Issue 488 December 2003v2 - Association for Clinical ... · PDF fileThe Association of Clinical Biochemists ¥ Issue 488 ¥ 20th December 2003 s. About ACB News ... Dr Judith Burrows

Christmas

Crossword

Forward

Looking

Clinical

Biochemistry

MRCPath

Part II

Research

Explained

Trainees and

Names & Roles

ACBNewACBNewChristmas

Crossword

Forward

Looking

Clinical

Biochemistry

MRCPath

Part II

Research

Explained

Trainees and

Names & Roles

The Association of Clinical Biochemists • Issue 488 • 20th December 2003

ss

About ACB News

The 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 BiochemistryCity HospitalDudley RoadBirmingham B18 7QHTel: 07973-379050/0121-507-5353Fax: 0121-765-4224Email: [email protected]

Associate EditorDr Judith BurrowsDepartment of Clinical BiochemistryRussell’s Hall HospitalDudley DY1 2HQTel: 01384-244081 Fax: 01384-238089Email: [email protected]

Associate EditorMiss Sophie BarnesDepartment of Chemical PathologySt Thomas’ HospitalLondon SE1 7EHTel: 020-7928-9292 x2396 Fax: 020-7928-4426

Focus Handbook EditorDr Richard SpoonerDepartment of Biochemistry 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]

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 ChairmanMiss Janet SmithDepartment of Clinical BiochemistryUniversity Hospital Birmingham NHS TrustBirmingham B29 6JDTel: 0121-627-8449 Fax: 0121-414-0078Email: [email protected]

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

Printed by Piggott Printers Ltd, CambridgeISSN 1461 0337© Association of Clinical Biochemists 2003

December 2003 • ACB News Issue 488 • 3

ACBNewsNumber 488 • December 2003

General News 4

Disposable Laboratory Tips 7

Federation of Clinical Scientists 8

MRCPath Short Questions 10

Christmas Fun 11

Current Topics 12

MRCPath Exam 15

More Federation News 18

Meeting Reports 23

Corporate News 26

Situations Vacant 28

Front cover: A giant ferris wheel in front of the ICC in Birmingham for the festive season. Focus 2004 takes place at the ICC next May.

ƒocus2004ICC • BIRMINGHAM • 18-20 MAYThe Association of Clinical

Biochemists National Meeting

ICC, Birmingham Tel: 01223 404830 Fax: 01223 404841

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

4 • ACB News Issue 488 • December 2003

General News General News General News General News General News

Insulin Man Retires

Derrick Teale retired recently and was given a goodsend off at a gathering in Guildford at the end ofOctober.

Derrick was known to many of us as an expert in thearea of insulin. Working in Vincent Marks’ dynamicdepartment, Derrick became the Deputy Director of theSAS Peptide Hormone Centre in 1981. He is associatedwith over 150 scientific papers and also provided scientific evidence for a number of high profile courtcases that involved insulin. ■

Abstract Deadline

Please do remember that the deadline for Focus 2004abstracts is 9th January 2004. You can submit yourabstracts on the Focus 2004 website where they willbe considered for oral, poster and the Bayer Awarddepending on your age and preferences. ■

ACB Wall Planner . . .

With this ACB News circulation you will receive a 2004wall planner. If you know of colleagues who would like to have one as well then do contact the Focus 2004 office who will be happy to send out additional copies. ■

Trainee Committee

Representative Sought

Are you interested in being the trainees’ committeerepresentative to the Workforce Advisory Committee?

Please contact Gwen Wark for more information onthe role and e-mail Sophie Barnes by 24th December ifyou would like to volunteer. ■

Glasgow 2005 Lunchtime

Roundtables

The scientific committee of the Glasgow EuropeanCongress of Clinical Chemistry is now inviting you tosubmit ideas for you to convene lunchtime roundtables.These will take the form of groups of about 12 delegates and can be on any topic relating to clinicalpractice, laboratory medicine, management, IT orrelated subjects.

Please submit a 100 word summary to: Dr SandraRainbow, Secretary, Scientific Committee, Glasgow2005, Clinical Biochemistry, Northwick Park Hospital,Watford Road, Harrow HA1 3UJ. Email: [email protected] is the end of February 2004. ■

Focus 2004 committee members Maggie Throup, Jane Lewis and Sophie Cordiner with the 2004 wall planner

Bell Lane, Lewes, BN7 1LG Tel: +44 (0)1273 484788

We wish all our customers a Merry Christmas

and a Happy New Year


General News General News General News General News General News

GlaxoSmithKline: Lucozade

and the Oral GTT GlaxoSmithKline, the makers of Lucozade, provideinformation on the use of Lucozade in the oral glucosetolerance test to healthcare professionals. Unfortunatelytheir database has been corrupted and they need to establish new mailing lists.

If you would like to receive updates on informationin the future please contact them by email, post or telephone, indicating if you would prefer hard copy orelectronic copy if available.

The Nutrition TeamGlaxoSmithKline Consumer Healthcare11 Stoke Poges LaneSlough, Berkshire SL1 3 NWTel: 01753-502132 E-mail: [email protected] ■

Thanks Everyone . . .

Focus Resident

Packagesfrom ONLY £400.00

Fully inclusive of admission to the scientific programme and exhibition

Priority booking for Workshops, Update Sessions and Training Day

Food and refreshments throughout the day

Conveniently placed accommodation

Exhilarating social programme

Focus on Birmingham Wheel

The front cover shows the front of the ICC and the ferriswheel that is in place for the festive season in CentenarySquare in Birmingham. Do remember that the time forFocus abstract submissions has now come round! ■

This has been a very busy year on ACB News. TheEditor would like to thank everyone who has helped tokeep the show on the road. Sue and Peter at PRC haveworked hard to ensure that the advertising from ourCorporate Members gives commerce the profile itdeserves. Graham and the staff at the ACB Office havehandled a record number of job adverts and hopefullymost of them have been filled.

Barbara and Karen have done a fantastic job in theEditorial Office in Birmingham to ensure that the continual bombardment of the Editor with emails hasbeen sorted and filtered to ensure that the editingprocess is still manageable. Meanwhile, the Editor hasgone and written another book on Birmingham –photos of the launch next month! Nikki has designedand typeset ACB News, often fitting proofs around her

frequent trips to Spain where her husband now works.Piggott Printers have excelled at printing the magazineto the highest of standards and Black Bear Press haveensured that the magazine has been sent out on time.

Meanwhile, Ian Godber has placed the PDF versionon the Internet where an amazing number of peoplenow download the magazine the day it comes out.

Judith Burrows has worked hard to correct theEditor’s English, and of course Sophie Barnes has takenfull control of the MRCPath short questions. In Januarywe will see two new Associate Editors join ACB News.We are planning some exciting developments to ensurethat everyone is kept up-to-date and also provide thatlittle bit of light relief in what looks like being another‘heavy’ year to come. ■

ame tingofmindseFocus 2004

Register now at www.focus-acb.org/2004

Tips Disposable Laboratory Tips Disposable Laboratory Tips


Federation of Clinical Scientists Federation of Clinical Scientists


The rules of the new Health Professions Council (HPC) regarding registeredpractitioners are very clear and it is expected that laboratory heads followthem or they themselves may be at risk of censure.

The HPC has now declared that the title of Clinical Scientist is protected in law andonly practitioners on the register may use it. This jointly protects the public, theprofession and the registered practitioner. These two words may not be included inany other title, for example, it is not permitted to use the titles:

Grade A Clinical ScientistTrainee Clinical ScientistPre Registration Clinical Scientist

There is however, no barrier to using a local title based upon the old terminology, eg:Trainee Clinical BiochemistGrade A Trainee Clinical BiochemistHigher Specialist Trainee Biochemist

The official title for registered practitioners is now Clinical Scientist in Biochemistry(Physics, Cytogenetics, Microbiology etc). Because of the protection of title there isno need to qualify this with ‘Registered’ or ‘State Registered’

Roles of Non-Registered Clinical BiochemistsGrade A Trainees and those in Grade B pre-registration are not Clinical Scientists andcannot therefore perform the roles and carry the responsibilities of a registered professional. It does not matter what courses they have completed, they are not registered.

As a trainee they should be acquiring knowledge and skills to fit them for the roleof a registered professional. This has to include learning to take responsibility forclinical decisions, service provision, resolving problems, handling complaints, providing clinical advice etc. But this MUST be under the tutorage and supervisionof an experienced registered practitioner (Clinical Scientist or Medical Consultant)in the same speciality.

The FCS and the ACB have been asked to advise upon the legitimacy of a Grade Aor non-state registered Grade B biochemist participating in the Duty Officer (DutyBiochemist) Rota. The interpretation of the FCS and the ACB Executives is that theDuty Officer (DO) is de facto in day-to-day charge of the clinical service provided bythe department during the period of duty. The DO has delegated authority from theHead of Department (HoD) however that HoD cannot delegate authority or respon-sibility to someone who is not registered.

The Position ofTrainee Biochemistsunder HPCBy Paul O’Leary, Federation of Clinical Scientists



Trainees must learn the role of DO, how to make on the spot decisions, give mean-ingful and helpful advice to medical and nursing staff and also provide clinical andscientific leadership to BMS, clerical and MLA staff. This can only be achieved bypersonal coaching and experience not simply by the acquisition of the academicqualification component of training. Once the supervisor is confident that goodprogress is being made and training logbooks have shown the required standards,then the trainee can be allowed to operate with more independence but still actingunder the responsibility of a senior registered Clinical Scientist or MedicalPractitioner.

Similarly pre-registration trainees cannot participate in an out of hours advice rota.As that senior registrant is responsible for every action of the trainee for that day,

he/she must be DO and must be readily available to advise the trainee and also takeover directly if any difficulties arise. This means being available on site just as theywould be if they were individually DO. Occasional circumstances may require thesupervisor to be off site, just as is the case with single-handed practitioners.Arrangements must be clear on contactability and the supervisor should regularly checkup with the trainee. If absence results in no registered practitioner being available alter-native arrangements should be in place, but a trainee cannot be left in sole charge.

Smaller DepartmentsPragmatically in small departments this often results in a very experienced registeredBMS of managerial grade being in charge with an on call arrangement with a neigh-bouring consultant who may visit regularly. It therefore follows that it is not appro-priate for a single-handed consultant (Medic or Scientist) to employ a trainee exceptfor short periods arranged by the regional tutor to gain wider experience.

The position of an experienced BMS who successfully applies to transfer to a CinicalScientist post is not clear at present. They are a registered practitioner with HPC andhave many of the knowledge and skills (but not all) requirements of a registeredClinical Scientist. We need to seek further advice on whether they can deputise forthe HoD or perform the full responsibilities of a Clinical Scientist unsupervised.Delegation of substantial chunks of responsibility within the competence of their registration is not a problem. In thisarea it is essential that the Clinical Scientist National Assessors are involved in theappointment to independently test the Knowledge, Skills and Experience. ■

MRCPath Short Questions MRCPath Short Questions MRCPath Short


Question No. 34 **Christmas Special**What is the pH of a 1.0 x 10-8 molar solution of hydrochloric acid?£10 book token for the first “correct”answer together with a convincing explanation received:[email protected]

Deacon’s ChallengeNo. 33 AnswerAn assay mixture for the measurement of lactate dehydrogenase constituted 2.7 mL of bufferedNADH and 100 µL of serum. The reaction was started by adding 100 µL of sodium pyruvate. Theabsorbance change over 5 minutes was 0.150 when measured in a 0.5 cm light path at 340 nm.Assuming the molar absorbtivity of NADH at 340 nm is 6.30 x 103 Lmol-1 cm-1, calculate theenzyme activity.

LDH activity = µmol substrate consumed/min/L plasma

The reaction is monitored by following the fall in absorbance at 340 nm due to the oxidation ofNADH as pyruvate is consumed:

CH3C0.COO– + NADH + H+ ® CH3CH(OH)COO– + NAD+

First calculate the amount of NADH oxidized over the reaction period of 5 min:

D Absorbance = D[NADH] mol/L x eNADH (Lmol-1cm-1) x Cell path (cm)

0.150 = D[NADH] x 6.30 x 103 x 0.5

D [NADH] = 0.150 mol/L/5 min6.30 x 103 x 0.5

To covert from mol to mmol multiply by 1,000,000, and from 5 min to 1 min divide by 5:

D [NADH] = 0.150 x 1,000,000 µmol/L/min6.30 x 103 x 0.5 x 5

This is the LDH activity per litre of reaction mixture not plasma.Since 100 µL of plasma was diluted to a final volume of 2.9 mL (i.e 100 µl plasma + 2.7 ml

NADH/buffer + 100 µL of substrate) the activity (mmol/min/L plasma) is obtained by multiplying this result by 2.9 and dividing by 0.1:

LDH activity = 0.150 x 1,000,000 x 2.9 = 276 mmol/min/L 6.30 x 103 x 0.5 x 5 x 0.1

Christmas Fun Christmas Fun Christmas Fun Christmas Fun


Solomon’s slave has a support that is partly magical (4)Seaman hears a cutter at a distance horizontally (8)Bony processes are colourless without drug habit,

but I’m in (7)Dread confused summer (5)Sloth! That sounds like me (2)Amino acid for backward dad introduces raga (5)One girl who’s lost a name (2)Fuse sly oaken source (8)Like a tailless donkey (2)Coded representation? Not one of spore bearers (4)Tech’s behind’s not socially acceptable (3)This year’s buzz-word cheats one in ancient country,

but headless (13)Sublimate head with power to eat away (13)Waterfowl, not a thousand, by old gold (5)The side of window-sill. Noel! (4)Gosh, go back for the brain test (3)Don’t start garland in Indonesian region (2) Separation process for diplococci (2)Confused Angy takes drug after brief study of female

diseases (5)Fish infectious diseases identity (2)Iceland exists (2)

It is three-quarters of some parts (3)Phone engineer becomes black (7)Second pair embracing large size, about a divider (6)Trotsky comes back at Christmas (4)No car storage, no horse, going by boat (6)Confused deity takes a brief look down in the mouth (3)Short amino acid about birds (8)Very large bone (2)Trooper, get me endlessly for example (8)Sound strip of bells (4)Potty post-office (2)Grantee becomes active component (7)Bent caliper is similar (7)Dug up precious metal eggs (3)Element of sport (2)Regret French street herb (3)Fawlty oracle (5)Sounds like it's flying with royal magician (8)Note the missing centre (2)Too much French on state rises after attack (8)Half a ballet dress for a short day (2)I cure mixed waste (5)Utilised second hand (4)

Christmas CrosswordCompiled by Dr Michael Colley, Great Western Hospital, Swindon

The clues are given

in alphabetical order

of their solutions.

The grid has mirror

symmetry.

Fill in the black

squares as required.

Please fax or post

your solution to the

Editor to arrive no

later than 10th

January 2004.

A prize for every

correct solution.

Current Topics Current Topics Current Topics Current Topics Current


Such an obvious thing to do – but this was a first! TheExecutive Committee of the Association of Clinical Biochemists(ACB) and the Chairmen of its Standing Committees met with

the SAC for Clinical Biochemistry at the Royal College of Pathologists(RCPath) for a day of shared thinking and vision for the profession.Fourteen of us met on a sunny day in October in the ACB Office, withits splendid view of Tower Bridge and David Blaine.

SWOT AnalysisWe started with a detailed SWOT analysis of the relative contributionsof ACB and RCPath to the profession and to the wider political agendain laboratory medicine. It wasn’t difficult to fill several pages with thisanalysis – these will serve for future reference. In very brief summarywe agreed that the ACB excels in training, scientific meetings, com-munication and links with industry whilst the strength of the RCPathlies in standards, examinations, CPD and its contacts within the pro-fession and with government. The ACB is perceived by many medicalmembers as being dominated by clinical scientist concerns whilst theRCPath is perceived by many clinical scientists as being remote andexpensive. Both organisations see opportunities and threats in theconstant environment of political change for the profession – andperhaps threats can be made into opportunities if the ACB and RCPathcan ‘sing from the same hymn sheet’.

Looking to the FutureHaving sweated on our SWOT we next turned our attention to sixspecific topics that had been chosen in advance by the participants.The present and future of each was considered by a small team of 4-5reporting back to the whole group.

Training and ExaminationsThe discussions centred on harmonising the support provided by theACB and RCPath. Medical and clinical scientist trainees should havethe same log book, curriculum, examination, programme director/regional tutor and educational supervisor. A common RITA processwould also be an advantage and should be pursued. By and large theACB provides the training and the RCPath provides the examinationand this is a system that works well. There is a growing problem withtraining capacity that requires a joint solution. Collaboration in theprovision of management training and specialist courses could alsobenefit the profession.

Forward LookingClinical BiochemistryBy Janet Smith, Association of Clinical Biochemists and Graham Beastall, Royal College of Pathologists

Report of a Joint ACB

and RCPathStrategic

Planning Day

Topics Current Topics Current Topics Current Topics Current Topics


Organisation and Delivery of Specialist Services

Specialist services are provided by a range of sources with little or no co-ordinationbetween them. As the range and complexity of specialist services increases there is a feeling that the quality of service, especially interpretation, is falling. The Supra-regional Assay Service (SAS) continues to enjoy the support of the profession butit should become more responsive to the needs of its users. The genetics white papercommits huge sums to service development and biochemical genetics will be part ofthis programme. The European in vitro diagnostics directive, as interpreted by theMHRA, poses a very real threat to the future delivery of specialist services and the ACBand RCPath must work together on a damage limitation exercise. Merit was seen in thepublication of a thought provoking article entitled “Whither specialist services?”

Promotion of the Profession and PublicRelationsThe contribution of clinical biochemistry to healthcare is poorly understood by ourclinical colleagues, by politicians and management and by the general public. Workingtogether the ACB and RCPath can stimulate the profession to become actively involvedin medical teaching at postgraduate level and in primary care. Active involvement inclinical audit, scientific reviews and evidence-based medicine will raise the profile ofclinical biochemistry with clinical colleagues. Involvement with NICE and other gov-ernment bodies needs to be developed. There is a great opportunity to work moreclosely with Primary Care Trusts in developing appropriate strategies for using diagnos-tics effectively for diagnosis and disease management. Promotion with the publicshould rely on emphasising the role of the clinical laboratory in the diagnosis andmonitoring of specific diseases, perhaps by the use of actual case studies.

Research and DevelopmentClinical biochemistry research is falling due to the loss of academic posts and thepressure of service work and training. Senior staff have a responsibility to stimulateresearch for trainees and newly qualified staff and to create the environment for itsactive implementation. Clinical biochemists can initiate research but we also have a keyrole in facilitating collaborative research. External funding remains important and thisis available from a range of local and national sources including the NHS, industry andcharities. As a profession we need to better publicise research opportunities andexamples of good practice. The ACB and RCPath should develop a research strategy forthe profession, perhaps moving the focus from analytical to applied research.

Workforce Planning for Medics and ScientistsThe joint ACB and RCPath document ‘NHS clinical biochemistry: a profession undersiege’ lays down the challenge for workforce planning. The database for successionplanning is well developed for both medics and scientists but professional coordinationis lacking, especially at Workforce Development Confederation level. In the short termpressure is being felt most acutely in specialist areas such as paediatric clinical bio-chemistry. The challenge for medics is to persuade sufficient numbers to enter the pro-fession and fill the increased number of specialist registrar posts – metabolic medicineshould help. The challenge for clinical scientists is to deliver the necessary increase intraining posts when there is no national oversight. The ACB and RCPath should beworking much more closely together at local, regional and national level – the futureof the profession is dependent on it.

Current Topics Current Topics Current Topics Current Topics Current


Support for the Profession and Wider Political

InvolvementApart from the examination and CPD it is the ACB that provides the majority ofsupport to the profession. This support needs to be better marketed and the resultsof a project to improve support to medical members are eagerly awaited. The ACBand RCPath should be collaborating to provide better support in areas such asclinical audit, evidence-based medicine and point of care testing. Conversely, theRCPath has better political connections than the ACB but these are not used effec-tively for clinical biochemistry. The ACB is considering appointing a ‘governmentofficer’ and impact for the profession is most likely to come from close workingbetween this individual and RCPath groups, including the Professional StandardsUnit and the Press and Publicity Officer. More joint work is required to develop thisproject.

Plenary DiscussionIn the open session at the end of day the topic of publications was raised. Strengthwas seen in the different content and style of ACB News and RCPath Bulletin.However, mutual benefit could be envisaged from greater contact between the twopublications committees in areas such as books, distance learning packages andwebsite initiatives.

The production, validation and promotion of clinical guidelines was identified asan area of mutual interest to the ACB and RCPath and it was recognized that theAssociation of Clinical Pathologists (ACP) could also contribute to this topic. Furtherthought would be given to developing this common interest.

Those present agreed that the strategic planning day had been a great success andthat the profession had moved forward a long way – much further than David Blainehad moved during the same period! The ACB and RCPath would consider the notesfrom the meeting in more detail and communication would remain at a high level.Graham Beastall and Janet Smith would prepare this summary article. All presentagreed that an annual joint meeting, perhaps focussed on one or two topics, wouldcontinue the momentum and benefit the profession.

The meeting concluded with thanks to the ACB for playing host, to GwynMcCreanor for taking the notes and to William Marshall for having the idea for the‘obvious’ joint meeting – the first but certainly not the last. ■

MRCPath Exam MRCPath Exam MRCPath Exam MRCPath Exam


Most candidates for the Part 2 examination submit a dissertation for theresearch element, although, as I mentioned in the first article in this series, acollection of papers or a PhD or MD thesis written during training are also

acceptable. Most candidates submit dissertations, and I will concentrate on them inthis article.

The scope of the projects on which successful dissertations are based is considerable.Many involve the development and introduction of a new analytical method but

increasing numbers focus on molecular genetic topics while others are largelyclinical.

There should usually be an element of practical bench work, but the project mustbe designed to allow a survey of and commentary on relevant literature, and toproduce results that can be assessed against this background. A project proposal mustbe submitted to and approved by the College. This ensures that the proposed workmeets the College’s criteria and avoids the risk that the dissertation might be rejectedout of hand as being unsuitable. It also provides an opportunity for the examiners tomake constructive comments on the proposal. This is not just another hurdle that hasto be jumped: any worthwhile research project should be the subject of a formalproposal that is open to peer review. Written guidelines for the preparation of disserta-tions are available from the College: get them, read them, act on them. In particular,be aware of the deadlines involved, and do not underestimate the time that it may taketo get a research proposal agreed locally, particularly if ethical approval is required.

In my experience, unsuccessful dissertations (graded B, and returned for amend-ment) are more usually unsuccessful because of poor presentation than because offlaws in the actual execution of the project. To my mind, there is no excuse for this. Icontinue to be surprised that not all candidates apparently use the spellchecker andgrammar facility on their PCs – though of course careful reading is also required aswell. It is easy to become so familiar with your own writing that you don’t noticemistakes, which is why it is essential that you should ask your supervisor to read themanuscript, preferably at draft stage and certainly when you think that it is in its finalstate.

References should be written in a standard, recognised format, with a consistentstyle for call-outs. Figures should be adequately labelled, sited as near the relevant textas possible, and given sequential call-outs. Similar figures (e.g. tables, graphs, molec-ular diagrams, etc.) should be presented in a similar format. They should be clear,and of a size such that the reader can understand the data easily. Look at some text-books and journals in your own library, and decide which ones present their figuresmost attractively and why you think this. Then adapt the favoured format for yourown dissertation. Note that the College requires that the dissertation should be of‘publishable quality’: this statement, in my view, is as relevant to the design as it is tothe content.

But if, after all your efforts, your dissertation is returned for amendment, theexaminers will have provided clear guidance on what they require you to do. You’d

Research and the

Part 2 Oral ExaminationBy Dr William Marshall, King’s College, London

Manage the Process -

Control the Future



hoped that it was done and dusted, the last thing you probably want to do is to have togo back to it but, unless you’ve made a real hash of it, it will probably turn out to takemuch less work than your initial review of the examiners’ comments suggests.Of course, it should go without saying that you have kept a copy on disc. Indeed, I rec-ommend that you make at least one back up copy, and keep it in a different locationfrom the working version. Back up regularly, and name each file clearly so that youknow which version you are working from.

Part 2 Oral Examination Once your dissertation (or thesis or papers) has been accepted, you will be eligible forthe last component of the examination. This often causes candidates more concern thanthe earlier parts, yet has the highest pass rate. That may be because its content is unpre-dictable, and because it is relatively unstructured, but it is designed to assess yourability to practise independently as a consultant clinical biochemist, and in that rôle,you don’t know what the next problem is going to be and the buck does stop with you.

Your examiners will be two senior members of the profession, chosen from depart-ments in which you have not undertaken any of your training – except, perhaps for ashort period of secondment. One will be a clinical scientist, one a medical clinical bio-chemist. Half an hour before your oral is scheduled to start, you will be given somewritten material to study. One is likely to be a problem related to laboratory manage-ment; for clinical scientists, the other is often a technical problem while for medicalclinical biochemists it is a problem centred on clinical management.

The first 20 minutes or so of the examination will be based on these problems, soprovided that you are not stumped by them (and if you are, you probably shouldn’t bethere) you should be able to think through the likely course of the questioning andhave at least some of your answers prepared. You will then feel more confident duringthe later stages of the examination, when the questions may range over a wide varietyof issues. These will include management topics, technical questions, questions relatedto clinical advice – in short, questions on any matter that, as a consultant, it might fallto you to deal with.

PreparationGiven the open endedness of this part of the examination, you might wonder how youcould possibly prepare for it. Appropriate experience is essential, and your educationalsupervisor will be doing you a disservice if he/she recommends you for the examina-tion before you are ready.

Examiners should avoid ‘parochial’ issues (e.g. relating to only one of the countries ofthe UK or to the UK only) but clinical biochemists will have a role in leading theservice wherever they have trained and are going to work. The management questionsthat you may be asked are intended to probe your awareness of this role, and yourability to deal with common problems that may confront you in your work. You shouldbe up to date on important general topical issues – for example, at the time of writing,risk management, data protection issues and evidence-based medicine, as well asstandard topics such as quality assurance, accreditation, continuing professional devel-opment and so on. You should have been attending the management meetings in yourown department and ideally should have direct experience of management issues, albeitunder supervision. For practical reasons, this is not always possible, but you should beaware, for example, of how to deal with incidents where a wrong result has been issuedor when a colleague’s behaviour has been unprofessional, how to make the case for anew investigation and how to liaise with a colleague who wants some assays performed

THE NEED FOR CHANGE IS USUALLYPLAIN TO SEE, the difficulty is in identifying what and how. In the view ofAlan Trinder, General Manager ofOlympus Diagnostic Systems, the NHSneeds to regard the bigger picture ratherthan the individual components if itÕs toachieve a single entity healthcaredelivery system.

Who is the NHS creating value for?What role does each part play in delivering that value and how do theylink with one another to create a whole that is bigger than the sum of itÕs parts?

Fundamental questions that need anobjective viewpoint to be answered.

Trinder has a simple three word solutionthat belies the depth and breadth of thephilosophy that Olympus has embracedand is now applying. He calls it, ÒTotal Process ManagementÓ.

ÒOlympus Process Management (OPM)is about tracking the patient journeyfrom the GP surgery to the hospital,from ongoing care (of which diagnosticanalysis in the laboratory is an integralpart) right through to eventual discharge and beyond. In the best medical tradition, itÕs about determininga cure not just treating the symptoms.Ó

ItÕs estimated that laboratory medicinecontributes to 80% of clinical decisions.As an experienced provider of laboratorytechnology Olympus is very aware thatefficient, successful healthcare hinges

on the rapid gathering and transfer ofreliable information.

Trinder continues, ÒOPM provides a topdown view of healthcare delivery. Firstwe conduct a detailed study (we call it Ôprocess mappingÕ) and thisexamines all aspects of the serviceincluding staffing resource, thetechnology employed, potential riskfactors and likely future requirementsand developments. This study oftenreveals processes that have evolvedfrom a fragmented approach toequipment introduction and highlightsareas where bottlenecks occur,unnecessary risk is present or thereÕsjust plain inefficient practice.Ó

One example of this is that by the provision of a positive patientidentification system which not onlyensures that the right diagnosis is givento the right patient, but also that thestatus of the patient is known at everystage of the process.

Subsequent stages in the study utiliseparallel mapping software to evaluatedesired outcome against an agreedrationale and the development of aÔprocess planÕ that details what isrequired. By evaluating each processthe plan encompasses staffing resource,external interactions and of coursefinancial implications.

THE SHORT TERM SOLUTION

IS TO BUY ANOTHER LABORATORY ANALYSER

OR MAKE THE STAFF WORK HARDER ...

THERE IS A BETTER STRATEGY

Alan Trinder

For further information: email [email protected]

ÒThis is about putting the patient

at the heart of the processÓ



as part of a research project. You should have been having regular tutorials with your educationalsupervisor. And you should have attended appropriate management courses, whether organisedlocally or nationally (e.g. by the ACB). But remember that attendance at courses is no substitutefor hands on experience and that, at this level of seniority, you may have to create educationalopportunities for yourself, and manage your time effectively to combine your continuing trainingwith the requirements of service delivery. That is a management skill in itself.

In addition, you should have had extensive experience acting as duty biochemist, liaising withboth hospital and primary care doctors and other health professionals and have been continuingto attend clinical meetings.

The Part 2 oral examination is sometimes criticised because the assessment of performance islargely subjective, but in my considerable experience as an examiner, it does work. A reveredmentor of mine described the oral as ‘a conversation between colleagues’. It is usually obviousfrom very early on whether or not the candidate has the experience necessary to be able topractise independently or whether, were you to have the candidate in your laboratory as a locumwhile you took a fortnight’s leave, you would find the place in chaos on your return. And I havenever known an occasion when the two examiners’ views differed as to whether a candidateshould pass or not.

If you pass, congratulations. You will have achieved a qualification that is held internationally inhigh esteem. If you don’t, don’t despair. You will be given feedback and guidance to help you inyour next attempt, and when you do pass, the qualification will be no less highly regarded than ifyou had passed first time.

ConclusionI hope that these articles have gone some way towards demystifying the MRCPath examinations inclinical biochemistry and will help both candidates and their educational supervisors. I amgrateful to Trevor Gray (Chairman of the Panel of Examiners) and Beverley Harris (currentlypreparing for the Part 2 examination) for their comments on early drafts of these articles, but theopinions expressed are my own, and if, despite our combined efforts, there are any errors or misleading statements, they are my responsibility and I apologise for them. ■

DEPARTMENT OF CHEMICAL PATHOLOGY

Tandem Mass Spectrometry

in the Clinical LaboratoryA One Day Meeting - Thursday 26th February 2004

Topics include application of Tandem Mass Spectrometry in

Neonatal Screening • Haemoglobin Analysis

Drugs • Enzymology • Small Molecules

CME and CPD accreditation applied for.Delegate fee: £40.00 (£10.00 for Grade A Trainee) - cost includes catering.

Further details from: Professor R Swaminathan, Chemical Pathology, St Thomas’ HospitalTel: 0207-928-9292 Ext 3542. Fax: 0207-928-4226 Email: [email protected]

GuyÕs and St ThomasÕ HospitalNHS Trust



ESR (Electronic Staff Record) ProjectThis is an IT system that will replace all existing HR and payroll sys-tems in the NHS. There are three ‘forward’ pilot groups (King’sLynn, North East Wales and Newham) and another 13 pilot groupswhich will test the roll out strategy.

This system will mean payroll functions will be centralised insteadof being located within each Trust. It also means there will be a cen-tral source of information about the number of staff and their grades,information which up to now proves elusive when we are discussingrecruitment and retention issues.

The impetus for the ESR is to replace existing HR and Payroll systems (the NHS currently runs 29 different payroll systems!).However, there are also additional optional modules covering “Time &Attendance” and “Occupational Health” so there is some concern overwhat information would be held centrally rather than just at the indi-vidual employee’s site of employment.

Further information and regular newsletters about the progress ofthe project are published on the website:http://www.doh.gov.uk/sharedservices/esr/newsletters/

Employment Law Supporting Family

Friendly WorkingThere have be recent changes in the legislation covering maternity,paternity and parenting leave. These changes to the law have beenreflected in the recently released (and probably last ever!) amendmentto the General Whitley Council Terms and Conditions,AL(GC)1/2003. Your Trust HR will have all the details. But it is beingmentioned here because there are limits about the timing when mak-ing claims, so contact your HR department and ask for their advice ingood time.

Employment Equality Further UK legislation, enacting the EU Human Rights Directive, willshortly introduce protection of employees against discrimination aris-ing from religion or belief and from sexual orientation in addition tothe established legislation against sex, race and disability discrimina-tion. Potential conflicts between the various headings will provide thearm-chair lawyers with cause for endless debates and the real lawyersincome, no doubt, for many years to come.

News fromManchester Training CourseReported by Paul Walker, Yorkshire FCS Representative

The recent FCS representatives

training session heldin Manchester was

the usual mix ofinformation

dissemination andskills development.

This is a flavour of what was discussed.


Legal Advice for MembersOur contract for Industrial Relations legal advice also has some additional benefitsfor the membership for help with non-IR legal matters. Further details are availablefrom your Regional FCS rep but the list includes

• legal advice on non-employment matters (we once had a case of “man bitesdog” needing advice!)

• (fixed-fee) conveyancing package• (fixed-fee) will-writing service• personal injury claims, including holiday injuries ■

ACB Management Course

2004University of Surrey

27th June-2nd July 2004

Maximum of 28 (Specialist Registrars/B & C grade Clinical Biochemists)Cost: £600

The week will build on the acclaimed 2003 ACB course.

• Designed for those preparing for MRCPath and senior laboratory management.

• Utilising lectures, workshops, discussions, group projects, debates and

presentations.

• Led by senior members of the profession, NHS managers and the Postgraduate

Medical School Department of Health Care Management.

The course will look at the NHS, its changing structure, finance and staff groups. Withlectures on the psychology of organisation structures, NHS & the law and managingyour laboratory budget, it will examine costing tests, laboratory organisationalstructures, training, job descriptions, employment legislation, ethics, appraisal andpeople management.

It will explore laboratory quality issues with presentations on CPA, NSF, MDA, Auditand Clinical Governance. Research presentations will examine governance, funding,intellectual property rights and critical appraisal.

With course places restricted to 28, interested trainees should apply as soon aspossible. Application forms can be obtained from the Association of ClinicalBiochemists administrative office ([email protected]). Further details from StephenHalloran ([email protected]).


Meeting Reports Meeting Reports Meeting Reports Meeting Reports


For many years I have seen the fliers for this series of meeting, untilnow I have not had the opportunity to attend. The Trust Director ofMedical Education thought the conference was expensive for a

couple of days and asked me to try and keep the cost to a minimum.Living a few miles from the Channel Tunnel I caught a Sunday eveningEurostar to Brussels and a local train to Antwerp. Belgian trains areexcellent, but unfortunately it took two hours to travel from Ashfordinternational to the tunnel at Folkestone a matter of ten miles. Arriving atthe magnificent Central station I went in search of my hotel and found itneatly tucked between a lap dancing club and other assorted adultentertainment establishments. The hotel was fine until 5 am when without the slightest warning my bed collapsed neatly rollingme on to the floor. A sense of humour was obviously necessary for thisparticular hotel.

On Monday morning the conference was opened by HenckGlodschmidt and Jean Claude Libeer in the beautiful “Het Elzenveld”which dates from the XIIIth century and was the first hospital in Antwerp.

Professor J C Libeer gave the first talk title “A CE label for medical laboratory services?” This talk cantered on the IVD directive (EC98/79)which should have full implementation by December 2003. How manyof us working Biochemists are aware of the possible implication of thisdirective on the services we offer. For most Biochemists I suspect GUM isa clinic that should be avoided and VIM is a household cleaner. In qualitycircles the GUM, short for the Guide to the expression of Uncertainty inMeasurement, and the VIM, the International Vocabulary of Basic andGeneral Terms in Metrology. For the dyslectic and poor sighted among usthis has nothing to do with the weather or the Paris underground.Metrology is the science of measurement. Dr Libeer argued that themajority of the measurements in clinical laboratories are not traceable toSI units but to arbitrary units. This makes the traceability much more dif-ficult. The theoretical consequence for laboratories is the harmonisationof results allowing the possibility of common reference ranges and thetransferability of results between laboratories based on true values.Metrological traceability is not the same as Clinical traceability as evidentwith HbA1c measurements using the IFCC standardisation which will beused by metrologists and the DCCT traceability which is used by the prag-matist.

This talk was followed by Prof Dr Matthias Müller current president ofthe IFCC and a renowned scientist discussing the Traceability in labora-tory medicine. This was the first time I was introduced to the term “mea-surand” which is a lot more relevant and meaningful than “analyte”. Hewent on to discuss the Joint Committee on Traceability in Laboratory

Quality in theSpotlightReported by Edward Kearney, Margate

A report of the qualitymeeting in Antwerp,17th & 18th March

2003



Medicine (JCTLM) which was formed in Paris last year. The JCTLM will support comparabil-ity and equivalence of measurement results in laboratory medicine, through world wideaccepted traceability efforts following the principles of metrology. In addition the JCTLMwill support the IVD industry in registration and licensing the CE label for their productsconforming to the EU directives. By the 7th of December 2003 new IVD products can onlybe distributed in Europe with the CE mark. What impact will this have on UK laboratories?Will all results eventually have to have a CE mark? Do we know the traceability of our results?Do we know the uncertainty of our results? I fell we still have a very long way to go.

Dr C M Cobbaert gave a very interesting talk titled “Calibration 2000 and lipid standard-ization in the Netherlands: an answer to European Directive 98/97/EC on IVD and MD?” Inthis elaborate study sixteen potential reference materials (PRM) were investigated for suit-ability for use as a certified reference material (CRM). None of the commercially availablematerials were suitable as a PRM. The use of this PRM in the Netherlands has the potential toreduce inter-laboratory variation to 2-4%. The group used the NCCLS C37-A procedure toprepare this material and have submitted a international lipid standardisation proposal to theIFCC.

Robert Kisabeth MD from the Mayo clinic foundation gave a passionate talk about thecentral role a laboratory plays in patient care. The slant of the talk was that it’s the laboratorythat decides treatment for a wide range of conditions, the Physicians only follow the resultswe give. Because of this role the quality of our results is even more important. From choles-terol to HER-2-NEU the laboratory decides who will be treated and in a lot of cases howthey are treated. Not only do we decide treatment but also if co-existent risk factors or targetorgan damage exists (previous MI, CHF, DM, Renal failure). Small shifts is bias of ourmethods can have a profound effect on patient welfare. His final statement is so true and Iexpect all of us can identify with it “Laboratories will continue to distinguish those MedicalTeams consistently effective in providing care from those condemned to go through themotions”.

The 2003 Westgard Quality Award was presented to Dr Carmen Ricos from Barcelona whoalso gave the cornerstone speech “Integration of data derived from biological variation intothe quality management system”. Her talk centred on the premise that Biological Variation(BV) is the pillar for managing quality in laboratory medicine. BV data is available for about250 common measurands. BV is integrated into the three areas of laboratory activity, pre-analytical, analytical and post-analytical. One draw back of published BV is that all the datawas collected from healthy subjects! Her conclusion was that BV is an open road for gaininginformation that will:

• assure sample quality• improve the analytical process• allow autoverification of laboratory reports• provide a clinical prognosis regarding patient status.

There is still a lot of work to be done in this area.A fascinating conference dinner talk was given by Per Hyltoft Petersen titled “Per’s

hobbies: the grandchildren, numbers, statistics and the garden. How long will quality be infashion? “Not only did the talk entertain but statistical links were made between all of theabove in a very amusing and interesting way. A challenge for any speech maker!

I must admit that I failed miserably at the infamous post-prandial Limerick contest, aninteresting diversion for any conference dinner.

The highlight of the conference for me was a talk on Tuesday by Prof J O Westgard on“Assuring quality by Automatic Validation”. He spent some time on the six sigma process



where we need to improve the quality of the methods we use and make them more robust.If we achieve six sigma methods then a single 13s control rule will be adequate for use.Rather than expand on six sigma here the Westgard web site (www.westgard.com) hasexcellent articles explaining this concept. For my own use the development of the multi-stage QC is probably the most useful addition to this area for several years. Prof Westgarddescribed the process where QC is in three stages. Stage 1: Start up QC which is designed forhigh error detection. Stage 2: Monitor QC designed for low false rejection. Stage 3: Measurerun length, where the average of normals is used to monitor stability and determine whennecessary to revalidate the process.

He went on to describe how we need to determine the quality we require for laboratorymethods and the desirable characteristics and the process for Automatic Validation whichwill lead to quality results.

As Gulf War II started the previous evening and with the uncertainty surrounding it, a large number of delegates decided to return home early and attendance atthe afternoon session was reduced. This did not detract from the continued high quality andinteresting talks on software for autovalidation and intelligent quality management just to name two.

For many years I have heard that “quality is not a problem and everybody knows how torun a good IQC programme”. Sadly a large percentage of our profession don’t really under-stand QC or QC planning. I can recommend a paper to be published in the Annals of ClinicalBiochemistry in November by James Westgard on “Internal quality control: planning andimplementation strategies.”

The conference abstracts run to over 500 pages and includes all relevant papers and copiesof all presentations, and is a very useful addition to any library.

Despite the travelling and accommodation problems the conference was well worthattending and I am hopeful of returning next year. ■

Enhanced Support for Blood Gas AnalyserUsers in Ireland

Radiometer has established a new company from 1 January 2004

Radiometer Ireland Limitedtogether with Radiometer Limited, will give an enhanced service to bloodgas users in the Republic of Ireland and Northern Ireland.

Further information from:

Radiometer Ireland Limited Radiometer Limited5th Floor Manor Court24-26 City Quay Manor RoyalDublin 2 Crawley RH10 9FY

Tel: 01 888 3611/2 Tel: 01293 517599Fax: 01 888 3613 Fax: 01293 531597

Email: [email protected] www.radiometer.com www.bloodgas.org

Corporate News Corporate News Corporate News Corporate News


The meeting room was packed full to capacity as delegates heardtwo presentations relating to BNP: one dealing with clinicalissues and the other looking at the development of the assay from

Bayer’s business perspective.

Clinical ConsiderationsIn her presentation, Theresa McDonagh from Glasgow explained thatdiagnosing heart failure in the primary care setting is very difficult, asthe key symptoms of breathlessness, oedema and fatigue are present innumerous different disease states. Diagnosis appears to be false in 50%of cases, and in some areas fewer than 50% of patients having a hospitalconsultation for coronary heart failure are referred for echocardiograpy.In Glasgow, only 20% of those patients referred for echocardiographyare found to have left ventricular dysfunction. This needs to be consid-ered in the context of the National Service Framework (NSF) for heartfailure and the requirement for GPs to establish heart failure registers,investigating those patients suspected of suffering from the condition.

Theresa then moved on to the specific subject of BNP measurement,describing the current state of knowledge in the literature. She said thatBNP levels have been shown to correlate with decreased left ventricularejection fraction, and also with the New York Heart Association’s clinicalclassification of heart failure. As a result of the evidence in the literature,the European Society of Cardiology has published a diagnostic algorithmwhich suggests using BNP as one of the frontline rule-in/rule-out tests forthe condition. With a negative predictive value of over 98%, this simpleblood test would be used to select those patients who should be investi-gated via echocardiography and other expensive techniques. A similaralgorithm has now been suggested in the second draft of the NationalInstitute for Clinical Excellence (NICE) guidelines for heart failure.

Delegates were then given an overview of the business case that NorthGlasgow University Hospitals NHS Trust is about to consider for theintroduction of a routine BNP testing service. According to Theresa,echocardiogram services are currently costing the Trust approximately£500,000 per annum, with consultant episodes adding a further£500,000. While the provision of a BNP testing service would cost anestimated £36,000 per annum, it could potentially realise a saving of£500,000 in reduced echo referrals for North Glasgow and £1 millionfor Glasgow as a whole.

Concluding her presentation, Theresa cautioned that the screening ofpatients with suspected heart failure may just be the tip of the icebergfor BNP testing, as the assay is also now emerging as a tool for progno-sis and monitoring the effectiveness of treatment.

Introducing a NewBayer TestBy Philippa Roberts and Julian H Barth

The BayerDiagnostics’

lunchtime workshop atFocus 2003

looked at BNP

Corporate News Corporate News Corporate News Corporate News


The Manufacturer’s View

The second presentation was given by Lauren Foohey, Bayer Diagnostics’worldwide marketing manager for cardiac markers. Lauren outlined thework involved in researching market opportunities, business case justifi-cation, research and development, manufacturing and the regulatoryeffort which underpins the launch of a new assay. In the case of BNP, thewhole process began four years ago and has involved reaching patent andlicensing agreements with Shionogi Company Limited of Japan whichsupplies the monoclonal antibodies used in the method. Following sub-mission of a detailed £510K application, the ADVIA® Centaur™ BNPmethod has also recently been granted FDA approval.

Lauren also talked about the decision to utilise the same cut-off pointfor diagnosis of heart failure in the BNP assay for the ADVIA® Centaur™as the one used in the Biosite Triage assay. She explained that thisdecision had been taken after extensive discussions with leading biochemists and cardiologists who wanted to see the same cut-off pointused in order to reduce clinician confusion. The need for an interna-tional reference preparation is currently under discussion with the IFCCCommittee on Standardisation of Markers of Cardiac Damage.

BNP AvailabilityHeart failure is the fastest growing area of cardiovascular disease in thewestern world and is the only cardiovascular condition which is increas-ing in both incidence and prevalence. Population statistics suggest that0.5% to 2% of the general population suffer from heart failure, with thisfigure rising to greater than 10% in the over-55s. A high proportion ofthe heart failure budget is currently spent on hospitalisation of patients.

Measurement of BNP can help to achieve delivery of the improved stan-dards of patient care envisaged by the National Service Framework.Availability of this test will not only benefit patients by facilitating earlierdiagnosis, but also has the potential to generate long-term cost savings byreducing demand for echocardiography and unnecessary therapy. Nodoubt we will be hearing a great deal more about BNP in the months tocome. ■

Situations Vacant Situations Vacant Situations Vacant Situations


Vacant Situations Vacant Situations Vacant Situations Vacant


York HospitalsNHS Trust

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LABORATORY MEDICINE

CLINICAL BIOCHEMISTGRADE B£24,128 - £26,097 pa 37 hrs pwApplications are invited from State Registered ClinicalScientists for the post of Senior Biochemist in theDepartment of Clinical Biochemistry at York Hospital.This hospital has recently become a teaching hospitalas part of the newly formed Hull York MedicalSchool. The hospital has 750 beds serving apopulation of 300,000 within York and surroundingareas. There is a wide range of clinical servicesincluding A&E, ICU, HDU, CCU, SCBU, Renal Unit,Neurology and a Diabetes and Endocrinology Centre.The hospital has been awarded 3 star status for thelast 2 years and the Department of ClinicalBiochemistry is fully CPA accredited.

The laboratory is well equipped with modernanalysers and there is an ongoing programme oflaboratory extension and refurbishment. We haveexcellent links with the clinical teams and you will beencouraged to develop your clinical understandingand take part in audit, teaching, research anddevelopment.

You will have completed Grade A training and havesome Grade B experience preferably with DipRCPathor about to take Part 1 MRCPath in the very nearfuture. Full training for completing MRCPath will beprovided including case discussion and attendance atclinics. You will be encouraged to attend regionaland national meetings and full funding will beprovided.

The offer of this post is subject to standardcriminal record disclosure.

Informal enquiries and visits should be arrangedthrough Dr Ahmed Waise, Consultant ChemicalPathologist on 01904 725670 or Dr Ian Holbrook,Grade C Clinical Scientist on 01904 725786.

Application form from Ann Mitchell on 01904 725852 or email:[email protected]

Closing Date: 23 January 2004.

Working towards equal opportunities, job share applications welcomed for all full time positions. We operate a no smoking policy.

Situations Vacant Situations Vacant Situations Vacant Situations


To advertise your vacancy contact:ACB Administrative Office, 130-132 Tooley Street, London SE1 2TU

Tel: 0207-403-8001 Fax: 0207-403-8006 Email: [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 towards state registration and the MRCPath examinations. For advice, contact your Regional Tutor.

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

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individual tubes, sealed with screw-tops, without touching them and to lift tubes out of the rack (even those tricky ones in the middle).

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Documents

Issue 488 December 2003v2 - Association for Clinical ... · PDF fileThe Association of Clinical Biochemists ¥ Issue 488 ¥ 20th December 2003 s. About ACB News ... Dr Judith Burrows