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In this issue
East of England …High ProfileNetworkingDisaster
RetiredMembersLook at AKIand STP Matters
BosomworthRetirementThoughts
OrganisingYour STPElective
POCT at theLondonMarathon
Reflectionson Focus2016
The Association for Clinical Biochemistry & Laboratory Medicine | Issue 641 | September 2016
ACBNews
About ACB NewsThe Editor is responsible for the finalcontent. Views expressed are not necessarily those of the ACB. EditorProfessor Jonathan BergDepartment of Clinical BiochemistryCity HospitalDudley RoadBirmingham B18 7QHTel: 07792-912163/0121-507-5353Fax: 0121-507-5290Email: [email protected]
Associate Editors Mrs Sophie BarnesDepartment of Clinical Biochemistry12th Floor, Lab BlockCharing Cross HospitalFulham Palace RoadLondon W6 8RFEmail: [email protected]
Dr Gina Frederick Pathology Laboratory, Level 5Royal Derby HospitalUttoxeter RoadDerby DE22 3NEEmail: [email protected]
Mr Ian HanningDepartment of Clinical BiochemistryHull Royal InfirmaryAnlaby RoadHull HU3 2JZEmail: [email protected]
Dr Derren Ready Microbial DiseasesEastman Dental Hospital University College London Hospitals (UCLH) 256 Gray’s Inn Road London WC1X 8LD Email: [email protected]
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ACB Home Pagehttp://www.acb.org.uk
Printed by Swan Print Ltd, BedfordISSN 1461 0337© Association for Clinical Biochemistry &Laboratory Medicine 2016
ACBNews
General News page 4
Practice FRCPath Style Calculations page 12
Council Matters page 14
Current Issues page 15
Trainees Committee page 16
Personal View page 18
Focus News page 19
Getting Out There page 22
ACB News Crossword page 26
Issue 641 • September 2016
The monthly magazine for clinical science
Issue 641 | September 2016 | ACB News
Front cover: Bill Fraser presentsthe Professors’ Prize to Dr Timothy McDonald
ACB Southern Region Scientific Meeting
Biochemistry of Acutely Ill Patients andMember’s PapersThursday 29th September 2016Luton and Dunstable Hospital, Luton
09.45-10.15 Registration and Coffee10.15-10.30 Welcome
Morning Session 10.30-13.00 Members’ Papers
13.00-14.00 Lunch
Afternoon Session14.00-14.45 Emergency Biochemistry
Dr Shankari Dhinakharen, Consultant Emergency Medicine14.45-15.30 Saved by Biochemistry – ITU Case Scenarios
Dr Loku Warnapura, Consultant Anaesthetist15.30-16.15 Acute Presentation of Paediatric Endocrine Disorders
Dr Nisha Nathwani, Paediatric Consultant, Head of Medical Training16.15-16.30 Bill Richmond Prize Awards followed by networking reception
Book on ACB website meeting area:
www.acb.org.ukACB Member: £25, Retired Member: £15 and non-Member: £40
4 | General News
ACB News | Issue 641 | September 2016
SudokuThis month’s puzzle
Last month’s solution
Many readers will have received the jointIBMS, RCPath and ACB letter to NHSImprovement commenting on the demand forNHS Acute Trusts to put forward proposals for“back office and Pathology” to produce plansfor networking by the end of July.The letter from the concerned professional
groups urged caution when reviewing theideas that have been sent in such a shorttimeframe after a few weeks of localdeliberation. The letter went on to giveexamples of networks in difficulty, includingthe recent high profile East of EnglandPathology Partnership collapse, with the hostlaboratory announcing their intention to leavethe project.
Origination of the PathologyPartnership
The East of England Pathology Partnershipcame out of the work of Dr Stephen Dunn’sStrategic Projects Team at the East of EnglandStrategic Health Authority. After protractedefforts in tendering and Trusts decidingwhether to be part of the network, six Trustsfinally joined together as the PathologyPartnership. This was launched in May 2014and was hosted at Cambridge University
Hospital Trust. It incorporated the pathologylaboratories of Cambridge, Ipswich,Hinchingbrooke, Colchester, and West Suffolkhospitals and East & North Hertfordshire NHSTrust. Legally the Trusts were set up as bothowners and customers, under a joint venturearrangement, with differing proportionalshareholdings. The shareholding of theCambridge Trust appears to have been thelargest, but it was under 25%, as stated in theOffice of Fair Trading report in April 2014.
In July 2014 Capita Healthcare Decisions wasawarded a 7 year, £9.7m contract to work,together with CliniSys, to deliver IT systeminfrastructure to the Partnership. At the time a company press release commented: “By working together, Capita HealthcareDecisions and CliniSys have delivered asolution that embodies the wider NHS aim ofdoing more with less, enabling the PathologyPartnership to benefit, immediately, fromimproved efficiencies and availability ofservices”. More recently work on new job contracts
took place, with staff all coming under theemploy of the Cambridge Trust. It is believedthat equipment contracts have also beenplaced.
Financial Problems Key
The Pathology Partnership reported a £4.9million loss in its first year and the 2015/16figures in July reported as a £15 million deficit.This appears to have been too much for theCambridge host Trust who, under a new chiefexecutive, are grappling with regainingfinancial balance. They announced theirintention to withdraw from the joint ventureat the end of June. They stated that in theirview: ”the current model is not proving to bethe most cost effective way of providingpathology services for the Cambridge Trust.The withdrawal process will take 12 months,
6 | General News
ACB News | Issue 641 | September 2016
East of England Network Collapse . . . Used as Example to NHS Improvement byProfessional BodiesJonathan Berg, Editor
The Ipswich Pathology Laboratory is thought to be thelargest left once Addenbrookes leaves the jointventure
and is not expected to be complete until July2017. As host, [we] will be liaising closely withpartner Trusts to ensure that the transition isas smooth as possible with the minimum ofdisruption.” The Cambridge Trust InterimFinance Director, Iain Alexander had stated inDecember 2015 that unplanned losses had inpart been due to “Transforming PathologyPartnership, a joint venture between six NHSTrusts in the East of England”, including theCambridge Trust and clearly the PathologyPartnership was already a cause of concern atthat time.
Carter Report Was Foundation to Network Adventurers
The website of the Pathology Partnershipstopped being updated towards the end of2015. The now out-of-date information still onthe site makes for salutary reading withaspirational statements including:“The Partnership was formed in response to
changes driven by commissioners and NHSEngland to transform pathology services andfollows the best practice recommendations setout in the Carter Report on Pathology 2008. By consolidating pathology services into anetwork of laboratories across a widergeographical area, the partnership will deliversignificant efficiencies and benefits forpatients, hospitals and GP surgeries.”So, how will the remaining five partners
proceed together now the host Trust is pullingout. The Office of Fair Trading (OFT)investigation into the setting up of the jointventure is available on the internet. Point 12of the OFT report considered the possiblethreat if the Cambridge Trust were to exit thejoint venture. The report suggested that therewas the ability of another Trust to host theventure and also there were safeguards with aminimum (but not disclosed) contract time and“unless there is unanimous agreement toterminate it or three of the JV Partners serveexit notices. The OFT therefore does notconsider that Cambridge could exercisematerial influence by threatening to exit.” The Ipswich laboratory is now considered to
be the largest partner left in the joint venture.With complex IT, equipment and staffing
contracts to be reviewed, there is a lot of workto be done to take things forward in a waythat any of the original aspirations of thisnetwork are delivered. ACB News understandsthat the five Trusts left in the joint venture arecurrently undertaking an option appraisal onhow to move forward. One option beingconsidered is to revert to each Trust being indirect control of their locality pathology work.However, this is far from easy, with thechanges in community pathology service forGPs that have already been made havingknock-on effects on long term planning forlocal laboratory design and size.Whatever happens there is clearly a lot more
work required to unpick this one. The overallcost to the NHS of this is very hard to evenbegin to estimate. Locally the visible costs tothe NHS of this affair are suggested to be wellover twenty million pounds. One can add tothis the time and effort of the SHA tenderingprocesses for community pathology and thelargely unaccounted for people-time withinthis. For the local laboratories involved onecan add the human cost of the continuinguncertainty of local services and the impact onstaff recruitment and retention that has beenseen over approaching a decade. �
� The PDF copy includes electronic links to primary information sources for thisarticle.
General News | 7
Issue 641 | September 2016 | ACB News
The Pathology Partnership website ceased to updatetowards the end of 2015 and contains some out-of-date aspirational content. Certainly worth aview, though may not last long now we have pointedit out!
Retired Members’ GroupAKI and STP Training Moving on to Higher PlacesRuth Lapworth
The second meeting for retired members washeld at the ACB Office on 27th June 2016. The first speaker was Dr Robert Hill who
gave a very clear and informative talk on theNHS England AKI Programme. He describedthe history behind the programme as well asthe evidence to support its establishment. TheACB has been involved with the programmesince 2012 when 3 ACB Members attended aRCPE Conference. A consensus statement fromthat meeting recommended the use of e-alertsystems to identify patients with AKI in bothprimary and secondary care. It wassubsequently agreed that production of analgorithm for national use would be based onmeasurement of enzymatic serum creatinineand that the suppliers of software utilised bylaboratory information systems should allowlocal flexibility. Use of the AKI algorithm wasenforced by the Quality Care Commission anda National Safety Alert issued to Trusts inEngland in 2014.
Robert also advised that in future UKCPAwill require laboratories to supply evidence toshow they are reporting test results and thealert to hospital and GP IT systems, as well asto the Renal Registry.
ACB Role in Training Clear to See
The second presentation was by Frances Boa,Director of Education, Training & Workforce,who gave a comprehensive review of theeducation agenda. She was accompanied byLaura Tooth a Clinical Scientist Trainee, whoshared her experience of the Higher SpecialistTraining Programme. It was very interestingfor retired members to hear how the trainingprogramme had developed since introductionof Modernising Scientific Careers. It wasapparent that many aspects of the newprogramme were designed to improveeducation and training for those professionalgroups which did not have access to the well-established national training programmeavailable to Clinical Scientists. During the subsequent discussion the hard
work of many ACB Members in establishingand maintaining our excellent education andtraining programme was acknowledged. Itwas also suggested that the wheel could beturning full circle: the possibility of restrictedfunding available for education and trainingnationally could result in a greater emphasison local programmes.
� The date of the next meeting will beMonday 14th November 2016. It had beenhoped to have one meeting each year atthe annual ACB Focus meeting. This hashowever proved to be too expensive anddifficult to organise within the availableconference space and at present meetingswill be at Tooley Street. �
Frances, Laura and Robert
ACB News | Issue 641 | September 2016
8 | General News
10 | General News
ACB News | Issue 641 | September 2016
ACB South West & Wessex RegionalScientific MeetingMetabolic Bone Disease & the Trainees’ Awards18th November 2016Derriford Health & Leisure Centre, Plymouth, PL6 8DH
09:15-10:00 Registration & Tea/Coffee10:00-10:45 Rheumatoid Arthritis and Anti-CCP
Dr Hutchinson, Royal Cornwall Hospital 10:45-11:30 Metabolic Bone Sisease Cases
Dr Endean, Royal Cornwall Hospital 11: 30-12:15 Vitamin D
Professor Fraser, Norwich Medical School 12:15-13:15 Lunch, networking & meeting Sponsors 13:15-14:00 Measuring Response to Treatment in Patients with Osteoporosis
Dr Viner, Derriford Hospital14:00-14:45 Holo TC
Dr Thomas, Derriford Hospital 14:45-15:00 Break & Tea/Coffee15:00-16:30 Trainees’ Awards
(ACB SW&W Members that have not fully completed the FRCPath)16:30 Prize giving and Close
This meeting is open for registration at the ACB website Regional Meetings page. Further information can also be obtained there on how to apply
for the Trainees’ Award (closing date 26th September).
We would like to extend the invitation for this and all future meetings to Biomedical Scientists and other laboratory staff.
Registration fees: ACB Members - £30, Pre-registration/Retired ACB Members - £20 and Non-ACB Members - £35.
www.acb.org.uk
12 | Practice FRCPath Style Calculations
ACB News | Issue 641 | September 2016
A new assay is being devised for the measurement of phenytoin. In an assessment of recovery,aliquots of a solution of phenytoin sodium (1 mg in 1 mL) are added to separate 1 mL aliquots ofa serum sample and the aliquots mixed then re-assayed with the following results:
Aliquot Added aliquot of Apparent phenytoinphenytoin standard (µL) concentration measured
by new assay (µmol/L)
A 0 40B 10 80C 20 125D 30 176
Calculate the recovery for aliquots A, B, C and D and give an explanation for the patternobserved (Mol. W. of phenytoin sodium 274).
FRCPath, Autumn 2001
When a specimen (already containing some of the analyte in question) is spiked by adding aknown amount of analyte the recovery can be defined as:
Total measured concentration – Endogenous concentration
The endogenous concentration is obtained using an aliquot of specimen in which no exogenousanalyte has been added. Analytical imprecision always limits the performance of recoveryexperiments – particularly if single measurements are used (see Question 160). The recovery mayalso be expressed as a proportion or percentage of the amount of added analyte.
As the concentration of phenytoin in the stock solution is given as 1 mg/mL this must first beconverted to µmol/L to be compatible with the units of measurement. Multiply by 1,000 toconvert from mg to µg, by 1,000 to convert from mL to L and divide by the molecular weight ofphenytoin sodium (274):
Phenytoin (µmol/) = 1 mg/mL x 1,000 x 1,000 = 3650 µmol/L274
Addition of exogenous stock phenytoin to serum dilutes the endogenous phenytoin and this willbe different for each aliquot since a different volume is added:
Endogenous phenytoin = Measured phenytoin in A x Volume of serum (1 mL) Volume of serum (1mL) + Volume added phenytoin (mL)
The added phenytoin will also be diluted by the serum and since a different volume was addedeach time then the dilution will be different for each aliquot:
Added phenytoin = Stock phenytoin (3650 µmol/L) x Volume of stock phenytoin (mL)Volume of serum (1 mL) + Volume added phenytoin (mL)
Deacon’s Challenge No 184 - Answer
The difference between the measured and endogenous phenytoin is the recovery (which canalso be expressed as a ratio to the added phenytoin – or as a percentage) but it is often moreuseful to compare the recovery directly to the amount added.
These calculations are performed for aliquots B, C and D. Note that it is impossible to calculate arecovery for aliquot A since no phenytoin was added!!
Aliquot Added Endogenous Measured Recovered phenytoin phenytoin phenytoin phenytoinµmol/L µmol/L µmol/L µmol/L
A 0 40 40 0
B 0.01 x 3650 = 36.1 40 x 1 = 39.6 80 80 - 39.6 = 40.41.010 1.010
C 0.02 x 3650 = 71.6 40 x 1 = 39.2 125 125 - 39.2 = 85.81.020 1.020
D 0.03 x 3650 = 106.3 40 x 1 = 38.8 176 176 - 38.8 = 137.21.030 1.030
All aliquots show a proportional over-recovery. There are two likely explanations:
1. Calibration error. If this is the case then the true value for aliquot A will be lower than theobserved value. If the phenytoin recovered is plotted against phenytoin added then there is agood linear relationship but the projected line crosses the axis for zero added phenytoin at aconcentration of approximately 11 µmol/L so that the actual concentration in aliquot Awould be 29 µmol/L.
2. There was an error in preparing the 1 mg/1 mL sodium phenytoin solution used to spike thealiquots – possibly by using phenytoin rather than its sodium salt.
Practice FRCPath Style Calculations | 13
Issue 641 | September 2016 | ACB News
Question 185A new drug (A) is inactivated by a deaminase in plasma to form metabolite (B). A raredeficiency in the enzyme can easily result in toxic plasma concentrations of the drug. Toassay the enzyme 10 µL of plasma was added to 2 mL of buffer then the reaction initiatedby adding 100 µL of substrate (A). The reaction was monitored by following the change inabsorbance in a cell with a 1 cm path-length. Unfortunately both the product and substrateabsorb strongly at the wavelength used with the following molar absorptivities:
Drug (A) = 3.0 x 105 L.mol-1.cm-1
Metabolite (B) = 1.2 x 105 L.mol-1.cm-1
Calculate the enzyme activity (in µmol /min/L plasma) for an initial rate of change inabsorbance of -0.021/min.
Lead for Workforce Advisory to the ACB:Nominations Sought
The shape of the workforce for Clinical Scientists is changing and the Association for Clinical Biochemistry and Laboratory Medicine
have a lead person to co-ordinate workforce issues across England, Scotland, Wales and Northern Ireland.
Nominations are now being sought for this post.
The deadline for nomination is 23rd September 2016.
If there are any questions please contact:Hazel Borthwick on Email: [email protected] or
Dr Frances Boa, ACB Director for Education, Training and Workforceon Email: [email protected] �
14 | Council Matters
ACB News | Issue 641 | September 2016
At the recent ACB Council held on 7th July atTooley Street, the topic of the day was on ourworkforce and the future challenges. How dowe maintain a workforce that is “fit for thefuture”.Frances Boa, Director for Education, Training
and Workforce, gave us a comprehensiveoverview of the current situation with regardsto the sustainability of training and our futureworkforce. What was clear from her reportwas that funding was going to be more of anissue going forward and indeed HealthEducation England’s budget has been frozenuntil 2020.
Grow Your Own IncreasinglyRecommended
Additionally, a recent consultation proposed amove from a bursary model of funding fornurses and allied health professionals to astudent loan model. Frances reflected on the number of Trainees
entering the profession was declining, andgrowing your own Clinical Scientist’s seemedthe only option open to laboratories. Threeoptions for this were proposed, each with prosand cons, including utilising the Academy for
Healthcare science (AHCS) equivalence route,best for those with training equivalent to MSCroute, using the Association of ClinicalScientists routes one or two, although routetwo is a 6 year route, however, the potentialto reduce the entry time to less than 6 years isan option, and finally through the HSSTprogramme, which requires funding fromTrusts, and would be considered difficult withthe current financial constraints, despite itbeing a good route.
Workforce Challenges . . . Article Coming Soon
This report prompted a lot of discussion and itwas highlighted that difficulties in recruitingmedical trainees, generally because of lack ofawareness due to the curriculum havingminimal biochemistry content. Watch out for a more comprehensive
review of the workforce challenges cominglater into the ACB News. In the meantime ifyou require any additional information, or wish to comment on the future of ourprofession, please email me,[email protected] �
Clinical Science Workforceinto the FuturePaul Newland
15 | Current Issues
ACB News | Issue 641 | September 2016
Volunteer to Complete anAMALCEmma Ashley, Chair, ACB Trainees Committee
Whilst a pre-registration Clinical Scientist, I happened upon an advert in the ACB Newsrequesting for volunteers to write AnalyteMonographs alongside the NationalLaboratory Medicine Catalogue (AMALCs).The monographs provide a detailed summaryof the nature and use of individual assays, inaddition to clinical and analytical informationfor laboratory and other healthcareprofessionals. I asked my supervisor whether,as a pre-registration Trainee, it would be anappropriate task for me to complete. She wasvery encouraging and thought it would be agreat way to improve my knowledge on theassigned analyte, in addition to offeringexposure to the peer-review process.
Monograph Leads to CPD Credits
The ACB Scientific Committee provided mewith a template in order to compile themonograph. The headings includeddescription of analyte, details of analyticalmethods, uses, causes and follow-up ofabnormal results with the final heading askingfor relevant guidelines and systematic reviewsavailable. I completed two monographs, eachof which took approximately six hoursproviding a total of ten CPD credits. Althoughit was potentially challenging finding the time
to dedicate to the monographs during mytraining, I found it beneficial receiving peer-reviewed feedback, as well as researchingmy particular analyte of interest.
Go On – Give it a Go!
Although it was several years ago now that Ifinished the AMALCs, I still often refer to thembesides the vast range of other analytes on theACB website (http://www.acb.org.uk/whatwedo/science/AMALC.aspx). Furthermore,feedback from Trainees highlights that theyare an invaluable revision tool. I wouldstrongly encourage STP Trainees and thosestudying for the FRCPath exams to volunteerto complete an AMALC. It was a rewardingexperience and a great accomplishmentcontributing to the knowledge base, inparticular recognising that you are assistingfellow Clinical Scientists studying forexaminations and providing a teachingresource. Moreover, participation looks greaton your CV. If you would like to contribute tothe project, please contact Chris Chaloner([email protected]) for furtherdetails. Volunteers are also required to revise
existing monographs, the first of which arenow 4-5 years old. �
16 | Trainees Committee
ACB News | Issue 641 | September 2016
The elective was introduced to the ScientistTraining Programme (STP) scheme in 2011, as part of the changes that occurred due tothe Modernising Scientific Careers initiative.The aim of this four to six week rotation is toencourage learning and development in anarea outside of the trainee’s normalenvironment and to gain a valuable insightinto how different services function. It is acompulsory piece of work that all traineescarry out as part of their work-based trainingand evidence for this is uploaded to thetrainees online portfolio, OLAT. It can be difficult to know where to begin
when organising an elective and availableinformation and guidance for trainees can bescarce. In this article, I will address some of thecommon questions regarding organising andfunding using information gathered fromtrainees in my year and in the years abovewho have completed, or are currently carryingout, their electives.
Choosing an Elective
It is intended that the idea for an electiveoriginates from the trainee. However, in someinstances the trainee’s supervisor will alreadyhave an elective in mind or they may suggestseveral possible options. The final decision onthe topic of the elective should be made bythe trainee but it is essential that this isdiscussed with the host institution ordepartment first. Of the trainees whoprovided information about their electives,66% came up with their own elective idea.However, in the vast majority of cases it wasthe trainee’s supervisor who made initialcontact with the department or organisationin order to organise the elective, particularlywhen this was based outside of the hostinstitution. Eighty-three percent of trainees carried out
their elective at another healthcare institutionin the UK, with the remainder of traineescarrying out an elective abroad or at their host institution.
For examples of electives that have beencarried out by trainees, please visithttp://www.acb.org.uk/whatwedo/trainees_home/electives-page on the ACB website.
Fitting in the Elective is Not Easy
The National School of Healthcare Scienceadvise that an elective can be arranged for anytime during specialist training in the second orthird years and that this can be a single periodof four to six weeks, or a series of shorterperiods. It can be difficult to find a suitabletime due to other training commitments suchas research projects, time spent at University,exams, completing rotations and specialisttraining etc. However, the majority of traineesaim to complete their elective towards the endof their second or beginning of their thirdyear. It is important to start exploring optionsas early as possible in your training as this willgive you plenty of time to discuss anappropriate time that will suit you and thepeople you hope to work with, as well asfinding funding if needed.
Finding the Money
Expenses incurred during an elective can bedue to accommodation, travel and universityfees. Very few trainees who providedinformation about their electives received any funding. This is likely to be the mainreason why more and more trainees arecarrying out electives at their host institution,or at healthcare institutions based nearby in the UK. For the few trainees who did receive
funding, this came from their training budgetsand in some cases, money was provided fromthe host department’s own budget. However, the majority of trainees who have
carried out their electives abroad self-fundedtheir accommodation and travel expenses. It is sometimes possible to arrange student
accommodation near the hospital orinstitution, and this can cut down on costs.Unfortunately, the ACB cannot provide
Organising Your ElectiveDr Harriet Allison, East of Scotland Trainee Representative, Dundee
Trainees Committee | 17
Issue 641 | September 2016 | ACB News
funding for electives as it is a core part of theSTP training. However, the CP Stewardmemorial fund (http://www.acb.org.uk/whatwedo/grants/cp_stewart_fund.aspx) isavailable to those trainees carrying out anelective abroad. In addition, if a trainee is planning on
combining their elective with a researchproject, they are eligible to apply for an ACBScientific Scholarship (http://www.acb.org.uk/whatwedo/ science/scientific_scholarshipsaspx).There will be only 5 grants awarded per year
but these can be quite substantial. There may be other professional
organisations you are a member of that offertravel bursaries or scholarship awards and so itis worth researching into what is available. The majority of funding bodies will want
detailed reasoning for you undertaking anelective abroad. They will also want to knowhow the work you’ll be doing will supportthem as an institution and what you thinkyour contribution will entail.
Practical Things to Think About
If you decide you want to carry out yourelective abroad, you may need to considerfactors other than how you will fund it. Forinstance, depending on where you plan tocarry out your elective, you may be required toorganise vaccinations, travel and healthinsurance and a work visa. Trainees shouldconsider what safeguards are in place in termsof their own health, as well as what wouldhappen if they make a mistake which has aclinical consequence. If there is no existing linkwith the department then it is important thatthe trainee has some understanding of thelaboratories track record and accreditation,and that this has been discussed in detail withtheir supervisor. Although sometimes difficult to organise
around an already busy training programme,the elective can be an extremely interestingand rewarding experience. Therefore, it isworth investing time and effort into planningan elective you will enjoy and find beneficialfor your future career. �
ACB News | Issue 641 | September 2016
At the end of September I will leave LeedsTeaching Hospitals. Whilst I struggle to use theword retire I guess that is what I am doing,after 43 years in the NHS.As Chemical Pathologists, Clinical Scientists
and Biomedical Scientists we make atremendous contribution to healthcare thatsadly, in many Trusts/NHS organisations, goeslargely unrecognised. The reasons for this aremany, but to me one that stands out the mostis because members of the ACB have been sosuccessful in bringing science to health careand embracing new technology, especiallyinformation technology. This in turn meansthat many of our reports contain computergenerated interpretive comments that ourstakeholders forget have been derived bymembers of this organisation. There are ofcourse many other reasons but to be brief,much of what we do is unseen and it is moreimportant than ever that we are representedby well-respected professional groups.The early days of my career were exciting
times in clinical biochemistry as the servicegrew exponentially and along with itprofessional bodies such as the ACB. Whilst Istill think there is much for us to be excitedabout, just look at the wonderful contributionthat we have been able to make to thedetection of acute kidney injury through thedevelopment of the AKI algorithm, these aremore challenging times in terms of austerity.The drive to reduce costs and hence thereconfiguration of our services and ourworkforce.
So What is the Point? For much of my career the ACB has been asuccessful and influential professional body,but I do fear for its future. It and that meansyou, have to decide what you want it to be. Inthese days of Blood Sciences etc do you want itto remain a niche body representing ClinicalBiochemists, or do you want it to embrace the
wider scientific community in Pathology? Yes we have welcomed Immunologists andMicrobiologists, or at least we think we have!We have tinkered with our name and yet westill refer to ourselves as ‘the ACB’. How manyClinical Scientists in Haematology have joined?I have talked to a number of Microbiologists inparticular, who do not feel that we are inclusive.
Compete to Thrive
The Association for Clinical Biochemistry andLaboratory Medicine, that is you, must decidewhat you want the Association to be. TheInstitute of Biomedical Sciences representsHealthcare Scientists in all branches ofPathology, with the possible exception ofgenetics. The RCPath represents all branches ofPathology and in particular some might sayHistopathology. Does the ACB wish tocompete with these two august bodies? I saycompete because there must be very fewpeople like me who belong to all three.Yes, it is easy to look back with rose tinted
glasses, but it is nevertheless true that clinicalbiochemistry expanded rapidly in the 70s and80s. Staff were allowed time to attendmeetings and also time to support theirprofessional body. The ACB will only continueto thrive if it you are clear what you wish yourorganisation to be, have a clear strategy forgetting there and are willing to put the timeand effort into supporting it.Finally, thank you to all those who have
served and continue to serve on variouscommittees within the ACB. Please do not takeany of this text as criticism of you asindividuals, as the ACB would not exist at allwithout us. It has been a privilege to workwith you and I should not sign off withoutthanking those of you who sponsored my New York to San Francisco cycle ride last year.In all I raised over £16,000 so once again manythanks. �
18 | Personal View
Decide What You Want to BeMike Bosomworth, Leeds
Focus News | 19
Issue 641 | September 2016 | ACB News
It is fair to say that Focus 2016 was a greatsuccess and carried the tradition of providingmembers and guests with a scientificprogramme of the highest standard, coupledwith a great opportunity to socialise with oldand new friends alike. Warwick University campus was an excellent
venue for us all; it had something foreveryone, and importantly was supported by agroup of staff whose primary aim was toensure we got that ‘welcome feeling’.The event was preceded by the Trainees’
Day, which proved a useful and interesting dayfor our trainees. For an in depth review, please see the ACB News, July 2016.Focus 2016 was opened by our President
Gwyn McCreanor, and this together with theopening Foundation Award set the tone forthe whole of the meeting. Professor Sattargave us a superb review of novel insights into
cardio metabolic diseases. For the first time atFocus, members had access to a mobile app,this meant that after each session, membersand guests could rate the presentations andnot surprisingly this scored high, withcomments such as “highly relevant”, “greatspeaker”, “really funny and engagingspeaker”. Importantly, this got the science inthe conference off to a fantastic start.
Excellent Science
Throughout the conference, I was personallyable to attend a varied selection of sessions.The metabolic medicine session was a greattour de force on FGF 23 by Professor Fraser,and very well received by the audience. Whatis so important and indeed the cornerstone forFocus meetings was the variety of sessions, you could mix and match and chose to attendbroad ranging sessions each day, from topics
Reflections on Focus 2016Paul Newland
Poster and trade stands in one tight place created an exciting environment
20 | Focus News
ACB News | Issue 641 | September 2016
on education and training through to up tothe minute molecular medicine.The ACB Awards give an opportunity for our
“up and coming” Scientists to showcase theirwork, was a great session. The standard ofpresentation was exceptionally high and thescientific work being undertaken by our morejunior members was of the highest quality,making the decision as to who should be thewinner of the award difficult. I am pleased tosay the winner this year was John Wadsworthfrom Liverpool with the runner up, RoannaGeorge from Cardiff.
Meeting of Laboratory and Commerce
Warwick was an excellent venue in supportingthe success of the exhibition. It was a compact
and therefore intimate venue, that allowedmembers and guests to visit our corporatepartners, enabling them to share their newproducts or discuss what exciting things wereon the way. It is good to meet up with colleagues on
the exhibition stands to chat about businessissues and catch up on life in general and it isthis mix that helps gives the conference such a great feel. The success of the exhibitionwas highlighted in the briefing session held at the end of focus where corporate and ACBcolleagues got together to discuss the prosand cons of the meeting. It is fair to say thiswas such a positive meeting and a truereflection on the success of Focus 2016. It would be remiss of me not to mention
Sarah and Raj doubled up with a stand and poster presentations! Thanks for your help with proof-reading ofACB News over the last few years Raj
Focus News | 21
Issue 641 | September 2016 | ACB News
the hard work that goes into organising these events, and so I would like to take theopportunity to thank and congratulate theorganising committee, expertly chaired by Neil Anderson for putting on a great
conference and innovating in particular with the Conference app. Also, I would like to offer my thanks to
Vicki Grant and her team at Meeting Makers,for making life so easy at Focus 2016. �
Serious conversations about the 1.8% pathology target and how it has been derived
22 | Getting Out There
ACB News | Issue 641 | September 2016
Biochemistry on theFrontline . . . POCT at theLondon MarathonThomas Morris, St George’s Hospital
The 36th London Marathon took place thisyear on Sunday the 24th April. London basedClinical Biochemistry STP trainees, includingmyself, were given the chance to volunteerour services for the day and assist in themedical care of unwell runners. By finishernumbers the London Marathon is the thirdlargest marathon in the world and is thebiggest single sporting event in the UK.Professor Sanjay Sharma, medical director forthe London Marathon, required scientists toman and operate the POCT devices during theevent. I jumped at the opportunity and waslucky enough to be selected, along withVictoria Treasure, Rebecca Tibbs, both fromKing’s College Hospital and Edmund Wilkesfrom University College London Hospital. As an STP trainee, I saw this as a great
opportunity to build upon my biochemistryknowledge as well as to see first-hand howbiochemistry results are used in the immediatecare and a management of patients. I also sawthis as the perfect opportunity to completesome of those professional practicecompetencies!On the morning of the marathon we met
with Mark Weaver, a Regional AccountManager for Abbott Point of Care, and weregiven a demonstration on how to operate thei-STAT POC device. When used in combinationwith the Chem-8 cartridge the i-STAT canmeasure a range of analytes on a whole bloodsample, including Na, K, Cl, Ca, bicarbonate,glucose, urea, creatinine and haemoglobin.The device was relatively simple and straightforward to use and Mark was present
Left to right: Victoria Treasure, Mark Weaver, Thomas Morris, Edmund Wilkes and Rebecca Tibbs; outside theintensive care/first aid tent on Horse Guards Parade
Getting Out There | 23
Issue 641 | September 2016 | ACB News
throughout the day to answer any questionsor queries we had. We reported to HorseGuards Parade and were given a briefing bySanjay on what to expect during the day andthe different types of medical issues that wemay be faced with. After this, we were splitacross the three different intensive care andfirst aid tents that were found in closeproximity to the finish line. Two tents oneither side of the finish line were intended forrunners who felt unwell immediately aftercompleting the course. A third tent on HorseGuards Parade was based where runnerswould meet their friends and family andcollect their belongings after finishing themarathon. The purpose of this final tent wasto provide medical assistance for runners whomay fall ill after the adrenaline has worn offand symptoms such as dehydration and severecramp begin to present themselves. I wasbased at Horse Guards Parade for the majorityof the day.
Working as Part of a MultidisciplinaryTeam
The medical team that I was a part of withinthe intensive care tent was comprised of awide variety of volunteer healthcare
professionals including St John AmbulanceCadets first aiders, nurses, podiatrists,physiotherapists, ambulance paramedics,Emergency Department registrars,cardiologists and sports science medics. In order to treat the patients in a safe andeffective manner outside of the normalhospital environment, team work was vitaland it was important to work acrossprofessional boundaries, as the variousmembers of our team came from differentclinical backgrounds and had not metpreviously. These were valuable lessons andones I will continue to use as I progressthrough my professional career. Being part ofthis multidisciplinary team helped me reflecton how important biochemistry testing is inthe prognosis, diagnosis and treatment ofdisease and the value that Clinical Scientistsadd to the overall care of patients. As I am generally lab-based, working as part
of this team allowed me to interact directlywith healthcare professionals I would notnormally encounter, and of course patients.This was rewarding as it gave me theopportunity to experience different aspects ofhealthcare and the central role that patientsplay in everything we do.
View inside the intensive care/first aid tent on Horse Guards Parade
24 | Getting Out There
ACB News | Issue 641 | September 2016
No Heatstroke Seen with a 2°CTemperature at the Start!
During the day, the biochemical measurementsplayed an important role in the managementof severely unwell runners. Measurementswere required before IV fluids could beadministered with clinicians concerned aboutgiving IV fluids to runners who may be over-hydrated, as a result of drinking waterduring the race. I tested four blood samplesusing the i-STAT and three of the four patientstested had to be taken to hospital for furthercare, demonstrating the severity of theirconditions. A similar number of tests were alsoperformed by the other STP trainees in theother tents. The majority of patients whocame to the intensive care tent had minorinjuries and did not need biochemistry testing,and were discharged within an hour. The mostcommon complaints amongst the runnerswere muscle cramps and blisters but moreserious cases included exhaustion andconfusion, but these were few and farbetween. A real concern that clinicians hadduring the event was runners suffering fromheatstroke, but as the temperature on the daywas relatively mild, no cases were seen in theintensive care tent I was based in. Thetemperature at the start of the race was 2°Cand peaked at 11°C during the race.
Medical Facts and Figures
Sanjay Sharma kindly sent round facts andfigures for the day which I have summarisedhere:� A record 39,140 runners completed the
course.
� The medical support for the Marathoncomposed of 1,500 St John Ambulancemembers, 160 Doctors, 10 paramedics, 4 medical students, 4 biochemists andnumerous nurses, physiotherapists andpodiatrists.
� In total there were 5,051 medical contactsduring the day.
� There was 1 death which was widelyreported, and 2 successful resuscitations for
cardiac arrest, one a runner and the other a spectator.
� During the day there were 44hospitalisations with 18 patients admitted overnight.
� Eight cases of heat injury/heatstroke were encountered that required transfer to hospital.
Great Learning Experience
I thoroughly enjoyed the day and found itboth rewarding and educational in equalmeasures. If the opportunity presents itselfagain next year then I will once again jump atthe chance to be involved. For me, the mostrevealing part of the day was to interact withpatients and see first-hand how biochemistryresults play a fundamental role in patient care.Being part of a multidisciplinary team was alsoan invaluable lesson and I would recommendto any STP trainees to get involved in eventslike this and experience working outside ofyour normal settings. A highlight of the dayfor all STP trainees involved was seeing EllenSargeant, and STP trainee at University CollegeLondon Hospital, complete the marathon in avery respectable time of 4 hours and 44minutes. Congratulations to everyone elsewho completed the course! �
The Abbott i-STAT POCT device with CHEM8+cartridges
26 | Crossword
ACB News | Issue 641 | September 2016
Last month’s solution
Across 5 Non-atopic phenotypical group (6)6 Fractured metatarsus sets off mental distress (6)9 Walk a line including base (6)10 Find out about possible careers before the
end of the month (8)11 In part genotypically determined appetite
for non-food substances (4)12 Working out applying (10)13 With this kind of element, avoid one trace
becoming misplaced (11)18 Skin, for example, misrepresented
euphemistically – not scaly (10)21 Long inaugural lecture held group back (4)22 Opening window (8)23 Dean from East Enders developed some
fragrant compounds (6)24 Some blunder, maltreatment of skin (6)25 Sober one fermented sugar (6)
Down1 Vessel of first vintage exceptional new aromatic
Spanish wine (4,4)2 Disrupt cell membrane holding in essential
nutrient (6)3 Peevish refusal to recognise incision goes
against the grain (5-3)4 Greek character artist left preliminary sketches,
displayed like Banksy (6)5 Bone structure: afterthought about live
broadcast (6)7 Articulation stress (6)8 Released extremist can cause damage and
disruption (4,7)14 Element of inactive physical state disturbed
resting midday (5,3)15 Leave diversification into Spanish wine (8)16 Reads page about informal elaborate meal (6)17 Weed out bad broadleaf hybrid plants (6)19 Belief there is no law about holy water (6)20 Cancelled task, mistakenly re-ordered organic
insulator (6)
ACB News CrosswordSet by Rugosa
