ACB News Crossword

In this issue

ACBWebsiteEditorWanted

Get Readyfor NationalPathologyWeek 2009

NewProfessorin Norwich

The HTAProgramme

The Association for Clinical Biochemistry | Issue 556 | August 2009

ACBNewsACBNewsAugust556v3 29/7/09 20:45 Page 1

ACBNewsAugust556v3 29/7/09 20:45 Page 2

About ACB NewsThe editor is responsible for the finalcontent. Views expressed are notnecessarily those of the ACB.

EditorDr Jonathan BergDepartment of Clinical BiochemistryCity HospitalDudley RoadBirmingham B18 7QHTel: 07973-379050/0121-507-5353Fax: 0121-765-4224Email: [email protected]

Associate EditorsMrs Sophie BarnesDepartment of Chemical PathologySt Mary’s HospitalImperial College Healthcare NHS TrustPraed StreetLondon W2 1NYEmail: [email protected]

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

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

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

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

ACB Administrative OfficeAssociation for Clinical Biochemistry130-132 Tooley StreetLondon SE1 2TUTel: 0207-403-8001 Fax: 0207-403-8006Email: [email protected]

ACB PresidentDr Julian BarthDepartment of Clinical BiochemistryLeeds General InfirmaryGreat George StreetLeeds LS1 3EXTel: 0113-392-3416Email: [email protected]

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

Printed by Piggott Black Bear (Cambridge) LtdISSN 1461 0337© Association for Clinical Biochemistry 2009

ACBNews

General News page 4

Practice FRCPath Style Calculations page 8

Meeting Reports page 10

Science Matters page 15

ACB News Crossword page 21

Situations Vacant page 22

Number 556 • August 2009

The monthly magazine for clinical science

Issue 556 | August 2009 | ACB News

Front cover: The “Class of ’89” twenty years on.See General News for more . . .


Focus 2010 Glasgow

Next year the Focus meeting returns toGlasgow and Richard Spooner is leading histhird, and final, Focus meeting team. ForRichard’s swansong we are expecting greatthings. With succession planning in mind, IanGodber steps up from his superb promotionalrole for EuroMedLab to shadow Richard, andSarah Jarvis is looking after finance in thesedifficult times.For the scientific programme, Bill Bartlett’s

return to Dundee is celebrated with an EastCoast Scientific programme team and thesessions will tell the story of “Policy intoPractice” under the strapline of Focus onTranslation. As always, Vicki Grant and theMeeting Makers team will be looking afterdelegates.Look out for further details at:

www.focus-ACB.org.uk

4 | General News

ACB News | Issue 556 | August 2009

Molecular PathologyEssentials: Diagnosisand Targeted Therapy1st & 2nd October 2009Copenhagen, DenmarkThis course is being jointly presented by theAACC, ACB, AMP and DSKB.For course and registration details go to:www.aacc.org/events/meetings/Pages/5263.aspx

Wanted -ACB Website EditorThe Association website is having a makeoverand the new website will be unveiled to theworld in Summer 2009. The website will be animportant face and the voice of theAssociation, so we need to get it right in termsof design and content, and keep it up to date.We require a keen, enthusiastic person withlots of ideas to become our new WebsiteEditor. If you are that person, then contact theDirector of Publications by emailon: [email protected] Nic Law at [email protected] for furtherdetails. �

SudokuThis month’s puzzle

Lastmonth’ssolution


General News | 5


Get Ready forNational PathologyWeek 20092nd - 8th NovemberIn November 2008, the Royal College ofPathologists organised its first everNational Pathology Week (NPW). Theaim was to raise awareness of the roleof pathology in modern medicineamongst members of public as well asother healthcare professionals. Theweek was a big success with over 300events being organised throughout thecountry. The College’s evaluation ofNPW 2008 showed that ClinicalBiochemists were at the forefront ofmaking 2008 a success, organising moreevents during the week than any otherpathology speciality.So if you haven’t already done so,

it’s time to get the creative neuronsfiring and start organising your eventfor 2009.This year’s theme is Pathology: The

Heart of Modern Healthcare, focusingon the central role of all the pathologydisciplines in the prevention, diagnosis,treatment and monitoring of all typesof heart disease. However, your eventdoesn’t necessarily have to reflect theheart theme. For more information onNPW this year including tips, templatesand downloadable resources to helporganise your event visit the website -www.nationapathologyweek.orgThe Royal College of Pathologists

would also like to thank Siemens for itscontinuing support in sponsoringNational Pathology Week in 2009. �

ACB Southern RegionAutumn Scientific Meeting

Kidney DiseaseMonday 12th October 2009Lister Hospital, Stevenage

09.45-11.15 Members’ Papers11.15-11.55 Early Detection of Kidney Disease

with MSMSProf R N Dalton,Evelina Children’s Hospital

11.55-12.30 EGFR – Friend or Foe?Dr M Sivalingam,Lister Hospital Renal Unit

12.30-12.30 Lunch13.30-14.15 Challenges Facing the Renal Unit.

The Death of the Iron LungDr P Warwicker,Lister Hospital Renal Unit

14.15-14.55 On Measuring SodiumProf K Farrington,Lister Hospital Renal Unit

14.55-15.15 Refreshments15.15-15.50 Proteinuria – Putting it into

PracticeMr A Everitt, Basildon Hospital

15.50-16.30 Clinical Immunology in KidneyDiseaseDr J Sheldon, St George’s Hospital

16.30-16.40 Discussion16.40-16.45 Members’ Papers

Presentations and Close

The meeting includes refreshments and lunchand is accredited for 6 CPD points.

Cost of meeting: £15 for pre-registrationClinical Scientists, £25 for ACB Members,£40 non-Members and free to retired Members.

For further information contact:Mrs Angela Woods, Biochemistry Department,QEII Hospital, Howlands, Welwyn Garden City,Hertfordshire AL7 4HQ.Tel: 01707 365 254.E-mail: [email protected]

Maps and travel details may be found at:www.enherts-tr.nhs.uk/PatientsVisitors/PatientsListerGettingThere.html

Lister Hospital is readily reached by publictransport. It is 1.5 miles north of StevenageRailway station, from which buses depart aboutevery 7 minutes (stop N). The bus journey time toLister Hospital is about 6 minutes. On-site carparking is available but not abundant, due toconstruction work. �


6 | General News


Chronic Diseases: Diabetes, Thyroid andCardiac Diseases3rd & 4th September 2009Royal College of Pathologists, LondonThe ACB and AACC are co-sponsoring a programme on the latest advances in chronic diseasediagnosis and management. Emerging cardiac risk markers – expectations and reality

� How best to screen for cardiac disease.� The latest information on cardiac risk in renal disease.� Implementation of thyroid guidelines.� Thyroid update: subclinical disease, amiodarone effects, treatment with T3.

The programme includes a debate on the use of HbA1C to diagnose diabetes.The programme and registration form can be found at www.acb.org.uk/site/meetings.aspOnline booking of registration for ACB members can be found atwww.acbstore.org.uk/site/index.aspxThen login and click on Meeting /Training - please do not forget to email your registration formto the ACB Office, [email protected] �

Professor Garry John of Norwich

Congratulations to Garry John, Consultant Biochemist at Norfolk and Norwich Hospital, whohas recently been given an Honorary Professorship in the School of Medicine at the Universityof East Anglia. Garry is seen here with his trainees Allison Chipchase and Emily Leach, andPrincipal Biochemist, Liz Groves.

ACBNewsAugust556v3.qxd 31/7/09 12:27 Page 6

General News | 7


Focus 2009 saw the twenty year reunion of the‘Class of ’89’ which celebrated a group whostarted on the cycle of ACB training coursesbeginning in April 1989 in Reading, organisedby Dr Gordon Challand, or November 1989 inHarrogate, organised by Dr Ian Barnes.Of the 81 Trainees who attended one of

those training courses, 45 (56%) remain in theprofession today. Over 20 of the originalsmade it to the Cavern Club to celebrate and toreminisce about old times. Luckily, it was darkenough to hide all the wrinkles, althoughcomment was passed that the girls seemed tohave faired better than the boys in the ageingprocess, probably due to over-indulgence inexpensive treatments! �

Left to Right: Shirley Spoors, Neil Anderson,Rachel Wilmot, Martin Myers, Mike Petchey,Philip Hyde, Kath Hayden and Paul Newland

Class of ’89 . . . 20 Years On


8 | Practice FRCPath Style Calculations


Question 101The 95% confidence limits for a creatinine quality control sample are 94-106 µmol/L.What is the minimum number of results required to detect, with a power of 80%, achange (P<5%) in bias equivalent to one standard deviation?

A patient is infused with a drug at the rate of 100 g/min until a steady state plasmaconcentration of 100 g/dL is achieved. Calculate the clearance of the drug in mL/min.Comment on your answer.

The clearance of a drug is the volume of plasma from which the drug is completelyremoved per unit time and can be calculated from its rate of removal and the plasmaconcentration once a steady state has been achieved:

Clearance = Rate of removal from bodyPlasma concentration

In a steady state the plasma concentration is constant because:

Rate of administration = Rate of removal

Therefore rate of administration can be substituted for rate of removal:

Clearance = Rate of administrationPlasma concentration

Divide the plasma concentration by 100 to convert from g/dL to g/mL (since 1 dL = 100 mL).

Plasma concentration = 100 = 1 g/mL100

Therefore clearance = 100 (µg/min) = 100 mL/min1 (µg/mL)

The significance of the clearance depends on the route(s) by which the drug is removedfrom the circulation, which could be:

MetabolismBiliary excretionRenal excretion

Only if biliary excretion and metabolism are insignificant will the value reflect renalclearance and only if the drug is not reabsorbed nor secreted by the renal tubules will therenal clearance be a measure of GFR.

N.B This is question 100 so I used 100 for each piece of data to give a final answer of 100!

Deacon’s ChallengeNo 100 - Answer


Venture Publications

CALCULATIONS IN LABORATORY SCIENCE

Perplexed by ‘Deacon’s Challenges’ in ACBNews?Involved in laboratory staff training or revising for FRCPath?

Then this book is definitely for you!

This book not only presents worked calculation examples but also bringstogether the relevant mathematics with the relevant physical chemistryand/or physiology of commonly encountered laboratory calculations.

Additional questions at the end of each topic allow the reader to practicecommonly encountered calculations.

Copies cost £35.00 plus P&PACB Members £31.50 plus P&P

AVAILABLE from The Association for Clinical Biochemistry website (www.acbstore.org.uk),or contact us directly on 020 7403 8001,

or via e-mail: [email protected]

Bulk discounts available on orders of 10 - 25 copies at 25% and 33% for over 25 copies

A company limited by guarantee, Registered in England, Registration No. 863235Registered Office: Association for Clinical Biochemistry, 130-132 Tooley Street, London SE1 2TU

Website: www.ACB.org.uk


10 | Meeting Reports


A joint meeting of the RoyalSociety of Chemistry,Chromatography &Electrophoresis Group and theAssociation for ClinicalBiochemistry Southern Regionwas held on 13th March atGuy’s Hospital.

Chang Kee Lim PhD CChemFRSC, latterly of BirkbeckCollege, University of London,has been at the forefront ofthe application of separationscience in clinicalbiochemistry for some 40years. It was a pleasure towelcome a capacity audienceto Guy’s to not only paytribute to him and hisachievements, but alsooutline current applicationsand possible futuredevelopments in theapplication of separationscience to clinical problems.In opening the meeting,

Professor David Perrett(Queen Mary, University ofLondon) recounted somemilestones in Dr Lim’s career.A BSc in Chemistry andZoology (1970) was followedby a PhD from WestfieldCollege, University of London,3 years later. In 1973 ChangKee went to work withProfessor Charles H Gray inthe Medical School at King’sCollege Hospital. There hebegan his seminal work onporphyrin metabolism, whichhe continued at the Clinical

Research Centre (CRC),Northwick Park, 1976-1991.With the closure of the CRC,Chang Kee moved to the MRCToxicology Unit, firstly atCarshalton and then in itsnew home at Leicester.In 2000 Chang Kee moved

back to London, still underthe auspices of the MRC, toestablish a BioAnalyticalScience Unit at BirkbeckCollege.Although officially retired,

Chang Kee continues to editthe journal BiomedicalChromatography.In paying tribute to Chang

Kee, Professor Perrettrecounted the meeting‘High Pressure LiquidChromatography in ClinicalChemistry’ Chang Keeorganised at King’s CollegeHospital in 1975 at whichChang Kee, David and yourcorrespondent first met, andthe ensuing book ‘HPLC ofSmall Molecules’ was a classicwork in its day.

Porphyrins 40 Years On

The session Chair, DennisWright recounted thevalediction ‘look at thechemistry’ that had guidedhim in his PhD studies onporphyrin metabolism withChang Kee. Porphyrins, ofcourse, have been ChangKee’s abiding interest, and inhis masterful opening lecturehe emphasised thecontribution of HPLC, andmore recently of LC-MS/MS, tothe study of porphyrins andthe porphyrias.Two topics stood out. Firstly,

it had been claimed in a paperpublished in the Proceedingsof the National Academy ofSciences, USA, in 2007 that aporphomethene inhibitor ofuroporphyrinogendecarboxylase, namelyuroporphomethene (m/z 835),was the cause of porphyriacutanea tarda. However, notonly was the LC retention of‘uroporphomethene’incompatible with whatwould be expected of aporphomethene, but also themass spectrum showed thefragmentation characteristicsof polyethylene glycol (m/z835 with product ions at 791,747, 703 and 659, i.e.successive loss of OCH2CH2).This was wrongly interpretedas the successive loss of CO2from the porphyrin carboxylgroups. Porphyrins do not

Hi Level Separation Sciencein Routine ApplicationsBob Flanagan, King’s College Hospital, London


Meeting Reports | 11


eliminate carbon dioxide fromside-chain carboxylic acidsubstituents on ESI-MS/MS,but characteristically loseHCOOH from acetic andCH2COOH from propionic acidmoieties, respectively.On a related theme, 2-vinyl-

4,6,7-tripropionic acidporphyrin (harderoporphyrin)had been reported in theHarderian glands of rodents.However, work by Chang Keeand colleagues using aneutral solvent extractionprocedure coupled withLC-MS/MS had shown that‘harderoporphyrin’ was in factprotoporphyrin monoxyloside,protoporphyrin itself andprotoporphyrin mono-glucoside being minorcomponents of the gland.Again, understanding theunderlying chemistry of theanalytical procedure was vitalto a proper understanding ofthe natural products understudy.On a lighter and colourful

note Chang Kee concluded byoutlining work undertakenearly in his ‘retirement’ inconjunction with the Centrefor Ornithology, Birminghamand the Natural HistoryMuseum on the origin,evolution and functions ofeggshell colours andpatterning. Porphyrins again –it seems that the colourationof sparrowhawk and emueggshells, for example, is dueto the presence of biliverdinand protoporphyin indifferent proportions.

Vitamin D, Purines, andDrugs of Abuse

Sandra Rainbow (Northwick

Park Hospital) pointed outthat vitamin D research wasvery active, with some 1,000papers being published in2007 alone. LC-MS/MS wasrapidly becoming the methodof choice for clinical25-hydroxyvitamin D2 and D3analysis. No derivatisation wasrequired and there wereadvantages of selectivity overimmunoassays. However, amajor problem remained thelack of an internationallyagreed reference materialand measurement of1,25-dihydroxyvitamin Dremained challenging. Sandraalso drew attention to recentwork using chiral LC-MS/MSthat demonstrated thepresence of both 25-hydroxyvitamin D3 and of epi-25-hydroxyvitamin D3 inpatient samples.In concluding the morning

session, Richard Evers (King’sCollege Hospital) discussedproblems and pitfalls inclinical drugs of abusescreening. AlthoughLC-MS/MS offered theadvantage of loweredconsumables costs and theability to identifyunequivocally a range ofanalytes without priorderivatisation, there weremany traps for the unwary.Analysis was sequential,thereby limiting samplethroughput. The potential forion suppression necessitatedgreat care in methodvalidation, and samplehydrolysis was still needed inthe event that sensitivitytowards morphine andbuprenorphine glucuronideswas poor or these compounds

did not survive the samplepreparation procedure(immunoassays often showcross-reactivity towardsglucuronides, for example).The use of ion trap andaccurate mass technology toovercome these problems isevolving.

From Tswett toMetabonomics

After lunch, David Perrettbegan by paying tribute toanother pioneer in theapplication of analyticalmethods to clinical problems,Professor Charles EnriqueDent (1911–1976). Using thethen new technique of2-dimensional paperchromatography, David feltthat Dent, whom yourcorrespondent had theprivilege of meeting in theearly 1970s – I rememberbeing saddened to hear of hisuntimely death - had probablydiscovered/developed majorinsights into more diseases(including Fanconi syndrome,Hartnup disease,argininosuccinic aciduria,homocystinuria, cystinuria,and xanthinuria) than anyoneelse. David then discussed hisown recent research usingcapillary electrophoresis withlow-wavelength UV detectionin which some 80 compoundscan be detected in urine in 10minutes. He also took theprize for the oldest samplediscussed during the day witha slide of the CE-DAD analysisof organic compounds in anextract of an Egyptianmummy!David’s talk neatly picked

up the theme initiated by




Chang Kee Lim earlier in theday – it is not simply‘hypothesis driven’ researchthat advances knowledge, butmore often than not it is theapplication of new techniquesto old problems, or the criticalappraisal of existing data, thatleads to key developments.Andrew Taylor (Royal Surrey

County Hospital) again tookup the ‘omics’ thread with abrief overview of metallomics(chemical speciation, dynamicsand kinetics of trace elementsin biological systems). Some ofthe applications discussedwere the measurement oflead isotopes to help identifysources of exposure to theelement, the use of 65Cuadministration as anadditional diagnostic test inWilson’s disease,differentiation of toxic andnon-toxic arsenic species inurine, and recent work aimedat unravelling thecomplexities of seleniummetabolism. An interestingaspect was the use of thepresence of selenium isotopepatterns to help identifyselenium-containing species incomplex chromatograms.Potential pitfalls such as‘polyatomic’ (for example40Ar2+ on 80Se+) and‘isobaric’ (e.g. 64Ni+ on64Zn+) interferences weregiven due prominence. Aclinical problem of

gadolinium used as contrastmedium was discussed –156Gd2+ has the same m/zas 78Se+.Edwin Carr (St Helier

Hospital, Carshalton) nextdiscussed catecholaminemeasurement using HPLC withelectrochemical detection(ED). Nowadays the use of EDin clinical chemistry is virtuallyconfined to diagnosis ofphaeochromocytoma, withurine being the specimen ofchoice unless the patient hasrenal failure. There is almostuniversal acceptance thatmetanephrine analysis issuperior to other means ofdiagnosing this condition, yetthe evidence for this is stillignored by many. ED isfeasible for catecholamines asthey can be oxidised atrelatively low appliedpotentials thus minimising theaccumulation of reactionproducts on the workingelectrode, a problem that hasnow seen ED largelysuperseded by LC-MS in otherareas. Of course, the massspectrometer is also a reactiondetector if other species arepresent in the source togetherwith the analyte (ionsuppression, polyatomicinterference, etc) hence LC-MSoperation is often not as easyas manufacturers wouldsometimes have us believe!The final talk returned to

the ‘omics’ theme with PaulThomas (University ofLoughborough) discussingvolatile profiling using GC-MSand other techniques. Afterdiscussing investigations intobreath volatiles in suchconditions as chronicobstructive pulmonarydisease, Paul outlined work todevelop a hand-held ‘sniffer’device based on ion mobilityMS to seek out peopletrapped in disaster zonessuch as might be caused byan earthquake. It seems thatnot only do specially trainedsniffer dogs have a very shortworking period (20 min or so)before needing prolongedrest, but also suffer highmortality (up to 70% wasquoted), hence there is a realneed for such a device.Paul concluded bymentioning work in progressaimed at developing a pointof care testing device formethanol, ethylene glycol,and other alcohols aimed atalleviating the chronicproblem of attempting toprovide these ‘orphan tests’in the laboratory on anemergency basis withoutproper funding.All-in-all the day was a

fitting tribute to Chang KeeLim and his contribution tothe development andapplication of separationscience in clinical chemistry. �


Meeting Reports | 13


The second UK NEQAS for Steroid HormonesLC MS/MS workshop was held in Birminghamon 25th February 2009. This well-attendedmeeting was open to all UK NEQASparticipants who use LC MS/MS to analysesteroids, as well as members of theImmunoassay Specialist Advisory Group.

The meeting was very much an informal one,with plenty of opportunity for the exchangeof ideas and tips over coffee and lunch.Jonathan Middle set the scene with anoverview of current performance in the UKNEQAS steroid hormone schemes. The twomain analytes being measured currently byLC MS/MS are urine free cortisol and femaletestosterone. In general performance is quitetight between MS/MS users with the exceptionof testosterone. All methods have a significantnegative bias when compared to the alllaboratory trimmed mean (ALTM). Re-settingthe ALTM to the MS/MS value was simulatedfor male testosterone and produced adisconcerting picture for all immunoassaymanufacturers. Recovery for all MS/MSmethods was reassuringly 100% with theexception of Androstenedione. Possiblesolutions to this problem were discussed laterin the day.Brief presentations from attendees who

routinely use MS/MS followed. The problemsexperienced by different users whenestablishing this technique were shared as

were solutions. Many people also presentedtheir ‘wish list’ of assays they would like todevelop. These presentations formed the basisof discussions in the afternoon.

Vitamin D Reference Standards

A round table discussion followed lunch wherepossible solutions to the problems identifiedearlier were discussed. In the coming monthsmembers of the group are to take part in acalibration checking exercise for femaletestosterone and androstenedione. A similarexercise was undertaken last year for VitaminD and produced good results. Appropriatecalibration matrixes were discussed, as wereproblems that are encountered when makingup calibrants. It was felt that a lack ofexperience within the workforce when itcomes to laboratory techniques maycontribute to the difficulties sometimesexperienced when setting up new accuratemethods using LC MS/MS. The possibility of alaboratory skills workshop was proposed.Although Vitamin D is not within the remit ofUK NEQAS, it featured quite prominentlythroughout the day. Many laboratories analyseVitamin D using LC MS/MS with many morelooking to enter the field. The lack of areference standard for Vitamin D causes manyproblems and prompted lots of discussion.The day was incredibly useful for sharing

best practice and collaborative ways of takingthis technique forward are in progress. �

The Second UK NEQASSteroid Hormone LC MS/MSWorkshopKirsty Gordon, Heartlands Hospital, Birmingham




The Endocrine Society’sAnnual Meeting:Washington, DCSusan Knox, Glasgow Royal Infirmary

Give me strength. Not only was I part of theteam winning the 2008 Scottish HealthcareScience Award, but I also had prize money tospend on a Scientific Meeting. My preferencewas an Endocrinology-based meeting, so Isought the advice of Colin Perry, ConsultantEndocrinologist at Glasgow Royal Infirmary.He recommended the British EndocrineSociety Meeting to be held in Harrogate inMarch 2009, or, if I had big bucks to spend, theAmerican Endocrinology Society Meeting inJune 2009. The British meeting had a greatprogramme, and Harrogate is quoted ashaving the best tea rooms in the UK and I cannever say no to a scone. However, the venuefor the American Meeting was the Walter E.Convention Centre, Washington, DC, and theprogramme was jam-packed withbreakthrough science. Wild horses couldn’thave kept me from the US of A.

The 91st annual conference commenced withthe Presidential Plenary session in whichJoseph Goldstein and Michael Brown of theUniversity of Texas Southwest Medical Centreexplained their research into how animal cellscontrol cholesterol synthesis and uptakethrough a feedback mechanism mediated byLDL receptors. These scientists have beencollaborating since 1972, and in 1985 they wonthe Nobel Prize for showing that mutations inthe LDL receptor cause homozygous familialhypercholesterolaemia. This finding laid thegroundwork for the development of statins.

Walking Encouraged

ENDO 09 was encouraging participants to ‘GoGreen’ and my next stop was the exhibitionhall to pick up my free pedometer in order toparticipate in the Step Challenge. I was

encouraged to track the number of steps Itook over the course of the four days andcompete for a grand prize (well whowouldn’t?).I attended a variety of clinical symposia, one

of which was entitled ‘Whenhyperandrogenism is not due to PCOS’. AshleyGrossman from St Bartholomew’s Hospital,London discussed the possible causes andinvestigations in women presenting withvirilisation secondary to hyperandrogenism. Heemphasised the clinical utility of the low-dosedexamethasone suppression test in thesepatients. In CAH, for example, increasedtestosterone levels are responsive tosuppression of ACTH and can, therefore, benormalised, or significantly reduced (>40%) bydexamethasone. When testosterone is notsuppressible by dexamethasone, an ovariansource or an adrenal tumour may be indicated.In addition to the symposia there were

endocrine debates, poster discussions and“Meet the Professor” sessions – Glasgow’s veryown Naveed Sattar and Faisal Ahmed hostedtwo such sessions, discussing the role of novelbiomarkers in cardiovascular risk assessmentand evaluation of growth plate disorders,respectively.Nearly 8000 delegates from more than 75

countries attended ENDO ’09 in Washington.The meeting contained a rich variety ofcutting-edge science detailing currenthormone research, progressive treatments andhighlighting endocrinology’s emergingchallenges. For those of you who areinterested, I did not win the Step Challenge,and I blame the thunderstorms. �

jonathan - if you want to use the pic of washington in thisarticle you need to lose 10 lines but its such a good article idont think you should drop anything!!


Science Matters | 15


To date, 86 Clinical Biochemists and ChemicalPathologists from the UK have successfullyapplied to the European CommunitiesConfederation of Clinical Chemistry andLaboratory Medicine (EC4) to hold the titleEurClinChem – ‘European Specialist in ClinicalChemistry and Laboratory Medicine’. Our coreof 86 supports 2045 registrants in 19 EuropeanUnion states who meet an agreed set ofeducation and training standards that allowsthem to be considered as independent(consultant grade) practitioners. We needmore people to apply. The register serves as adatabase that supports ongoing lobbying ofthe European Commission for specialists inclinical chemistry to gain recognition of theprofession and to accord better practicingrights across the EU, especially clinicalscientists who do not have automaticrecognition between the member states.Greater numbers gives greater influence andwith our highly developed training andqualification programmes UK is well placed tocontribute to achieving “co-regulation”whereby responsibility for recognition ofprofessional qualifications is shared betweena professional organisation and an EUinstitution.

Benefits for the Profession

By way of history, EC4 now comes under thedirection of the European Federation ofClinical Chemistry and Laboratory Medicine(EFCC), a new organisation that emerged in2007 from the merger of EC4 (EU countriesonly) and FESCC – the Federation of EuropeanSocieties of Clinical Chemistry (covering allEuropean countries). Confused? Well, pictureIFCC as being at the top of the tree with EFCCas its European branch whose leaves includepromotion of professional growth anddevelopment, harmonisation of QA andaccreditation (former lead roles for FESCC)as well as leading on recognition of theprofession. For greater clarity, theEFCC website went live earlier this year

(www.efcclm.eu). Mike Hallworth, who wasinstrumental in steering EFCC’s emergence,stepped down as president at the AGM in Junethis year to be succeeded by Rita Horvath(Hungary) with Ian Watson as President-elect.Janet McMurray continues as Secretary of theEC4 Register Commission and the EFCCProfessional Committee. The UK is wellrepresented!The 86 UK Clinical Chemists who have joined

the EC4 register represent only 20% of thoseeligible to support it. France has the largestnumber of registrants – over 1000. Givenemerging opportunities to achieve“co-regulation” through political lobbying, allEU national societies in EFCC are also beinglobbied to boost numbers. It is acknowledgedthat the biggest benefit in joining the registeris for our profession rather than the individual.However, our support in achieving recognitionis greatly valued by many in Europe who seethe UK model as an exemplar of good practice.

How to Join

Applying to register is easy via the EC4 website(www.ec4register.eu). UK applicants must beHPC or GMC registered, must be participatingin CPD activities, have a university degree inmedicine or an appropriate science, 9 yearsundergraduate and postgraduate study and aminimum of 5 years specialist training in anapproved laboratory, usually evidenced byattainment of FRCPath. To save bank charges,UK registrants can pay £55 in pounds sterlingto the ACB for 5 years registration.Re-registration is £46 for a further 5 years.

Further updates on achieving co-regulationand the outcomes of political lobbying willfollow. The EFCC Professional Committee iskeen to highlight examples of difficultiesexperienced by clinical chemists movingbetween EU countries. Please feed these intome ([email protected]) as ACBrepresentative on the Register Commission –I will forward. �

Going EuropeanGilbert Wieringa, ACB European Officer


16 | Science Matters


The Health Technology Assessment (HTA)programme is a national programme rununder the auspices of the NHS NationalInstitute for Health Research (NIHR) by theNIHR Evaluation, Trials and StudiesCoordinating Centre (NETSCC) based atSouthampton University, known as NCCHTAtill April this year. The HTA program wasestablished in 1993 following the publicationof the first NHS R&D strategy, which aimed toinform health policy, clinical practice andservice management and producesindependent research information about theeffectiveness, costs and broader impact ofhealthcare treatments and tests for those whoplan, provide or receive care in the NHS.

The HTA programme commissions research orawards funding for research based on threemajor routes.

The HTA commissioned workstream developsresearch topics from recommendations itidentifies either from a wide range ofinformation sources such as NICE, ClinicalEvidence, Cochrane and DARE reviews,professional groups or from suggestionssubmitted directly to its own website(www.hta.ac.uk/suggest/index.shtml ). Thesesuggestions are passed through a filteringstage before being considered at one of thesix HTA prioritisation panels. Each panel selectsits top six research suggestions on the basis of‘importance’ of the question to the NHS afterwhich the potential research topics aredeveloped into short research ‘vignettes’written by the HTA coordinating centre. Thosewhich emerge from the panels as prioritysubjects then pass to the Prioritisation Strategygroup whose role is to review and approvethose which will go forward to open

Research Proposals:The HTA ProgrammeStuart Smellie, ACB Director of Clinical Practice, Bishop Auckland




advertisement. Researchers submit outlineproposals for consideration at their first HTACommissioning board, following which asmaller number are invited to submit a fullproposal to a second board. All proposalsundergo rigorous scientific andmethodological review before proceeding tocommission. The standard calls are advertisedfour times each year.At present, most of the topics considered by

panels originate from systematic reviews andother research rather from clinicians on theground. The programme wishes to change thisand is actively seeking research suggestionsfrom professionals or groups. There arehowever, many questions which come up inour own everyday practice, which fall belowthe radar of systematic reviews, especially inlaboratory medicine where the evidence basefor much of our testing is weak. When I firstjoined the panel, I noticed that there was astrong representation amongst the projectsfrom radiology in particular (have PET scan,will travel!) and rather few in clinicalbiochemistry and haematology in particular.Therein lies the challenge.

Evidence Base to Laboratory Tests

Suggestions which do come to the HTAwebsite can come from any source. For peopleworking within clinical and laboratorymedicine, these suggestions may be topicswhich have struck someone as needing to beaddressed during their work - do we reallyneed to measure liver enzymes in patients onstatins. What evidence is there that theyactually cause clinically relevant liver changes?This research suggestions can be for primary orsecondary research, from clinical studies toevidence reviews. The person making thesuggestion may have no facilities to do theresearch (or interest in doing it!) but ifprioritised the topic will still emerge as aproposal to be commissioned from anothergroup/body.The HTA Clinical Evaluation and Trials

workstream is researcher-led and considersproposals submitted by researchers seekingfunding to conduct research to answer specificquestions. These are considered on an ongoingbasis rather than by specific calls, althoughthere are four deadlines for submission eachyear. An outline of the process for this route is




shown in Box 2. Again the ‘importance’ of thequestion to the NHS is emphasized and mustbe demonstrated. This approach, if successfulwill lead to the proposal being commissioneddirectly from the person/group submitting theproposal. Details of the standard calls forproposals can be found on www.hta.ac.uk/funding/standardcalls/index.shtmlThirdly, one-off themed calls are advertised

for specific areas where a need for moreresearch has been identified. A themed call fordiagnostic test and test technologies closed inFebruary this year, and over 160 proposalswere received. Following 2 rounds ofprioritisation, 32 have been invited to submitfull proposals for consideration at the finalfunding board. The next themed call is forresearch in the field of obesity, which will alsoinclude tests used in its diagnosis, monitoringor management. It is due to open in Novemberthis year. Themed calls are described furtherat www.hta.ac.uk/funding/themedcalls/index.shtmlWithin the HTA commissioned workstream,

the diagnostic and screening technologiespanel is not surprisingly the one of mostrelevance to pathology and laboratorymedicine. It has around 20 members, drawnfrom across a wide range of skills andinterests, the laboratory-ologies, healthscreening, radiology, endoscopy, internalmedicine and, very importantly, patientrepresentatives. It is presently chaired byProfessor Paul Glasziou, a GP by originaltraining, who, when not doing clinics in hispractice, is the Director of the Centre forEvidence Based Medicine and Professor in the

Department of Primary Care at the Universityof Oxford. Paul has a keen interest indiagnostics.The current members of the group from the

pathology disciplines are myself, Dr StephanieDancer, Consultant Microbiologist, HairmyresHospital, and Dr Michael Miller, SeniorLecturer in Microbiology, Barts & The LondonNHS Trust, Royal London Hospital.Much of the above will not come as news to

those in academic posts or engaged in biddingfor research as the HTA is now one of the mostimportant funding streams nationally andindeed internationally for NHS-orientatedresearch. However for those of us in lessexalted positions in the research food chain,there is still a great deal to contribute, eitherin terms of our own individual researchaspirations, or towards the betterment ofpatient care through suggestions aboutquestions which arise in daily practice.Whether the ideas relate to specific studyproposals or simply to a ‘fishing trip’suggestions which reach the panel can berefined and turned into potentially valuableinvestigations, and even if not actuallyplanning to do the research, being the sponsorof a proposal which goes on to become anHTA commissioned project is a valuable andrecognisable achievement.So come on, suggest a research question,

your HTA needs you!

Acknowledgements

Many thanks to Nick Hicks, Consultant Advisorto NETSCC, HTA for his comments on theoriginal version of this article. �




On Thursday 21st May, delegates to Focus2009 in Liverpool had the opportunity to learnhow international cooperation was helping todevelop and promote quality systems.

Janet Smith (Chair, EMD-IFCC) introduceddelegates to an ambitious project begun byIFCC in June 2007 which aimed to help thosecountries that were still in their early stages ofdeveloping an approach to Quality Systems.The intent of IFCC was to create and offer amodular blueprint which could be adapted tolocal needs and so would support thedevelopment of a modern locally sustainableapproach to quality of laboratory results.

Quality in Vietnam

Delegates then heard Professor Leslie Burnetttalk about a long-standing project betweenthe Australasian Association of ClinicalBiochemists (AACB) and the VietnameseAssociation of Clinical Biochemists (VACB).He spoke of the spirit of good will and

cooperation through which the AACB hadsupported the Vietnamese in developing anexternal quality assurance system which wasbased on the highly successful QA programmesrun jointly in Australasia between AACB andRCPA (Royal College of Pathologists ofAustralasia, through the RCPA QualityAssurance Programs Pty Ltd).The original project involved an informal

collaboration between individuals withinVietnam and Australia, with the sponsorshipof visits between the two countries to attendscientific meetings. This developed into a pilotproject which ran through 2003 and 2005,involving a number of laboratories butbecoming focussed on 5 key laboratories, 3 inHanoi and 2 in Ho Chi Minh City and its successsaw the expansion of the programme to 60laboratories and an increased awareness ofquality concepts in the country.

The program’s success led to aspirationsfrom both sides to extend the scope further toinclude laboratories from each of Vietnam’s 56provinces offering them an EQA programmeof 2 samples per month for an 8 month period.Crucially it also brought with it interest fromthe Vietnamese Ministry of Health and thepossibility of continuing support. The WorldHealth Organisation (WHO) also providedsome support for the program, as did manyindividual members of the AACB, in particularDr Renze Bais, Dr Tony Badrick, Mr PeterGraham and Ms Janice Gill, Mr Lloyd Penberthyand Mr Les Watkinson. It was at this stage thatIFCC was able to offer financial support topump prime what it was hoped would becomea sustainable model for the future and anexemplar for others around the world.The initial enthusiasm of a few individuals in

having the vision and passion to move thisproject forward in its early days and thesupport offered by their national association(AACB) should be an example to us all.

Extending the Project

The sharing of experience and knowledge tothose within and beyond regional boundariesand the collaboration of AACB and VACB hasshown how sustainable developments can bemade to improve the quality of laboratorymedicine and ultimately better patient care.It has been clear to those involved in theIFCC/AACB/VACB project that there are manyother countries across the globe which couldbenefit from similar help and support. In thesame way that Australia has become a buddy toVietnam perhaps we too, through the auspicesof our own Association, should considersupporting the development of laboratorydiagnostics beyond our traditional boundaries.The model developed between AACB and VACBcertainly provides a template for us to reach outto those less fortunate than us. �

International Collaborationto Improve QualityMike Thomas, Royal Free Hospital, London




The Scientific Committee and theClinical Practice Section of the ACBwill be joining forces to promotethe production of guidelinescovering both good laboratorypractice and clinical service deliveryvia a knowledge managementnetwork. The guidelines will beevidence-based where evidenceexists or consensus-based wheregood evidence does not exist.

The Scientific Committee will commissionindividuals via the network to produce papersthat will be subjected to peer review andeither published in the Annals of ClinicalBiochemistry or published on the ACB website.An example of this latter approach appears

currently on the ACB public access sectionunder the title ‘Verification of analyticalprocedures in the clinical laboratory’.The network will be headed by a panel ofindividuals chosen from both the scientificcommittee and the Clinical Practice section.The process will be separate from theClinical Sciences Review Committees (CSRC)activity which will continue to commissionreview articles for the Annals of ClinicalBiochemistry.In addition to being of practical use to ACB

members, the guidelines are intended toinform the Department of Health and RCPathinitiatives currently aiming to produce anational laboratory handbook and a nationalcatalogue of tests.

Come and Get InvolvedThe Scientific Committee and the ClinicalPractice Section wish to emphasise that this isan opportunity for all ACB members tobecome involved. We envisage, for example,that Trainees or others requiring projects(e.g. FRCPath projects) could conduct reviewsof the literature in the areas defined by thescientific committee to inform the productionof guidelines.ACB members may wish to propose areas of

practice for the Scientific Committee toconsider and also may be involved inreviewing documents at the scoping or draftstages. We will need the input of experts intheir fields but also we will need ACBmembers who have a sound understanding ofservice requirements and delivery.All Clinical Biochemists and Chemical

Pathologists within the ACB, whether or notmedically qualified, are invited to take part inthe production of all guidelines regardless ofthe topic.The ACB office is currently compiling a list of

members’ interests which will include anattribute that identifies members who wish tobe involved with this activity. Until this iscompleted calls for participation in the writingof guidelines will be distributed via themembership e-mail distribution list and theclinical practice section mailing list.The activity of the network will be

transparent to ACB members via the ACBwebsite where progress can be tracked andcorrespondence can be directed. �

ACB KnowledgeManagement NetworkRobert Hill, Director of Scientific Affairs &Stuart Smellie, Director of Clinical Practice


Crossword | 21


ACB News CrosswordSet by RugosaKeep sane at coffee time with the ACB News Crossword. Always relating to the science and practice ofClinical Chemistry, you will never cease to be astounded by the convoluted mind of the ACB NewsCrossword compiler.

Prizes for your department: The first five correct solutions to appear on the ACB News fax machine (Fax:0121-765-4224) will receive a copy of the new educational Calcium Cases CD-ROM by Aubrey Blumsohn,Christina Gray, Neil McConnell, John O’Connor, Anne Pollock & Roy Sherwood and which retails at over£50. Please state clearly the name and address of the Department that is entering the competition.Remember that ACB News appears first as a PDF on www.ACB.org.uk around the 7th of each month.

June’s Solution

Across1 See 16 Down7 Apple-core bearing a seed (3)9/13 Rigorous restraint may be

applied to keep 23/19 down(5,7)

10 Tries beta version used in23/19 27s (9)

11 Specialist record-keeper (9)12 Gives references orally for

situations? (5)13 See 915 Describes this odd culture (4)18 Old-fashioned 4 in new

high-heels (4)20 Touch Cinders on the knee (7)23/19 Our main energy supply log

could be so unreliable (5,7)

24 Regarded as unprofessionaluntil each reformed (9)

26 Try hard to discoverInspector Morse's secret (9)

27 Measure in bars (5)28 Cut in redevelopment (3)29 Leeds envied rebuilt

Hendecagon property (6-5)

Down1 Production of three rabbits?

(3,5)2 Attractive sweetheart put

on very little weight withincreasing age (8)

3 Promises loathsome molehas been completelyremoved (5)

4 Generous party (7)5 Treated brutally all left in

charge of acid (7)6 Essential when Nick is at the

wheel (5,4)7 Puts to bed: lack of oedema

predominates (6)8 Judge seas breaking over

ship (6)14 Way to treat soldier on dry

heat manoeuvre (9)16/1A New lab technology imaged

a reflection of average23/19 (8,11)

17 Incorrect detail or made tospecification? (8)

19 See 23 Across20 Membranes resulting from

puerperal mistreatment (nopublicity) (7)

21 Somehow is able to ropedown (6)

22 Delay robbery (4-2)25 Middle Eastern dish, sort of

posh mush (5)


22 | Situations Vacant



Situations Vacant | 23


To advertise your vacancy contact:ACB Administrative Office,

130-132 Tooley Street, London SE1 2TUTel: 0207 403 8001 Fax: 0207 403 8006Email: [email protected]

Deadline: 26th of the month prior to the month of publicationTraining Posts: When applying for such posts you should ensure that appropriate

supervision and training support will be available to enable you to proceed towardsstate registration and the FRCPath examinations. For advice, contact your RegionalTutor. The editor reserves the right to amend or reject advertisements deemedunacceptable to the Association. Advertising rates are available on request



Documents

ACB News Crossword