became equal to the rate of infusion. By this time the cumulativeurinary output since starting treatment was 2 litres of fluid containing 70 mmolsodium. The patient had been catheterised on admission and the residual urine discared.

Estimate the extracellular fluid deficit at the time treatment was begun, indicatingany assumptions that you made.

MRCPath November 1999 - modified

Thanks to the Royal College of Pathologists for allowing us to reproduce these questions. ■


Trainees Committee Trainees Committee Trainees Committee

From Flipchart toPowerPoint™ . . .Reported by Judith Burrows, Russells Hall Hospital, Dudley, West Midlands

Ensuring that everyone arrived on time for this course, delegateswere kindly reminded that the University of Warwick was not inWarwick but was situated on the outskirts of Coventry! Thus

eventually, eight grade B biochemists, two SPRs in microbiology, threein chemical pathology, eight in haematology and ten in histology, twoconsultant chemical pathologists, six consultant histopathologists, andone reader in virology made it onto the course.

Don’t Forget the Finance Department!The first session was entitled ‘The wider NHS structure and manage-ment issues for pathology as a whole’ where Mr Stuart Fletcher, ChiefExecutive of Pembrokeshire NHS Trust presented an overview of thestructure and management of the NHS. Martin Myers (Royal PrestonHospital) then gave a presentation on ‘The development of pathology asa clinical directorate’. Dr Myers described a number of models for thestructure of a clinical directorate and talked about the need for changein some clinical departments due to advances in technology andchanges in skill mix.

Mr Alun Jenkins, (University Hospitals of Leicester NHS Trust), thenspoke on ‘Equipment procurement in pathology: leasing, purchase orwhat?’ He gave an overview of the historical context of purchasing inthe NHS and the identification of purchasing groups. Mr Jenkins alsodescribed ‘the do’s, the don’ts and the legalities’ when procuring equipment and reminded delegates not to forget to use their financedepartments! He also highlighted that the time, effort and documentation required in the pursuit of an ideal analyser should notbe underestimated.

A session entitled ‘Financing Pathology’ was covered by Mr J. Loftus(senior finance manager, University Hospitals of Leicester NHS Trust)who spoke on ‘Purchasing pathology: the hospital perspective’ and DrDavid Gozzard (consultant haematologist, Glan Clywd Hospital, Rhyl)who spoke on ‘Laboratory budgets and costing pathology’. Delegateslearnt all about purchasing pathology services, about different purchas-ing groups, internal trading and service agreements. Delegates alsoheard all about concepts of costing including data trees and weightedWELCAN units (Welsh Canadian workload units, equivalent to approxi-mately 1 unit of a biomedical scientist’s time!).

Recognise the Negatives . . .

Push the PositivesOn the first day of the course, delegates were informed that they were toprepare a business case for presentation on the final day. The aim of this

Report of theLaboratory

ManagementCourse for

‘Pathologists’,University of

Warwick 6th-8thSeptember 2000


Trainees Committee Trainees Committee Trainees Committee

exercise was to put together a case to improve services, morale and reduceoverspend at a fictional small non-teaching DGH situated five minutes from acity centre teaching hospital. Time was allocated throughout the course foreach group to prepare their business cases.

In session four; ‘Making it Happen’, a presentation on business casepreparation and negotiation was given by Mr Derek Kitchen (ManagementSchool, University of Warwick). Mr Kitchen described the main functionsand key elements of a business case indicating that there should always bemore than one option even if one of the options is ‘do nothing!’. He alsoexplained that it was important to recognise the negatives and to push thepositives of a business case.

Dr Jonathan Kay (John Radcliffe Hospital, Oxford) then gave a presentationentitled ‘Information technology and pathology’. Dr Kay highlighted the factthat basic IT skills are a requirement in this profession, as indicated by theRoyal College of Pathologists: Working Group Core Training Programme inPathology Informatics. Dr Kay suggested that a widely available establishedtraining scheme is required and that this may be available in the form of theEuropean Computer Driving License (ECDL) ([email protected]).Delegates also heard about personal digital assistants, the new NHS number,handheld wireless computers, expert systems and the human factor: a reasonwhy some departments are more computerised than others!

Pressures for changeIn session five: ‘Pressures for Change’, a very interesting presentation wasgiven by a GP from Birmingham. In this presentation the GP suggested thatto improve the services offered by pathology, patient results could perhaps bereported in a more understandable format, with any abnormalitieshighlighted and with all results for one patient reported on one report form.The GP found it frustrating that, results were received for tests that had notbeen requested but that at the same time results for tests that had beenrequested were not received! To overcome this, it was suggested thatimprovements to the two-way electronic communication system could bemade. It was also suggested that exchange visits between GPs andpathologists might be a good idea.

Course participants presented their business cases to Mr Derek Kitchen(Management School, University of Warwick) who acted as the ChiefExecutive of the fictional hospital. The aim of this exercise was to persuadethe ‘Chief Executive’ to accept the business case. Presentations varied in style(from the use of a flipchart to the use of PowerPoint with a laptop computer)and the exercise was generally thought to be a useful one. It was interestingto work with, and to see the perspectives of, those from other disciplines.

In summary, this was a very well organised course, with good courseinformation and useful accompanying literature, all held at a universitycampus with excellent facilities.

Some of the material covered was considered to be too basic by manyconsultants attending this course. However, grade B biochemists and SPRs in chemical pathology thought that the course was very useful,especially for those preparing for parts 1 or 2 of the MRCPath, and it was the general consensus that they would recommend this course to their colleagues. ■

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Info Tech Info Tech Info Tech Info Tech Info Tech Info Tech Info Tech

Medical Informatics is a very wide body of knowledge. Manyaspects of it impinge on the practice of Clinical Biochemistry.The ACB is to run a 3 year rolling programme of one day

courses looking at the impact of medical informatics in the develop-ment of information and communication systems used throughoutclinical biochemistry laboratories. The courses are not designed toteach basic IT skills as these may be personally learned through participation in the European Computer Driving Licence (ECDL). This certifies that the holder has knowledge of the basic concepts of information technology (IT) and is able to use a personal computerand common computer applications at a basic level of competence(http://www.ecdl.com/). Similar clinical speciality programmes arebeing developed by the Royal colleges to meet the needs of their ownmembers1.

It has not always been easy to explain to those outside the fieldwhat medical informatics is all about. Its terminology and concepts,and perhaps, more than anything, its focus on technology, have madeit hard to bridge the gap to the concerns of those working day-to-dayin clinical practice.

A description of medical informatics has been coined by a highlyrespected researcher in this field Enrico Coiera:

“If physiology literally means ‘the logic of life’, and pathology is ‘the logic of disease’,then medical informatics is the logic of healthcare.”

This “Logic of Healthcare” will be addressed in these courses in 3main streams of content relating to Information systems in Education,Management and supporting the Clinical Biochemistry service.

Introducing the New ACB CourseGoals of the course are:

• To provide an overview of the way computers can be used tomanage clinical information and deliver the routine service.

• To communicate key technical issues in the developing field ofinformatics.

• To reinforce major topics in medical informatics with hands-onexperience in software programmes in a training laboratory environment.

Get Your MedicalInformatics Up toSpeed By John O’Connor and James Falconer Smith

Background to the first session

of a new informatics

course which willbe held at

Leeds University23rd April 2001



There will be news updates to describe state-of-the-art research topics that are relevantto the practice of information management for clinical biochemists through a series of presentations and demonstrations.

Each of the 3 days will be devoted to a mix of the main three themes. Specific areaswhich will be addressed are as follows:

Medical Information on the WWW• Using internet search engines.• Medical gateways on the internet.• Evidence-based medicine.• Bibliographic searching.

Communication and information systems are starting to become indistinguishablefrom one another and the convergence is evident in the evolution of the internet as avehicle for delivering information on demand. This part of the course will explore how we may best use this resource to assist in improving the way we work. Theconverse is also true that inappropriate or misguided use of this facility actually endangers effective working practices and has also led to the “empowered” but misinformed patient.

Clinical Chemistry Decision Support Tools• Knowledge representations.• How neural networks work. With hands-on examples.• Probability reasoning and bayesian networks.

This part of the course will consider some of the most complex computer systemscreated so far - those based upon the technologies of artificial intelligence (AI). Theearly promise of computer programmes that could assist clinicians in the process ofdiagnosis have yet to find a place in routine use in any clinical situation and the limitations of such systems will be discussed. We will be considering how technologieslike expert systems and neural networks can help interpret clinical signals, and workingthrough examples of probablistic reasoning using biochemical data.

Laboratory Information Systems• Procuring Laboratory Information Systems.• Aspects of writing operational requirements for Laboratory Information Systems.

Laboratory Management Systems should have powerful clinical facilities across all of thedisciplines that go way beyond simply allowing you to automate the processing of“normal” results and providing easy and rapid access to results requiring authorisation.The following aspects of functionality in LIS systems will be addressed:

• The authorisation process.• Using rule-based authorisation. • Adding intelligence to the order requesting process to manage workload demand.• Dynamic views of patient results.• Mechanisms for suppressing or modifying results.• Facilities for the recording and noting of clinical information.• Enquiries that are easily and rapidly executed. • Ability to analyse data from all of the disciplines.



Do we need to write an operational requirement for LIS systems given that most of thefunctionality has already been defined. What makes the perfect LIS? Should theseparate functions like order entry, data collection from analysers, reporting functionsbe modularised for improved efficiency. This part of the course will involve an interac-tive debate.

Information Systems for Training, Protocols

and Guidelines

• Multimedia intranet training for point-of-care testing.• Educating laboratory staff in the use of equipment using information systems.

Clinical guidelines or protocols have been in limited use for many years. The currentemphasis on evidence-based medical practice has made it more likely that biochemistswill use, and perhaps be involved in, the design and maintenance of protocols.Disseminating and maintaining such protocols and guidelines as well as online trainingin the use of intranets will be discussed.

Their characteristic advantages and limitations of protocols and guidelines will bediscussed. Guidance will be given in protocol design principles. Finally, the variousroles that computer-based protocol systems can play in clinical biochemistry will beoutlined. These cover both traditional ‘passive’ support where protocols are kept as areference, and ‘active’ systems in which the computer uses contextual links to proto-cols and guidelines to assist in the interpretation of biochemistry reports.

Managing the Laboratory with Information

Systems• Modelling workload.• Financial forecasting.• Maximising the efficient delivery of the service.

Many software applications exist for sophisticated data visualization, mining, report-ing, analysis, and ad hoc query capabilities using data held within LIS systems. Theseanalytical tools can be used to develop executive management information systems toplan the provision of the pathology service. The skills to extract this information areincreasingly being required by those of us who provide the service. The course willhave a presentation from a commercial supplier of such systems to make us aware ofwhat can be achieved, and to aid us in planning the routine use and development ofour service.

Electronic Health Care Records• Understand the nature of traditional patient records. • Database approaches to the electronic patient record (EPR).• Examine how browser technology could be used to provide effective EPR.

Hospital records are complex and generally, attempts to use computers in this arena,have yet to deliver the EPR. Traditional approaches have been based on conventionaldatabase technologies which are strong at handling data but poor at coping with freetext. New approaches include the use of XML and Browsing technologies to meet theneeds of the EPR which are:



• Inform the clinician. • Appraise other healthcare professionals. • Defend clinical action. • Examine the process of care.• Audit the process of care.

Patient records are produced in a variety of means from pen and paper to electronic, andby a broad range of different healthcare professionals. It is not uncommon for a relativelylarge proportion of the medical record to be made up of paper printout from variouslegacy computer systems. This makes record management extremely difficult and increasesthe likelihood that the clinician does NOT have patient data in the format, quality andorder needed for safe patient care. Audit Commission report (Setting the Records Straight - a study of Hospital Medical Records. Audit Commission, HMSO; 1995). This part of the course will discuss how these issues may be addressed

Pathology Messaging and Coding and Security• The challenge of the EDIFACT Pathology Messaging service.• Coding issues.• The future XML.• Encryption strategies.

If laboratory data is to be safely communicated between disparate systems and ultimatelyincorporated in electronic patient record systems, then it needs to be encoded and trans-mitted in some standardised way. There is the need to overcome variations in medical terminology used by different individuals, institutions and nations. To address theproblem, large dictionaries of standardised medical terms have been created. This part ofthe course will introduce the basic ideas of concepts, terms, codes and classifications, anddemonstrate their various uses. The inherent advantages and limitations of using terms andcodes will discussed. In particular we will look at the current national position in encodingpathology data and the use of the EDIFACT message structure. Aspects of encryption technologies will be covered and the basic working of a public key infrastructure (PKI)described.

Come and Join Us!The intended audiences are trainee biochemists, established biochemists who wish torefresh themselves in this field and chemical pathologists.

So, you really do need to come to the first in this new series of one day courses. Thelectures will be held in the computer laboratories at Leeds General Infirmary UniversityHospital. The format would be accommodation before the course and an early start tomaximise the use of the facilities. Lectures would take place in the morning with the after-noon session devoted to hands-on experience of multimedia altering tools, Expert Systemsand neural networks, metabolic simulation systems and other software related to the coursecontent. PCs will be used for all the laboratory work. For further information pleasecontact: Dr John O’Connor, Biochemistry Department, Eastbourne General Hospital, KingsDrive, Eastbourne, Tel: 01323 417400 Ext 4103.

References1 Jonathan Kay, Report on Informatics Training Bulletin Royal College of Pathologists

September 1999 ■



Web Sites forEveryone . . .By Craig Webster, Nottingham City Hospital and Andrew Wootton, Melbourne, Australia

No one can have failed to notice the explosion in web sites that has occurred in the last 3 years. Everything now has www.somethingorother.com as a by-line. Laboratories are no

different. However, some of the more technologically cautious mayquestion whether the creation of a laboratory web site is a good andworthwhile use of someone’s time. In exploring some of the problemsand issues with laboratory web sites here, we will try and convince thereader that the creation of a laboratory web site is a good thing.

There are two factors in creating a web site: what are you going to putin the web site and how are you going to do it.

Content is KingContent, content and content must be the starting point of any web site.If you do not have good material, no matter how pretty your site is, it isjust not going to be used. It is also critically important to consider whothe audience for your cybermasterpiece will be, external clinician orinternal laboratory staff, so that appropriate content can be developed.

HandbooksPerhaps the starting point of any laboratory web site is the laboratoryhandbook. This, no doubt, has been lovingly produced in paper formby the laboratory every couple of years. At first glance this seems anideal project for a laboratory web site. After all www publishing and e-books are supposed to be the way forward. The electronic version of thehandbook has a number of possible attractive features; it’s easilyproduced; it’s easily updated; you can perform electronic searches in thetext and you already have the content. However, on closer inspection wecan see there are a number of problems with having a web-based labo-ratory handbook. The most obvious of these is that you have to be at acomputer terminal to access it. You lose one of the main usabilityfeatures of the paper handbook in that it is portable and accessible justabout anywhere. Inside an institution, ward-based users of the servicealmost never use these handbooks (in our experience). What’s thepoint? You can always phone biochemistry and they will tell you whatbottle to put test X in even if it’s not a biochemistry test! E-handbookscome into their own for remote users of the service, for example GPs oreven clinical biochemists authorising at home. The niche for the laboratory handbook therefore is perhaps as a resource targeted atremote users.

Despite this, using the handbook as a starting point is perhaps the bestway to get a web site off the ground. Once this is done, concentrate on



adding value to the content you have there. As the site develops, it ispossible to add context-linking, so that, for example, sodium in thehandbook links to hospital guidelines for treating hypo- and hypernatraemia.

Something More Imaginative• Educational material. This could be in the form of lecture notes or

PowerPoint presentations. It could, for example, be used as astarting point for continuing professional development for depart-mental staff. The addition of audio to these lectures is now rela-tively simple and will transform the usefulness of these resources.

• Profiles of people in your department. A web site can be good PRfor a laboratory if done correctly. You should not forget (particu-larly if your web site is viewable on the internet) that clinicians arenot going to be the only visitors to your web site. For example ifyou have patients coming to the department why not providepictures (or even video!) of the areas they are likely to see in thedepartment. This could help them familiarise themselves with thedepartment and be comfortable when they come to the laboratory.

• Provision of maps and directions to the department will helpoutside visitors.

The above are just ideas for some starting content for your web site.Then add a search facility. This in itself is not a hard task, for exampleMS FrontPage includes a useable search component that can provide thisfacility.

Manufacturing your MasterpieceHow do you do it? Web page creation skills are now common amongstlaboratory staff so you should not have to pay someone to create it foryou. In terms of time required to produce the site this will obviouslydepend on the complexity and the amount of content you have andwhere on the learning curve you start. As a guide, the Nottingham CityHospital web site took only a few hours to produce initially. Thedatabase section took a little longer but ongoing maintenance is usuallyless than 30 minutes per week.

HTML Editors Web pages are essentially plain text documents with tags which instructthe browser how to display the material. Adding these tags is nowlargely done using appropriate software packages. Choice is a matter ofpersonal (or IT department choice), some of the common packages arelisted below (these are Windows-based software, I am sure Macintoshusers will have a list of similar software)

• Microsoft FrontPage (http://www.microsoft.com/frontpage/)• Macromedia Dreamweaver

(http://www.macromedia.com/software/dreamweaver/)• Adobe GoLive

(http://www.adobe.com/products/golive/main.html)



Each of the above has advantages and disadvantages. Of course it is possibleto create web pages just using a text editor or Microsoft Word for Windowsbut you need to know some HTML. The advantage of the dedicatedproduct usually manifests itself with automated content creation tools andsite management facilities. Therefore in the long term it is usually better toinvest in some dedicated software.

Design DogmaNow you have the right person and the right tools, it’s time to take a lookat the design of the web site. Many people have their own views on whatmakes a good web site; here are ours.

Don’t forget the media you are publishing to. A computer screen is verydifferent to paper media. What looks good on paper may look awful onscreen. Your main aim is to make it easy for users of your web site to getthe information they require. In addition to this you should make the sitepleasant to use. There are some good sites on the internet e.g.http://www.htmlhelp.com/ and www.useit.com that can provide infor-mation on this topic. Also, it is a requirement that NHS web sites followthe NHS identity rules (http://nww.doh.nhsweb.nhs.uk/commsnet/identity.htm), and website specific NHS identity guidelines (athttp://nww.doh.nhsweb.nhs.uk/commsnet/websites.htm).

In general try to follow these basic design ideas.

1 Black text on a white background may be boring but offers the bestcontrast and is therefore easy to read. It’s been tried and tested forgenerations on paper and seems to work in that medium as well ason the computer screen! Most sites use black text on a white back-ground (http://www.msn.co.uk/homepage.asp, www.virgin.com.

2 Fonts generally used on web pages are again a matter of choice.Classical designs tend to use serif fonts (e.g. Times New Roman) forlarge tracts of text and sans serif fonts (Arial, Helvetica) for creatingan impact and small amounts of text (e.g. headings). This might notbe the case for web pages. Well designed sites do not have largeblocks of text since most people still do not read large amounts oftext from a computer screen but prefer to print it out. The Georgiaand Verdana fonts have been specifically designed for on screen use,with larger, more open characters. One final point regarding fonts isthat the size of the font is important. Macintosh users cannot seefonts under 9pt in size on their browser, so 9pt font is the minimum.

3 Try and reduce the amount of scrolling involved. The web is all abouthyperlinking to information; use the technology.

4 Again, use the technology. If someone has already done it, link to itdon’t copy it!

5 Graphics and images: For those users who do not or cannot viewimages, Alt-tags which are text labels for the graphic are essential.They are also useful for search engine positioning.

6 Don’t use frames because, despite the improvements in their implementation, they can still cause problems with linking andbookmarking. The current NHS guidelines on web sites ““No



frames” should be the default design for all our websites” If thereis no alternative to frames, you need to provide a no-framesversion of your whole web site and perform extensive testing toensure that no nesting occurs. Generally, it is better to use tables tocreate a layout. e.g www.ncht.org.uk/clinchem (the current IFCCweb site www.ifcc.org uses frames but this will be removed whenthe new web site is launched – February 2001)

7 Broadband hasn’t arrived on everyone’s desktop yet! Don’t uselarge graphics or java applets that take ages to load. Although youmay be using a superfast NHSNet connection, your users may notbe. Design for pages to load over 28.8K modem link in less than40 seconds. If you need to link to a large file etc, provide a linkand a warning so that users can make the choice whether to viewthat resource.

8 Links should look like links; since most people have come toexpect hyperlinks to be blue and underlined, why make it hard?

9 Navigation should be intuitive and based around the user’s needs,not the organisational structure of your institution.

10 Consider the browser. These unfortunately will treat your designin an idiosyncratic way and may make a dog’s breakfast of yourcareful design.

Lastly, add a link to acb.org.uk and aacb.asn.au and then publish, orpetrify in the printed world.

• Craig Webster is currently a Grade B clinical biochemist atNottingham City and the IFCC WWW Co-ordinator. AndrewWooton is the IFCC communications and publications division Vice-chairman and the web Coordinator Assistant. ■


Federation of Clinical Scientists Federation of Clinical Scientists

Clinical Scientists’

Pay Award, 2001-2002By Alan Penny, Staffside Secretary

Last year all staff groups outside the Pay Review Body hadaccepted a three year pay deal and our management side refusedto discuss any supplementary issues from our pay claim 2000.

Members should all have received the backdated award for 2000-2001 of 3.25%, which we accepted in November.

The offer included for the third year, 2001-2002, an award of atleast RPI (X) as of December 2000 plus 0.5%. This calculation wouldhave give us 2.7%. However, as the nurses PRB awarded a higherfigure of 3.7%, the Minister has offered the same to all non-PRBgroups.

Pay developments have been much misquoted in the press recently.So it is important that members are clear about the award to clinicalscientists which we have now accepted for 2001-2002.

All clinical scientists will receive an increase of 3.7% on all pointsand allowances from 1st April 2001. The new scales are shown below.

The payscale adjustments offered to MLSOs (largest for trainees)do not apply to clinical scientists, nor do the intensity payments formedical consultants. Locally some trusts may agree to make addi-tional payments or to pay enhancements to address problems ofrecruitment and retention. This would be a local pay agreement andnot a national agreement and we cannot claim additional paymentby right. However, don’t let that stop you asking - you might belucky! ■

Clinical Scientists’ London Allowances

with effect from 1st April 2001

Zone £pa

Inner London 2,502Outer London 1,488Extra-Territorially Managed 836Fringe 235Resident Staff 523 (Inner and Outer London)

232 (Extra-Territorially Managed)60 (Fringe)

Details of each zone and the provisions governing payment of these allowances are set out in Section 56 of the General Whitley Council Handbook.


Federation of Clinical Scientists Federation of Clinical Scientists

Clinical Scientists’ Salaries with effect from 1st April 2001

Spine

Point £ pa £pa £pa

00 G 14,657

01 r 15,244

02 a 15,853

03 d 16,485

04 e 17,144

05 17,831

06 A 18,547

07 19,284

08 G 20,059

09 r 20,859

10 a 21,693

11 d 22.562

12 e 23,463

13 24,403

14 B 25,379 Individual posts in Grade B

15 26,392 will be assigned a personal

16 27,450 payscale of three consecutive

27,450 points within the range 08 to 24

17 28,548 on the spine.

18 29,687

19 30,877

20 32,113

21 33,397

22 34,732

23 36,121 G 36,121

24 37,567 r 37,567

25 a 39,069

26 d 40,632

27 e 42,259

28 43,949

29 C 45,704

30 47,534

31 49,435

32 * 51,414

33 * 53,471

34 * 55,609

35 * 57,836

36 * 60,147

Spine points marked * are for use only when salary scales have been advanced in accordance with paragraph 9.3 in Appendix B of Advance Letter (SP) 1/90.Pay rates should be applied pro rata to sessional staff under Appendix D to Advance Letter (SP) 2/84.



Recruitment intoClinical BiochemistryBy Gwen Wark and David Kennedy, Trainee’s Committee, Howard Worth, Workforce Advisory Committee

The Department of Health has recognised thatthere are major problems of recruitment andretention which should be addressed through

all branches of the service if it is to aspire to achiev-ing the Government’s plans for the new HealthService for the new millennium. It has also recog-nised that these problems are no more acute thanthey are in the professions related to science andtechnology. To this end the Recruitment andRetention Unit was set up about two years ago as apart of the NHS Executive’s Directorate of HumanResource. Within this, a working group was estab-lished to look specifically at science and technology.From the work of this group, and from our ownexperience we know that retention is the greaterproblem with clinical scientists. This is born out bythose of us who are involved in interviewing poten-tial Grade A trainees, as the calibre of those applyingfor these posts is high, indeed it is probably as highas it has ever been, and that there is a relatively largenumber of candidates to choose from. However,there is some evidence, anecdotal at the present time,that recruitment may become a serious problem inthe future.

There are a number of indicators for this: • Although the calibre of the intake of trainees

remains high, there is a feeling that the jobs arebecoming less competitive in that the number ofgood interviewees is decreasing.

• The number of grade A trainee posts availablefalls short of the number needed to maintain thestatus quo.

The Workforce Advisory Committee (WAC) hasalready produced data which show that, when therequirements are projected forward, the need fortrainee numbers increases, as there is a ‘bulge’ ofclinical biochemists who will retire over the next 15years or so. More recent data, as yet incomplete,suggest the problem may be even more acute thanwas first thought.

Views of Current TraineesFor all of these reasons our profession needs to besure that it is going about its recruitment in the mosteffective way. Aggressive recruitment is important inorder to get the right people in the right jobs at the righttime, but it is time consuming, and it is thereforeimportant that any available time is spent in profitableways and not in those areas that bear little fruit. For thesereasons we asked trainees to complete a simple question-naire on how they became clinical biochemists.

They were asked:

How did you learn about clinical biochemistry as a career?

• Through your university careers service.• Through your degree course.• Through placements or employment in a

hospital laboratory.• By other means.

How did you find out about the Clearing Houseapplications system?

• Through your university careers service.• Through advertisements.• By other means.

How do you think the ACB should publiciseclinical biochemistry as a career choice?

Did you receive any publications from the ACB orthe NHS before applying?

Twenty-five trainees responded and the analysis oftheir answers is given below:

13 (52%) learnt about a career in clinical biochem-istry through their university careers service, 3(12%) through their degree course, and 3 (12%)through placements or employment in a hospitallaboratory. Of the remainder, each one heardthrough different routes:



• From a friend who was applying for a post inmedical physics.

• From another clinical biochemist.• From an MLSO.• Through a university open day.• Quite by chance through the Clearing House

advertisement in the New Scientist.• Through a schools careers evening followed by

work experience and a university careers dayorganised by the Biochemical Society.

2 (8%) were not aware of the Clearing House, buthad responded to Regional advertisements put out byan Education Consortium. 11 (44%) found outthrough the university careers service and 7 (28%)through advertisements, 3 (12%) in ACB News and 4(16%) through the Clearing House’s advertisementin the New Scientist. Of the remainder, each one discovered by the following routes:

• Through a friend.• Through another clinical biochemist.• Through his/her university head of department.• Through one of his/her university lecturers.• Through an NHS leaflet on clinical biochemists

(presumably from the university careers depart-ment although this was not stated).

Publicising the ProfessionWhen it came to thinking about how the ACB shouldpublicise clinical biochemistry as a career choice,there was a wide range of ideas and many traineescame up with more than one. However, 5 couldn’tthink of any, or at least didn’t fill up that question onthe questionnaire, and one thought the ACB had gotit just about right.

Of the others, 12 suggested targeting the universi-ties (through the milk round), 6 suggested careersfairs and 4 the New Scientist. Of these, 1 suggested anarticle in the New Scientist, with the others it wasunclear whether they were just proposing advertise-ments for posts. 2 proposed laboratory open days,and 2 others, speakers to go round the universitiesgiving presentations on careers in clinical biochem-istry. One suggested it would be nice to see literature(and presentations?) that tell you about how impor-tant our work is. ‘Everything I’ve seen so far seems tobe just about what the job actually involves. Butpeople always go ‘Wow’ when I explain to themwhere we are in the grand scheme of things’! Two

suggested advertisements (for the jobs presumably)in newspapers, one in the national press and one inthe local press. Finally 1 suggested a repeat of therecruitment drive carried out at Pathology 2000.

When asked whether they had received any publi-cations from the ACB or the NHS before applying fora post, 5 (20%) did not answer the question, 7(28%) said yes and 13 (52%) said no.

SummarySo, how do we summarise these results. There areclear messages coming out, some of which may be asurprise. The greatest source of information hasclearly been through the universities and particularlythe universities career service. This has tended tocome in for adverse criticism over the years, butnone the less, they appear to be receiving informa-tion, and passing it on, about jobs in the NHS andwithin clinical biochemistry. This would seem to bea good area to explore further. For instance, are alluniversity careers services promoting clinical bio-chemistry (or just a few) very effectively? With regardto the advertising of the Clearing House, this clearlyhas not worked well through advertisements in eitherACB News or the New Scientist. The lack of response toACB News is perhaps not surprising as its circulation isprincipally to its members who are already in the pro-fession. It is perhaps slightly disconcerting thataspiring young scientists don’t read the New Scientist (orat least not the advertisements). It is also clear thatthere is a diversity of ways in which individuals cometo learn about, and take an interest in, clinical bio-chemistry. Of these, many come through personalcontacts, and this is clearly a route that we could allpursue at available opportunities.

It is perhaps depressing that few had received pub-lication about a career in clinical biochemistry beforethey embarked on the process. The NHS careerswebsite is becoming increasingly well developed andthe roles of clinical scientists feature within that.There is a need to widen the awareness of thiswebsite, and perhaps this should be done throughthe university careers service.

For the ACB, it would be worth spending sometime considering the diversity of suggestions withregard to wider publicity, and to check universitycareers services to see whether some are more wellinformed than others concerning jobs for clinicalscientists. It is likely that that is the case. This lookslike a job for the WAC. ■


Meeting Reports Meeting Reports Meeting Reports Meeting Reports

Endocrinology andDiabetes in LeedsReported by Geoffrey Armstrong, Rachel Carling and Miranda Jones

The first meeting of the newly formed ACB North Eastern Region(a merger of Yorkshire, Trent and Northern) was held at LeedsGeneral Infirmary on Thursday 18th January 2001. Over 90

delegates attended the meeting, which was organised by Dr. Julian Barthand kindly sponsored by Roche Diagnostics Ltd and Nichols InstituteDiagnostics. The morning session was devoted to endocrinology andwas chaired by Dr Hazel Wilkinson from York. The first lecture, whichwas given by Dr Ismail from Pinderfields, described interferences inimmunoassay. The main focus of this talk was the potential forinterference caused by heterophilic and anti-animal antibodies whichcan produce false positives or false negatives. The causes, theirprevalence and the future impact this could have on patients werediscussed. Dr Falconer-Smith then described his experiences insuccessfully establishing thyroid and lithium registers in Leicester, aproject done in collaboration with the endocrinologists and thepsychiatrists. He talked in depth about the benefits that such registerscan bring to patients, clinicians and laboratory staff. Once registered,patients are bled at GPs or hospitals and their drug dosage (T4 or Li)managed by a protocol, with fewer patients needing to visit hospitals orclinics. Patients were compliant and happy with the service. Dr Belchetz,a consultant endocrinologist from LGI, gave the last lecture of themorning: an assessment of pituitary function. A variety of dynamicfunction tests were compared (CRH, glucagon, overnight metyrapone,synacthen, desmopressin tests) and the talk was well illustrated withsome interesting clinical pictures.

Glycated HaemoglobinDr Julian Barth chaired the afternoon session, which began with DrJohn from the Royal London Hospital, who introduced the afternoon’stopic of diabetes with a detailed review of the current status ofstandardised glycated haemoglobin. Dr John reviewed the progress ofthe IFCC in developing a standard for glycated haemoglobin and theway in which it will be approved and introduced. The material does notoffer identical calibration to the Diabetes Control and ComplicationsTrial (DCCT) and, if accepted, there will be a need for a considerableeducation programme for both laboratories and physicians. The nextspeaker was Mr Mason, a consultant in Foeto-Maternity Medicine fromLGI. Mr Mason discussed the effect of gestational diabetes on the foetusand reviewed data on fasting glucose tolerance status and glucosetolerance tests, and their impact on the outcome of pregnancy. Themeeting ended with Dr Campbell who gave a fascinating lecture onpaediatric aspects of diabetes. This lecture was given from a clinician’s


Meeting Reports Meeting Reports Meeting Reports Meeting Reports

perspective and highlighted the fact that, with respect to paediatricdiabetics in particular, the goals of the laboratory and the clinician maybe different. She illustrated her talk with the case of a young childwhose mother was scared of tight control, as she was afraid he wouldinadvertently become hypoglycaemic and fall off the climbing frameand hurt himself. Dr. Campbell also mentioned several other casesregarding rebellious teenagers, including young girls who refused totake insulin as they were worried about the potential for gainingweight. She discussed the importance of quality of life for the childrenand their families and explained how in her opinion this was often ofmore importance than maintaining the HbA1c at less than 8%.

The meeting also enabled the region to bid farewell to David Kennedy,the consultant chemical pathologist at Grimsby and Scunthorpe, who isretiring shortly. Several of the presentations from this meeting will beavailable on the ACB website shortly. The meeting was very informativeand we would like to take this opportunity to thank all the speakers fortheir informative and thought-provoking talks. ■

ACB News Fact File . . . ACB News Fact File . . . ACB News Fact File . . .

Diabetes Control and Complications Trial

• The DCCT was a clinical study conducted in the USA and Canada between 1983

and 1993. It involved 1,441 patients with insulin-dependent diabetes mellitus(IDDM). Trial participants had diabetes for at least a year but no longer than fifteen years.

• The DCCT study compared the effects of standard therapy and intensive

control on diabetic complications and patients were randomly assigned totreatment groups. Intensive therapy reduced the risk of developing retinopathyby 76%, kidney disease by 50%, cardiovascular disease by 35% and complications of the nervous system by 60%.

• The most significant side effect of intensive treatment was increased risk of

severe hypoglycaemia. The DCCT does not recommend intensive therapy forchildren under 13 years, people with heart disease, those with advanced complications, older adults, and people with a history of frequent severe hypoglycaemia. Patients in the intensively managed group also gained weight,suggesting that intensive treatment may not be appropriate in obesity.

• The DCCT trial estimated that intensive management doubles diabetes care

costs but that this should be weighed against the cost-benefit of reduced medical costs relating to long-term complications and improved quality of life.

The Association of ClinicalBiochemists National Meeting

ExCeL, London Docklands

ƒocus2001LONDON • APRIL 30 – MAY 4

www.focus-acb.org

Focus 2001PO Box 409

Cambridge CB1 4QDTel: 01223 404830Fax: 01223 404841

email: [email protected]


Obituary Obituary Obituary Obituary Obituary Obituary Obituary

Gentle Man ofTauntonDr Peter Dawkins, Top Grade Biochemist,

Musgrove Park Hospital, Taunton

Peter began his career in The Royal Army Medical Corps where hetrained as a radiographer. He subsequently studied biochemistryin London, gaining BSc and PhD before obtaining a post as

postdoctoral biochemist, lecturer in biochemistry and senior lecturer inbiochemical pharmacology at the Department of Chemical Pathology,King’s College Hospital Medical School, London. He was a senior gradebiochemist at the Royal Lancaster Infirmary from 1971-1974 beforebeing appointed principal grade at Musgrove Park Hospital, Tauntonwhere he became top grade in 1979. In addition to running this verybusy department he contributed very fully to the profession, serving asChairman, Secretary, Treasurer and Meetings Secretary of the RegionalACB Committee and he represented the Region at Council. He was amember of the Broadsheet Committee of the ACP and Editor forChemical Pathology. In addition, he published thirty-two scientificpapers. He also contributed to the wider aspects of the Hospital Trustand latterly was closely involved with the Children’s Research Unit andadvised on aspects of Health and Safety.

Peter was a gentle, generous and greatly respected colleague who contributed to the profession and discipline at all levels. We will missthose moments when he would appear at your elbow during the intervals at scientific meetings “just for a chat”, and we extend oursympathy to his family in their sad loss.

P.A.

Annual General MeetingsMonday 30th April 2001

Platinum Rooms 3 and 4, Conference Suite, ExCeL Centre, London

The forty-eighth Annual General Meetings of the Association of Clinical Biochemistswill take place on Monday 30th April 2001 in Platinum Rooms 3 and 4

of the ExCeL Centre, London.

The Federation of Clinical Scientists’ Annual General Meeting commences at 17.30 and the Association of Clinical Biochemists’

Annual General Meeting commences at 18.15.


Letters Letters Letters Letters Letters Letters Letters Letters

LettersReaders speak out

?You Should Get Out More

Mate!

I was rather taken aback to read in the January ACBNews (Issue 453, page 13) the comment by DrRobert Cramb that ward staff “have forgotten theimportance of discarding the first drop of blood”when using a glucose meter. This has not beenaccepted practice on the wards for some years.

When blood glucose meters were first introducedonto wards, puncture sites were first thoroughlyswabbed with ethanol. The alcohol caused interfer-ence with the analysis, and so the first drop waswiped away to ensure a representative sample wasobtained. Patients self-testing at home often didn’tbother with this, as they regarded the wiping awayas a waste. As the test strips in those days required alarge drop of blood, it often meant the patient ornurse would squeeze the puncture site to milkenough blood, with ensuing release of cell fluid anddamage to the surrounding tissue. Not obtainingenough blood meant a second puncture, with all theincreased risk of damage to fingers already sufferingfrom neuropathy.

It is now recognised that alcohol does little to

prevent infection, and causes a more painfulpuncture. The manufacturers of glucose meters cur-rently on sale in this country actively discourage theuse of alcohol. The recommended procedure is towipe the puncture site with warm water, dry with agauze swab, and puncture. The use of biosensor elec-trodes has seen a decrease in the size of samplerequired, and most meters now use less than 5 µL,enabling easy and relatively painless sampling.

The answer to improving understanding and moti-vation lies in education. As Near-Patient TestingManager for four hospitals, I have an active involve-ment in nurse training and give weekly lectures onglucose testing and diabetes. There is no substitutefor getting on the wards and observing what actuallygoes on, and talking to the staff. Perhaps Dr Crambshould get out more?

Mrs Janice E. Still, FIBMSNPT ManagerDepartment of Chemical Pathology Watford General HospitalVicarage RoadWatfordHerts WD18 0HB

ACB National Training Course

University of Surrey, Guildford

from April 1st - 6th 2001

There is still time to book for this excellent course.

Topics will include:

• GI Tract

Liver, pancreas, gut function, malabsorption

• Nutrition

Vitamins, trace elements, lipids, antioxidants

• Immunology

Autoimmune disease, Ig-subclasses, allergy

• Histology/Cytology

Molecular biology, cervical screening, PMs

Topics will include:

• Techniques

Immunofluorescence, FACS, electrophoresis, AA,ICP-MS

• Management

Finance, budget management, business cases

• Case Reports

Oral presentation skills

The social programme will include an ice-breaking quiz, village pub skittles and local ale, nightlife in Guildford and a banquet to die for!

For further details please contact Stephen Halloran or Bryan StarkeyClinical Laboratory, Royal Surrey County Hospital, Surrey GU2 7XX. Tel: 01483-464121 Fax: 01483-464072

Email: [email protected] ACB website: http://www.ac.org.uk


Forthcoming Meetings Forthcoming Meetings Forthcoming Meetings

Update in Gastroenterology

Postgraduate CentreDerby City General HospitalTuesday 27th March 2001ACB North-Eastern Regional Meeting

09:45 - 10:15 Registration and Coffee

Morning Chair: Dr J Harrop, Derby10:15 - 10:55 Dyspepsia

Dr B Norton, Derby10:55 - 11:15 13C-Urea Breath Test

Dr P Hill, Derby11:15 - 12:00 Stable Isotopes in Gastroenterology

Dr T Preston, Glasgow12:00 - 12:30 Pancreatic Elastase

Mr I Phillips, Southampton12:30 - 14:00 Lunch13:00 - 14:00 ACB NE Region AGM

Afternoon Chair: Dr P Hill, Derby14:00 - 14:40 GI EQA – Laxatives and Fluorescein

Dr A Duncan, Glasgow14:40 - 15:30 Coeliac Disease and Diabetes

Dr G K T Holmes, Derby15:30 - 16:30 Serological Screeing for CD

Dr J West, Nottingham

CPD Accredited by the Royal College of Pathologists (5 points). IBMS CPD accreditation applied for.

This meeting is kindly sponsored by: The BindingSite, Launch Diagnostics and ScheBo Biotech UK Ltd.

The meeting is free for ACB members.

Non-members pay £10 (includes lunch). Please makecheques payable to Yorkshire-Trent ACB.To register, contact: Steve Goodall, ClinicalBiochemistry & Immunology, Leeds General Infirmary,Leeds, LS1 3EX. Tel: 0113-392-3691. Fax: 0113-233-5672. Email: [email protected]

ACB Training Course No. 3

BirminghamSeptember 2001

The third of the National Training Courses will takeplace from Sunday 16th to Friday 21st September 2001.The following topics will be included:-

• Renal function• Fluid & electrolytes• Hydrogen ion metabolism• Respiratory function• Concepts of screening

• DNA analysis• Prenatal & neonatal screening• Mass spectroscopy• Quality assessment• Reference values

Full details will appear here soon Preliminary information is available from Eddie Legg, Departmentof Clinical Biochemistry, Heartlands Hospital,Birmingham B9 5SS. Tel: 0121-424-0707. E-mail: [email protected]


Situations Vacant Situations Vacant Situations Vacant Situations

National Health Service in Scotland

TRAINEE CLINICALBIOCHEMISTS ‘A’ (3)

£14,134 with annual increments (award pending)Honours graduates in chemistry or biochemistry, or thosegraduating this year, are invited to apply for appointmentas Trainee Clinical Biochemist in the National HealthService in Scotland.You should have, or expect to gain, a first or upper second class honours degree. Anappropriate higher degree is an advantage but not essential.The three year training programme will includeattendance at the Master of Science in ClinicalBiochemistry and Molecular Biology course at theUniversity of Surrey on a block release basis with travel,accommodation and fees supported in full by thescheme, participation in training courses conducted bythe Association of Clinical Biochemists, and attendanceat regional and national conferences. Practical trainingin laboratory, clinical and other aspects of laboratorymedicine will take place in Ninewells Hospital andMedical School, Dundee, or Aberdeen Royal Hospitals,or the Western General Hospital, Edinburgh. Thetraining will be subject to formal annual appraisal.Details of the training scheme can be discussed withthe co-ordinator of the Scottish Programme, Dr CGFraser, Biochemical Medicine, Ninewells Hospital, tel:01382 660111 ext 32512.Application packs available from Personnel Dept,Perth Royal Infirmary, Taymount Terrace, Perth, PH1 1NX tel: 01738 473285, quoting ref: SW/12/01.Closing date for applications: 23 March 2001.

LANARKSHIRE ACUTE HOSPITALS NHS TRUST

MONKLANDS HOSPITAL LABORATORY

Relief Senior Biochemist Grade B

(6 months in the first instance to cover maternity leave commencing mid April/early May)

£19,343-£26,471

The Trust has a vacancy in the Biochemistry Department atMonklands Hospital for a relief Biochemist to provide mater-nity leave cover in the department. The postholder should beable to take a full share of the reporting and liaising duties ofa busy routine department. The post may suit a Grade Atrainee wishing to gain relevant experience, someone wishingto refresh skills after a career break or someone recentlyretired, etc. Single accommodation could be made available inthe nearby residences, if required.

Reference: PS450Informal enquiries to Mr Elliott Simpson, Consultant

Clinical Scientist in Biochemistry. Tel: 01236-712110.Information packs available from Personnel Services,

Corporate Services, Monklands Hospital, Monkscourt Avenue,Airdrie, ML6 0JS. Tel: 01236-713263.

Closing date: 3rd April 2001


Vacant Situations Vacant Situations Vacant Situations Vacant

DEPARTMENT OF CLINICAL CHEMISTRY

CITY HOSPITAL NHS TRUST, DUDLEY ROAD, BIRMINGHAM

Clinical Biochemist Grade B

Starting point in the range 11-16 depending on qualifications and experience

Applications are invited for the post of Senior Biochemist in the Department of Clinical Chemistry. CityHospital has Associated Teaching Hospital status with over 700 beds providing a wide range of high qualityacute services. The hospital is one of the leading research centres in the country and good opportunities existfor collaborative work. An Ambulatory Care Centre will open in 2004 for one-diagnosis, testing and treatment.

The Department provides a comprehensive service with specialist interests in vitamins, specific proteins andendocrinology and diabetes. The successful candidate will be expected to be self-motivated and have goodinterpersonal and team-working skills. He/she will participate in all aspects of service provision, includingclinical liaison, audit, teaching, and research and development. An interest or experience in the clinical biochemistry of vitamins would be an advantage but not essential. Possession of the DipRCPath is desirable, andprogression to MRCPath will be encouraged and supported.For further information or to arrange an informal visit, please contact the Head of Department, Mr Alex Bignell,on 0121-507-4278. A job description and application form are available from the Human ResourcesDepartment, City Hospital NHS Trust, Dudley Road, Birmingham B18 7QH, telephone 0121-507-4481.

Closing Date: Friday 20th April 2001

ST HELENS & KNOWSLEY HOSPITALS NHS TRUST

DEPARTMENT OF CLINICAL BIOCHEMISTRY, WHISTON HOSPITAL

Principal Clinical Biochemist Grade B

Starting point in the range 17-24 depending on experience and qualificationSalary: £26,921 - £35,428

Applications are invited for the above post from a suitably qualified, experienced and motivated clinicalscientist. The post-holder is expected to work as part of a team providing comprehensive clinical biochemistry service to St. Helens & Knowsley area, Merseyside. You will be expected to have extensiveexperience in clinical biochemistry and in possession of a higher professional qualification (MCB or MRCPath). You will be involved in all aspects of laboratory work and expected to have a leading role in the analytical and clinical sides of the service. Special interests and experience in any area of clinicalbiochemistry are welcome while MCB or MRCPath would be an advantage.

For further information or to arrange an informal visit, please contact Dr Mohammad Al-Jubouri,Consultant Chemical Pathologist on 0151-430-1833.

Application forms, job descriptions and information packs are available from Personnel Department on0151-430-1771.

Ref: 4481.Closing date 20th April 2001


Situations Vacant Situations Vacant Situations Vacant Situations

To advertise your vacancy contact:

Dr Graham Groom, ACB Administrative Office, 130-132 Tooley Street, London

SE1 2TU Tel: 0207-403-8001 Fax: 0207-403-8006

Deadline: 26th of the month prior to the month of publication

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

DEPARTMENT OF CHEMICAL PATHOLOGY

Clinical Scientist - Grade B,scale points 17-22SALARY: £ 28,548 - £ 34,732 PER ANNUM (NEW PAY SCALES)Applications are invited for this new post of Clinical Scientist -

Grade B, based within the Directorate of Pathology at the

Princess of Wales Hospital, Bridgend. The department is well-

equipped and provides a comprehensive Chemical Pathology

Service. You will assist the Consultant Chemical Pathologist in

the provision of a clinical laboratory service and undertake

duties in all aspects of the service. The department is looking

to develop the provision of its Toxicology Service and an interest

in this area would an advantage. You should be in possession of

a recognised professional qualification (DipRCPath or MRCPath).

For further information, please contact Dr E J Williams,

Consultant Chemical Pathologist on 01656 752337.

For an application form and job description, please contactthe Department of Human Resources and Development, Bro Morgannwg NHS Trust, Neath General Hospital, Neath,West Glamorgan SA11 2LQ. Tel: 01639 769004. Please quote reference number: P263.

Closing Date: 17 April 2001.

We are an equal opportunities employer.

GREATER MANCHESTER EAST EDUCATION

AND TRAINING CONSORTIUM

WITH PARTICIPATING NHS TRUSTS

(NORTH WEST REGION)

Clinical Biochemist Higher Specialist Trainee Grade B (8-10)

£18,734-£20,261

Applications are invited for the above post in the North WestRegion. The post is part of an initiative designed for HigherSpecialist Training and carries a 5 year fixed-term contract.You will be employed at one of the participating Trusts. Youwill be expected to complete MRCPath in post as well as pro-viding the service contribution required by the Trusts. Thiswould include: clinical liaison, audit, teaching and Researchand Development. Attendance at meetings and other trainingevents will be encouraged. This is a unique opportunity toextend Grade A training to complete Higher SpecialistTraining in challenging and stimulating environments.

For further information contact: Ms C.R. Squires on 0151-706-4467, or Mr C.J. Seneviratne on 0161-276-4584.

For an application form and further details please contact:The Recruitment Office on 0161-276-6666, quoting ref.PT17/2001.

Closing date: 7th April 2001

UNIVERSITY OF LONDON

MSc CLINICAL BIOCHEMISTRYApplications are invited for this two year, part-time intercollegiate course beginning in September 2001.

Candidates should have a first or second class honours degree in chemistry, biochemistry or a relatedsubject, or hold a medical qualification registrable in the United Kingdom. Candidates without thesequalifications may be considered providing they have relevant work experience. Students will usually beexpected to have at least one year’s experience in clinical chemistry, but well qualified candidates working ina clinical chemistry laboratory for less than one year will be considered.

Candidates must hold posts in suitable laboratories for the duration of the course and must be in aposition to attend lectures and seminars at a London medical school on Wednesday afternoons (2pm-7pm)during the university terms. Students will be registered as internal students of the University of London.The degree is awarded on the basis of examinations held at the end of the course, a project and assessmentof the practical work set throughout the course.

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

For further details and application forms write to: Dr Gill Rumsby, Department of Chemical Pathology, UCL Hospitals, Windeyer Building, Cleveland St., London W1T 4JF. Tel: 020 7679 9229; Fax: 020 7679 9496; email: [email protected]

Closing date for receipt of applications will be 1st June 2001

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the association of clinical biochemists •issue 455 …...acbnews the association of clinical...

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