Harrogate Style Controlling VitaminD Demand Diagnostic HbA1c · 2014-03-14 · Inthisissue...

In this issue

AusterityPlanningHarrogateStyle

ControllingVitamin DDemand

DiagnosticHbA1c

SensitiveTroponin

Nominationsfor NationalMember

The Association for Clinical Biochemistry | Issue 580 | August 2011

ACBNews

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

EditorDr Jonathan BergDepartment of Clinical BiochemistryCity HospitalDudley RoadBirmingham B18 7QHTel: 07973-379050/0121-507-5353Fax: 0121-507-5290Email: [email protected]

Associate EditorsMrs Sophie BarnesDepartment of Clinical Biochemistry12th Floor, Lab BlockCharing Cross HospitalFulham Palace RoadLondon W6 8RFEmail: [email protected]

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

Dr Derren ReadyMicrobial DiseasesEastman Dental HospitalUniversity College London Hospitals (UCLH)256 Gray's Inn RoadLondon WC1X 8LDEmail: [email protected]

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

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

Display Advertising & InsertsPRC AssociatesSundial Court, Unit 4 - Ground FloorBarnsbury LaneTolworthSurrey KT5 9RNTel: 0208-337-3749 Fax: 0208-337-7346Email: [email protected]

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ACB PresidentDr Julian BarthDepartment of Clinical BiochemistryLeeds General InfirmaryGreat George StreetLeeds LS1 3EXTel: 0113-392-3607Email: [email protected]

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

Printed by Swan Print Ltd, BedfordISSN 1461 0337© Association for Clinical Biochemistry 2011

ACBNews

General News page 4

Practice FRCPath Style Calculations page 7

Focus on Harrogate page 9

Trainee News page 16

Council Nomination Form page 21

ACB News Crossword page 22

Situations Vacant page 23

Issue 580 • August 2011

The monthly magazine for clinical science

Issue 580 | August 2011 | ACB News

Front cover: Martin Myers, Peter Wheeler, Philip Hudson and Ian Barnesdelivered an interesting session at Focus 2011 in Harrogate which isreported in this issue

The Arena & Convention

Centre, Liverpool30 April - 3 Maywww.focus-acb.org.uk

focus on the patient

4 | General News

ACB News | Issue 580 | August 2011

SudokuThis month’s puzzle

Lastmonth’ssolution

Old Film Now On InternetFollowing the item in last month’s ACB News aboutthe early film of the Pathology Department at theRoyal Hospital in Sheffield, clips have now beenplaced on the internet for viewing. You can find themonline in the Wellcome Library catalogue. The linksare as follows:

Part 1: https://catalogue.wellcome.ac.uk/record=b1750054~S3Part 2: https://catalogue.wellcome.ac.uk/record=b1750050~S3Part 3: https://catalogue.wellcome.ac.uk/record=b1750057~S3

Call forNominationsfor Position ofNational Member2011In accordance with the provision ofArticles 14 and Bye-law 6, nominationsare called for the position of NationalMember of Council for a term of threeyears. There is one vacancy.National Members may be asked to

take on additional roles during theirterm of office.Nominations for these positions,

duly countersigned, should be made onthe nomination form in this issue ofACB News and sent to:

ACB Administrative Office130-132 Tooley StreetLondonSE1 2TU

before 30th September 2011. �

General News | 5


Focus on NHS ImprovementNext month we will be profiling some of the work that theNHS Improvement team has done in the area of pathology.Over the past three years the NHS Improvement Diagnostics

Team have been working with a number of pathology sites totest Lean methodology, to demonstrate the benefits both topathology and the impact on the wider healthcare system usingthis methodology. Find out more next month. �

Staff working in the Department of ClinicalLaboratory Sciences at Doncaster & BassetlawNHS Foundation Trust were amazed to receivethe Department of Health Chief ScientificOfficer’s Award for Leadership. Their projectshowed how Clinical Biochemistry andHaematology were able to work together toprovide a multidisciplinary out of hours servicefor Bassetlaw Hospital thereby securing andsustaining these vital services. TheDepartments merged to form the Departmentof Clinical Laboratory Sciences. A full 24 hourmulti-disciplinary Haematology and ClinicalBiochemistry service has now been achievedwith massive benefits for staff and patientsalike. The judges remarked on the excellentleadership skills displayed and were impressedwith the collegiate approach in a project thatshowed ownership by all. The judges alsocongratulated the project team on achievingthe delivery of the multidisciplinary servicewithin six months. “There was a real possibilitythat the Haematology service at Bassetlawwould collapse and have to be provided by theDoncaster Royal Infirmary site 20 miles away.This would have meant a significant reductionin service to the patients of Bassetlaw, withincreased test turnaround times and delays inthe availability of cross-matched units of bloodfor transfusion.”Dr Shirley Spoors, Consultant Biochemist and

Head of Department said, “The entry wasoriginally entered for the Improving Qualityand Demonstrating Impact category, but wasshortlisted for the Chief Scientific Officer’s

Award for Leadership. It is a privilege and anhonour to receive this award on behalf of allstaff who have enabled this project to succeed.“The Advancing Healthcare Awards are in

their fifth year, promoting and celebrating theoutstanding achievements made byindividuals, teams of allied professionals andhealthcare scientists. Nicky Fleming, LifeSciences Professional Advisor, Department ofHealth, and special guest S J Watson, novelistand audiological scientist, presented the teamwith their trophies at a celebratory lunch atthe Royal Garden Hotel, London on Friday 8thApril 2011. �

Clinical Scientists Win Healthcare Scientist Awards

Shirley Spoors, in the centre, with to the left,Alun Price and Jean Wardell and on her rightNicky Fleming along with Steve Watson, Jan Sobieraiand Nick Dudding

6 | General News


Cardiac Marker Dialogues13th October 2011Hilton Grosvenor, Glasgow08:00 Registration09:15 Introduction

Alan Reid

Chair: Dr Paul Collinson

09:30 Sensitive Troponins – Pros, Cons, and Impact on Every Day Clinical PracticeDr James Januzzi

10:00 Sensitive Troponin in the ED: Golden Shot or Own GoalDr Nick Mills

10:30 Coffee11:00 The A, B, Cs of Implementation of High Sensitivity Cardiac Troponin Assays into Clinical Practice

Prof Fred Apple11:30 Dialogues: Moderated Breakout Session to Discuss Relevant Topics from the Morning Session12:15 Lunch13:00 Cardiac Troponin: Dialogue Session Outcome Summary

Chair: Prof Fred Apple13:30 Biomarkers in the Diagnosis and Monitoring of Acute Heart Failure

Dr Beatrice Drexler14:00 Heart Failure Biomarkers: Current Evidence, Future Promise

Prof Robert Christenson14:30 Dialogues: Moderated Breakout Session to Discuss Relevant Topics from Heart Failure Session15:15 Coffee15:45 Markers of Heart Failure – Dialogue Session Outcome Summary

Co-chairs: Prof Robert Christenson and Alan Reid16:15 Novel Markers – The Baltimore View

Prof Robert Christenson16:45 Novel Markers – The Minnesotan View

Prof Fred Apple17:00 Novel Biomarkers in the ED – We Don't Need Another Hero

Dr Paul Collinson17:30 Discussion/Open Session18:00 Summing Up

Alan Reid19:30 Conference Reception & Dinner

CPD Accreditation: Cardiac Marker Dialogues 2011 will be fully accredited for CPD schemes of theRoyal College of Pathologists and the Institute of Biomedical Science.

To submit an poster abstract please go to the website meeting: www.cmdmeeting.org.uk

Registration Fees: Early Registration prior to 1st September 2011. Fees vary from Trainee at £120 to commercial at £360.

Further details from: Tel: 0141-201-5631 Website: www.ukneqas-cm.org.uk Email: [email protected]

Topic 1: Cardiac Troponin – Analytical and Clinical Issues Pertaining to High Sensitivity Assays

Topic 2: Markers of Heart Failure – Analytical and Clinical Issues Pertaining to the Measurement ofBNP, NT-proBNP, pro-BNP and MR-proANP

Topic 3: Novel Biomarkers

Practice FRCPath Style Calculations | 7


A screening programme for Down’s syndrome has a screen positive rate of 4% and a detectionrate of 85%. Calculate the probability that a pregnancy judged to be at low risk will result in anaffected child, given that the incidence of Down’s syndrome at term is 1.84/1000 births in theabsence of selective abortion. State any assumptions made.

FRCPath, Autumn 2010

Let TP = true positives = proportion of all results which are positive in Down’s pregnancies

FP = false positives = proportion of all results which are positive in normal pregnancies

TN = true negatives = proportion of all results which are negative in normal pregnancies

FN = false negatives = proportion of all results which are negative in Down’s pregnancies

Solution of this problem requires knowledge of TN and FN. Values can be determined from theinformation given:

Incidence of Down’s at term = TP + FN = 1.84/1000 = 0.00184

The detection rate is the proportion of Down’s pregnancies detected by the test = 85% =sensitivity

Sensitivity (%) = TP x 100 = 85%(TP + FN)

Substitute (TP + FN) = 0.00184 and solve for TP:

TP x 100 = 850.00184

TP = 0.00184 x 85 = 0.001564100

and FN = (TP + FN) - TP = 0.00184 - 0.001564 = 0.000276

Deacon’s ChallengeNo 123 - Answer

8 | Practice FRCPath Style Calculations


The screen positive rate (4%) is the percentage of all results which are positive. The remainder(96%) must be negative and will constitute both true and false negatives.

Therefore TN + FN = 96% (or 0.96 as a proportion).

The probability of a pregnancy judged to be at low risk (negative result) actually having Down’sis the proportion of negative results that are false negatives:

Probability of Down’s with a negative result =

FN = 0.000276 = 0.0002875 (i.e. 1 in 3478)(TN + FN) 0.96

Question 124A man admitted with nausea and confusion was found to have a serum sodiumconcentration of 107 mmol/L. Calculate the volume of 1.8% sodium chlorideanticipated to raise his serum sodium to 125 mmol/L, and the rate of infusion expectedto achieve a rate of increase of 0.5 mmol/hour (atomic masses: Na 23, Cl 35.5).

FRCPath, Autumn 2010

Focus on Harrogate | 9


The last day of Focus brought together somekey players in our world of pathology change,including two who have strong and clearmessages. Dr Ian Barnes has now putpathology firmly alongside other key servicesin the Department of Health and that willclearly be a long-term legacy. Phil Hudson,Managing Director of Collinson GrantHealthcare, has developed an impressiveunderstanding of clinical laboratories in the UK,his views are always supported by an evidencebase, and most importantly he puts it all over ina friendly and slightly combative style.Ian started by looking at implementation of

the Strategic Health Authority driven Cartersavings programmes. He reported that nearly

all SHAs had submitted proposals to him formeeting the DofH targets, though it is clearnot all are at the same stage ofimplementation. Plans, as we all know, requirea saving valued at 20% of the total spend onNHS Pathology and this is reckoned to bearound £500 million or £50 million saving perSHA. An overview of the current situation inthe wider NHS saw a pause in reforms whilethe Government sought further consultationbefore deciding how to proceed. However,there is no reason to suggest that anythingother than the current way of thinking willdrive pathology forward. Ian felt it is veryimportant that we are positive about thefuture. We must try and overcome historical

Pathology in an Age ofAusterity . . . Lead or be Led!Jonathan Berg, ACB News Editor

Participants in the Age of Austerity session included; Martin Myers, Peter Wheeler, Phil Hudson and Ian Barnes

10 | Focus on Harrogate


structures and realise that changes arehappening now not just in the UK but alsoaround the world. We need to understandthat we are in a period of instability and thatthis is likely to continue for some time.Pathology cost improvement following on

from Carter findings is founded on thefollowing key elements:

� Lean working� Formation of networks� New testing strategies� Better clinical pathways

Ian pointed out that the DofH had made muchprogress with SHAs in progressing regionalplans. Indeed, all but one SHA now has whathe considers to be a plan for structural changein place.

Long Contracts are High Risk

Regarding the private sector Ian felt that therewould be further joint ventures andoutsourcing.There were a lot of issues withlaboratories proceeding with the procurementof new equipment and negotiating long termcontracts, and this appeared to be somethingthat the DofH strongly disapproved of. Inparticular, Ian alluded to those trying to takeout long term contracts with diagnostic

companies which he considered high risk aslaboratories cannot presently guarantee workthat far ahead. Procuring equipmentindependent of near neighbours was alsodeprecated.With regard to primary care and pathology

Ian sees a pathway-based approach as ourfuture goal. There will certainly beconsolidation, with general practitioner’shaving much more input into the service thatthey desire. There will be more competitionbut not, Ian felt, too much more. For generalpractice initiatives in point of care testingwere seen as a part of the mix but would notsolve everything.

Leadership Success

With regard to the work of the DofH itself, Iancited the pathology leadership programme asa considerable success. Pathology Harmony,the work of Gifford Batstone on the PathologyCatalogue and also the Atlas of Variation wereall areas where considerable progress has beenmade. Ian spoke briefly of the new NICEguidelines regarding ovarian cancer andCA-125 testing. Ian appreciated that this wasto some controversial, but warned againstlaboratories refusing to undertake CA-125analysis from primary care.

Ian Barnes



Left Shift on AfC

Addressing workforce issues there willcertainly be a “shift to the left” on Agenda forChange bandings, with many more laboratorystaff at AfC Band 2 to 4. Recent reviews ofpathology departments have suggested thatnumbers of staff were doing work that shouldbe assimilated to lower AfC bands.Finally, Ian asked himself the question

“Where am I going to go for the next year ortwo?” The answer to this rhetorical questionwas concentrating on service improvement,maintaining scientific input into Pathologyand not allowing the service to be dumbeddown. “We are where we are, and there areplenty of opportunities”, was Ian’s upbeatending.

Same Story Needs Action Now

Collinson Grant Healthcare came to ourattention first when they undertook studies oftwelve Pathology Departments as part of theCarter Review. Now, Phil Hudson explained,the firm has undertaken over forty suchreviews with a report about to be produced ona further sixteen in the West Midlands,(reported last month in ACB News). Phil gave atypically upbeat presentation. His first premisewas that “I don’t want to talk about dataanymore!”, though the audience was perhapsnot so easily convinced! He felt that thechanges advocated in Carter’s reports and alsoin Collinson Grant studies more recently, haveproved the point. Now, in 2011, it was time todo something about it.

Lead or be Led!

Phil pointed out some of the key political andpractical issues facing us. The aim is for allTrusts to have foundation status by 2014,necessitating the requirement for a muchmore business orientated approach tohealthcare. Tariff received by Trusts willeffectively reduce and this will certainly impacton Pathology. Policy from the DofH is stillevolving, but clearly the £500 millionpathology savings targeted by the DofH willnot go away. It is acknowledged thatFoundation Trusts are not always easy topartner with. Of course Primary Care Trusts

have difficulty now in entering into long termplanning relationships with secondary care.Hospital Trust boards do clearly care greatlyhow much is lost if their current slice ofpathology work is given to someone else. Evenwith these potential hurdles there appeared toPhil to be no case for a pathology laboratoryat every hospital. Proposing consolidation Philfeels is entirely reasonable and desirable. Thework of Collinson Grant has shown that everydoubling of capacity gives a very conservativeestimate of a 20% cost reduction.Over the longer term Phil believes the

current 150 large laboratories (in England) willreduce to somewhere between 25 and 50. Thetake home advice from Phil was:

� Firstly, you need to care much less aboutthe structure of the organisation you workfor.

� Secondly, consolidation needs to beaccepted as the right way forward.

We also need to ask ourselves if we aretraining enough leaders for Pathology for thefuture. Phil ended by saying that “ If you don’tlead it is important that you support thosewho do or else you will face being led bypeople like Phil Hudson!”. �

Phil Hudson



Practical Advice onCurrent IssuesOwen Driscoll, Stoke and Helen Ashby, Wolverhampton

The hot topic sessionrounded off Focus andhere Owen looks atTroponin and Helen atVitamin D guidance fromthe UKs clear leaders inthese respective areas

The use of diagnostic cut-offs and algorithmsdo not stay fixed, rather they evolve to reflectchanges in the evidence base and changes intrends and attitudes. This led to theorganisation of the Hot Topics session. Thethree talks in this session were viewpointsfrom three leaders in their field to help makesense of the developments in use of threebiomarkers in laboratory diagnostics.

HbA1c for Diabetes Diagnosis

After pointing out the potential inverselyproportional link between average waistcircumference and the thickness of televisions,Professor W Garry John (Norfolk and Norwich)kicked off by discussing the role of HbA1c. Theaccepted glucose cut-off values for diagnosishave changed a number of times. In 1979WHO criteria included the measurement ofglucose tolerance using 7.8 mmol/L as a fastingcut-off and 11.1 mmol/L as the cut-off twohours post glucose load. The fasting value wasrevised down to 7.0 mmol/L in 1997 along withinclusion of symptoms in the criteria and theintroduction of impaired fasting glucose.The use of HbA1c for the diagnosis of

diabetes is the next development, albeitseemingly changing the definition of diabetesfrom hyperglycaemia to hyperglycation.An HbA1c of 48 mmol/mol (6.5%) or greater

is considered to be diagnostic of diabetes.What has precipitated this development?HbA1c has a lower intra-individual variationthan both fasting and 2h post-load glucosevalues and has become the cornerstone ofassessing the risk of developing diabeticcomplications. Improvements in thestandardisation of HbA1c measurement (IFCC)have improved traceability. However, a patientwho usually has an HbA1c of 4.5% will need asignificant increase to reach 6.5% in contrastto a patient with a usual HbA1c of 6%.The WHO recommendations have made it

into NICE guidance in PH35 Public HealthGuidance Preventing type 2 diabetes:population and community interventions.It has arrived so we must get used to thepitfalls and these have to be made aware toservice users.HbA1c results can be misleading. The ability

of HbA1c to detect diabetes is affected inmany common situations including:

Professor Garry John discussed the use of HbA1c in thediagnosis of diabetes



� Iron deficiency anaemia

� Haemolytic anaemia

� Renal failure

� Rheumatoid arthritis

� Chronic liver disease

� Haemoglobinopathies

This requires the interpretation of the resultalongside LFTs, full blood count, ferritin,haptoglobin, urea and creatinine.Recommendations are HbA1c method

specific and there is still significant analyticalvariation between laboratories. Further,people have different individual glycationrates, there are differences in glycation ratesbetween ethnic groups and glycation increaseswith age. The guidelines fail to take intoaccount the inter individual relationshipbetween glycation and average glucoseconcentration. Professor John’s feeling is thatHbA1c should be used alongside existingcriteria to avoid missing those patients with aglucose above7 mmol/L, but with an HbA1c of 6.4% or less.However, the decision to diagnose still restswith the clinician.

Using High Sensitivity Troponin

Developments in the diagnosis of myocardialinfarction (MI) have in the past decade ormore revolved around the use of troponin.Dr Paul Collinson (London) spoke about howtroponins superseded other cardiac markersfor specificity and sensitivity in the evolutionof the diagnosis of MI. The universal definitionof MI came about in 1997 giving a central roleto troponin. The improved precision of highsensitive troponin assays (with 10% CVs wellbelow the 99th percentile) have helped tobetter define the normal range and have agreater ability to detect relative change in thelower end of the analytical range.With detection of MI the name of the game

is early detection and avoidance of missedevents and high sensitive troponins do justthat. High sensitivity assays enable earlierdetection of troponin elevation above the99th percentile. Dr Collinson cited severalstudies including one which had implemented

a higher sensitivity troponin assay andassociated cut-offs which reduced mortalityand morbidity as a result. Those withsuspected acute coronary syndrome appear tobenefit from the increased interventionresulting from lowering the diagnostic cut-off.Dr Collinson’s assertions are that anydetectable troponin is a poor prognosticmarker even if the elevation is secondary to,for example, reduced eGFR, an independentrisk factor for poor cardiovascular outcome. Incontrast a troponin below the 99th percentilecarries an excellent prognosis.The use of dynamic changes helps

distinguish non-ACS from ACS elevations.What constitutes a dynamic change introponin result is the subject of much debatewith studies reporting the use of deltatroponins varying from 20 to 90%. This is amove away from using troponin as a ‘yes orno’ test to query elevation and a move to amore complicated/sophisticated interpretation.Dr Collinson displayed a number of diagnosticalgorithms and recommended drawing upthem up locally in conjunction with thecardiology department. The timing of thesamples is important. This example using time0 (on admission), 3 h and 6 h results andlooking for: An increase of troponin to abovethe 99th percentile with at least a 50% changeor for a troponin above the 99th percentile, a33% change (and consideration of non ACScauses of those that don’t change). The timingof the second troponin to 6 h was acompromise and may reduce with increasedevidence, familiarity and confidence. The cut-offs are assay specific, but use of a highsensitivity assay is essential. The speakersuggested that the potential for misseddiagnosis might see The Hague taking aninterest in those laboratories not doing so andleft with the final comment that the diagnosisof AMI is clinical, involving all of the data.

Vitamin D . . . Regaining Some Control

Professor Bill Fraser started his presentation byshowing a graph of number of publicationsinvolving vitamin D against year of publication– the chart took off like a rocket. Everylaboratory in the UK is reporting that requests



for vitamin D have increased in the region of50% to 200% per annum, confirming thecurrent level of interest. He then told us ofone laboratory in Denmark where requestswere approximately 800 to 1000 samples perweek! By posing the questions “why hasrequesting of vitamin D increased?” and “canwe do anything to decrease the requests”, hewent on to revise the classical and non-classicalactions of vitamin D. Classical actions are itseffects on calcium homeostasis and the moresubtle involvement in bone health and musclefunction. Non-classical actions are the pooreroutcomes seen in low vitamin D states incancer risk, multiple sclerosis and immunefunction etc.Non-classical actions of vitamin D are

actually associations and do not provecausality. For example, it may be that lowvitamin D is a marker for something else. Hereviewed the original research showing theseasonal variation of vitamin D, before

moving on to show us the latest graphs forrepeat of these studies - seasonal variation isstill present, but the overall baseline value ofvitamin D has increased. As further weightbehind the “why?” argument, hedemonstrated that the measurement of25-hydroxyvitamin D gives the best indicationof a patient’s vitamin D level, by showing therelationship between PTH, ALP, 25-hydroxy-and 1,25-dihydroxyvitamin D, adding it isimportant to measure both 25hydroxyvitamin D2 and D3. Prof Fraser gave acautionary tale of natural remedies formenopausal symptom relief containing D2,and gave us an insight into his ownlaboratory’s practice where they seemeasurable D2 in around 10% and 30% ofsamples. Moving on to analytical techniques,he gave us a quick overview of advantagesand disadvantages of tandem MS andimmunoassay techniques. DEQAS data werepresented to show the current accuracy ofmeasurement, and problems encounteredwith NIST standardisation were discussed.Bill then considered optimal vitamin D

status, and a recent move by the all of thedata to define adequate vitamin D as 75nmol/L or above. If this level is achievable, heasked how often should we should check apatient’s level and can we decrease testrequesting. He showed data involving threegroups on supplementation with eitherplacebo or different concentrations ofvitamin D.Having told us that the half life of 25

hydroxyvitamin D is approximately 30 days,he demonstrated that it took six months forvitamin D levels to reach a steady state.Key take home points included:

� 25 hydroxyvitamin D is the best measureof a patient’s vitamin D status.

� It is necessary to measure Vitamin D todiagnose deficiency and insufficiency.

� Values assigned to deficiency, insufficiencyand sufficiency of vitamin D are constantlychanging.

� A high proportion of the elderly arevitamin D deficient.

Professor Bill Fraser looks at current approaches whichwill help to ensure that vitamin D requesting isappropriate



Bill ended by stressing that in non-classicalactions association is not causation and thatmore prospective studies are needed to provethe clinical benefit of high dose vitamin D areneeded. He did, however, give us hope that forthose patients on treatment, minimum sixmonthly retesting intervals could apply, whichmay help to reduce the number of requestscoming through the laboratory. �

James Crofts, a “lifer” at the Focus exhibition drawscustomers onto the IDS stand with his bone markerpen!

16 | Trainee News


State Registration is a formal process which weall face in our career to prove that we haveacquired sufficient knowledge, experience andcompetence to work safely withoutsupervision. It is thus considered a rite ofpassage for many trainees as well as beingessential requirement for most posts at Band 7and above.The main part of the process of gaining

State Registration (Registration with theHealth Professions Council) is administered bythe Association of Clinical Scientists (ACS) onbehalf of the HPC, and the vast majority oftrainee biochemists following the standardClinical Science training route full time areeligible to apply after 4 years. This means theearliest you can submit your application is theSeptember at the start of your 5th year.

Two Stage Application

The application is a two stage processinvolving firstly completing a portfolio whichis submitted to the ACS along with yourapplication form. Once the portfolio isaccepted, you will be invited for a formalinterview. Once you have successfullycompleted the ACS interview, you will receivea Certificate of Attainment, which can then beused for the second stage of applying to theHPC for State Registration.

Preparing your Portfolio

The ACS website (www.assclinsci.org) has aninfo pack explaining the application process,the application form, as well as a copy of thetable of competences that must be included atthe start of your portfolio, plus an exampleportfolio. There are different tables ofcompetence for different sub-specialities ofclinical science so make sure you have thecorrect one. The tables are also updatedregularly so make sure you have the very latestversion, as using an out-of-date edition will

result in rejection.The portfolio itself is large document

collating information of all aspects of yourtraining including details on your rotationsand secondments, audits and project work,meetings attended, and presentations given.In many respects it can be considered to be aformal write up of your trainee log book. Foreach major aspect described, a piece ofevidence must be provided to back up whatyou have written. Examples include letters ofsupervision, end of year assessments, abstractsof projects and presentations, as well trainingschedules and meeting certificates. You willthen need to fill in the tables of competencycross-linking your text to a piece of evidence.The aim is to prove that you have achieved therequired competences and have the evidenceto back this up.

Portfolio Detail is Key

Do not underestimate how much work isrequired to complete your portfolio, so don'tleave it until the last minute! Start a minimumof 1 month before the deadline to giveyourself enough time to collate all the bits ofevidence you need, request statements frompast supervisors, write it up, show yousupervisor and others around you who haverecent experience of the process and then getit printed and bound!Ideally, preparation for your portfolio should

begin from the start of your training and notleft until the end of your 4th year!Completing it will be much more difficult ifyou have failed to keep your trainee log bookup to date with a comprehensive list of allyour activities. Keeping a diary or list of all thedepartmental, regional, national meetings andcourses you have attended andtraining/rotation dates is very useful! Alsomake sure you keep copies of all theconference and meeting certificates to include

State Registration FromAn Applicant’s PerspectiveDarren Powell, Salford Royal Foundation Trust

Trainee News | 17


in your evidence list. Cross-referencing yourevidence to the list of competences can betricky, as knowing what pieces of evidence areapplicable to a particular competence is notalways as obvious as it sounds. It is essentialthat you get to see the completed portfolio ofsomeone who has recently gained StateRegistration as this can help you a lot!There are strict criteria for the layout,

formatting and binding of the portfolio. Threebound copies must be submitted along withyour application form.

The Interview

Once submitted and accepted, you will beinvited for an interview, which are typicallyheld at the ACB head office in Tooley St,London. If lots of people have applied at thesame time, they may also hold interviews inalternative locations and possibly on alternatedates, so be prepared to travel.The interviews generally cover a fairly

standard pattern of questions to establish yourknowledge about the importance of stateregistration, questions about yourbackground, your training, projects and auditsyou have completed and a series of technical

and clinical questions to gauge that you knowenough to deal with common problems in acompetent and safe manner. It typically lastsaround 1 hour.Make sure you are familiar with every bit of

information and piece of evidence that youhave put into your portfolio as they can pick atthe most minute detail you have included. Ifyou don’t know an answer, don’t be afraid tosay so! You will not be expected to knowabsolutely everything and one of the aims ofthe interview is to check that you aware of yourlimitations, and know when to ask for help.

Fees all Along the Line

Once you have passed the ACS interview, youwill receive your Certificate of Attainment,and can then apply to the HPC for StateRegistration. You should expect to receive ananswer from the HPC within a few weeks ofsubmission. Unfortunately, a fee must be paidat every step.You can then look forward to collecting CPD

points to maintain your HPC registration.Currently it is not known how traineesgraduating from the new MSC program willapply for State Registration. �

18 | Trainee News


This year’s March ACBTraining Course held atUniversity of Birmingham’sConference Centre was aninteresting mix of lectures,workshops and clinicalcases. Interaction andaudience participationmade this training course alively and engaging week.

Lectures

The week started off with an analytical theme,that included lectures on Fluorescence andLuminescence as well as Immunoassaytechniques and the details of porphyrinsmethodology. The day ended with someaudience participation in the form of an MCQquiz on the topics covered in the lectures – itwas clear from the results of this that sometrainees had paid more attention than others!Haematology for biochemists! We had a day

of lectures outside of our comfort zonescovering the important aspects of

haematology that we come across asbiochemists. Jo Sheldon introduced the themewith an overview of haematology whichprepared us for Roberto Stasi’s very usefulguide to identifying and diagnosing differenttypes of anaemia. Iron metabolism, red cellsenzymes and coagulation were covered andthe day was concluded with a look at the roleof the laboratory in the diagnosis andtreatment of leukaemia.Most trainees will have had limited exposure

to the management side of laboratorymedicine. So the lectures focusing onleadership and management gave us anappreciation of different management stylesand leadership skills, as well as tips on how tomanage ourselves!The day on inborn errors of metabolism was

started off with George Gray’s advice on howa DGH can contribute to the early detection ofvarious conditions. The very topical area ofprenatal diagnosis was also covered as well aslectures on purine and pyrimidine metabolismand steroid hormones.

Workshops

The first interactive workshop of the weekoccurred on the management day and lookedat what to do when things go wrong. Traineeswere split into groups, each of which weregiven a different scenario (such as a bombscare, total IT failure, power cut). The exerciseinvolved each member playing the role of acertain staff group, something which some ofus took more seriously than others! Afterdeciding (or in some cases not!`) how to dealwith the problem, a member from each grouppresented their plan of action back to all thetrainees. On the whole, most groups came upwith a logical and appropriate solution to theproblem at hand, with not too many looks of‘what were you thinking’ on the faces of theworkshop organisers.

Common Disorders UntilProved Wrong Guys!Chris Duff and Krithika Subramaniam

Trainee News | 19


The final day of the training coursecomprised of two workshop sessions. The first,organised by Danielle Freedman, involved agroup exercise on taking a patient history.With trainees posing as patients, the rest of uswe tasked with have a stab at a diagnosisbased on taking a history from the patient.Although generally well done, not everyonetook Danielle’s sound advice that ‘commondisorders are common’, with some groupsplumping for a rare endocrine conditions onthe basis of a few vague symptoms, much tothe amusement of many in the room!Following on from this, trainees participated

in an informative effective scientific writingworkshop, delivered by Mike Hallworth.Amongst other things, it was clearly evidentfrom this session that although Trainee ClinicalBiochemists are very good at writing scientificabstracts, they would not, on the whole, makevery good tabloid journalists!

Cases and Presentations

The week included a variety of fascinating andeducational clinical case presentationscontributed by trainees attending the course.Under the theme of Metabolic Disorders,

trainees from specialist laboratories gave aseries of case presentations. In addition,trainees from around the country gave a seriesof clinical case presentation on a variety ofsubjects ranging from maturity onset diabetesof the young (MODY) to autoimmune adrenaldisease. All of the cases presented by thetrainees were delivered to an incredibly highstandard and highlighted the many interestinginvestigations that trainees are gettinginvolved in across the country - a real highlightof the week!

Evening Activities

After a full day of haematology lectures,Tuesday saw the first planned social event ofthe week – Go-karting! This adrenaline fuelledevent saw teams of trainees engage in somewheel-to-wheel action in a Le Mans styleendurance race. After two hours of harddriving, and a close finish, the teamcomprising of Jonathan Grant, Briony Johnson,Neil Greig and Chris Gay came out top.Wednesday played host to the traditional

Trainees’ Evening. Following dinner and allwith drinks in hand, the trainees headed backup to the seminar room for the talks. The first

20 | Trainee News


address, given by Francis Boa, updatedeveryone on the current situation of theimplementation of the Modernising ScientificCareers initiative. Following her presentation,Francis answered a number of questions fromthe trainees. Next up, after a brief pit-stop atthe bar for those who needed liquid‘refreshment’, was Owen Driskell, a SeniorClinical Biochemist from Stoke-on-Trent whogave a talk entitled ‘The Evolving Role of theClinical Biochemist’. Amongst other things,Owen highlighted the issue of inappropriatetesting and ways in which we, as biochemists,can try and counter this problem. He alsotouched on opportunities for biochemists toget more involved in direct patient care and

how we should all try to ‘get out there’!In celebration of another fantastic training

course, trainees attended a course dinner atHighbury Hall. This gave the chance foreveryone to let their hair down, enjoying asmack up meal and a disco followed by thosewith real stamina by a trip to Birmingham’sfamous Broad Street.The week in Birmingham proved to be a

valuable learning experience and a greatopportunity for trainees to be updated onvarious topics by experts in the field. A bigthanks must go to all the speakers and theorganising committee for putting on a brilliantevent. �

Association for Clinical Biochemistry West Midlands Region

Joint Scientific Meeting withthe Royal College of PathologistsWednesday 9th November 2011Think Tank, Millennium Point, Birmingham

Morning Session� Robert Gaddie Award and RCPath President’s Lecture

� Grade A Trainee Presentations for the Robert Gaddie Award

� Multidisciplinary Approach to Provision of Pathology Services

Afternoon Session� Multidisciplinary Approach to Multiple Myeloma

� Multiple Myeloma – A Patient Perspective

� Shared Care Pathways and the Diagnosis of Multiple Myeloma and MGUS

� Tests for Polyclonal and Monoclonal Immunoglobulins in the Diagnosis andManagement of Myeloma

� Myeloma - New Test for an Old Disease and New Application of an Old Test

� Molecular Techniques and Their Uses in Multiple Myeloma

To register, please go to www.acbwm.org.uk

Council Nomination Form | 21


Association for Clinical BiochemistryCouncil Nomination Form 2011

Election of National Member of Council of theAssociation for Clinical Biochemistry

We, the undersigned, being Members* of the Association nominate

Name …………………………………………………………………………….

Address…………………………………………………………………………….

…………………………………………………………………………….

…………………………………………………………………………….

for election as National Member of ACB Council.

Name 1. …………………………… ………………………………………….Capitals Signature



I am willing to undertake the duties and responsibilities of this office if elected.

………………………………………….Signature

………………………………………….Date

* Please indicate if a Nominator is not an Ordinary Member. Every member other than aCorporate, Retired, Temporary Retired, Temporary, or Federation Member shall have onevote and is therefore entitled to support a nomination. Only Ordinary Members areeligible to hold office.

This form, duly countersigned, to be returned toThe Administrative Office, Association for Clinical Biochemistry,

130-132 Tooley Street, London SE1 2TU, before 30th September 2011

22 | Crossword


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

Prizes for your department: The first five correct solutions to appear on the ACB News fax machine (Fax:0121-507-5290) will receive a copy of the new educational Calcium Cases CD-ROM by Aubrey Blumsohn,Christina Gray, Neil McConnell, John O’Connor, Anne Pollock & Roy Sherwood and which retails at over£50. Please state clearly the name and address of the Department that is entering the competition.Remember that ACB News appears first as a PDF on www.ACB.org.uk around the 7th of each month.

Last month’s solution

Winners from Last Month:: AN Other, AN Other, AN OtherANOther, AN Other

AcrossThe 1 across, 6 across is part of thework of 19, 23 across

1 Mention recommendation (9)6 Roam prairie (5)9 Sure old Ford had become

corroded (7)10 Turn entire abnormal relation to

hollow organ (7)11 Supply water at the ready made

tea bar (7)12 Feeling sorry for complicated

pharyngitis, no rash (7)13 ‘Fawlty’ seashore hotel loses teal

footwear (9)15 Material of artist, distant but in

view (5)16 Some innumerate’s even number! (5)

19 Forced apology about return ofinitial hypertension disorder (9)

22 Gymnast organised car boot sales –loses out (7)

23 Agreeable sound of a hymn oralternative rendition (7)

25 Polypeptide resulting in you and mereturning pupil home (7)

26 Prepare rock pigeon stew withoutgin (7)

27 Follow in moss green suede shoes(5)

28 Rude offspring we hear but, as awoman, showed respect (9)

Down1 Heard unfortunate gag? (5)2 Generator break down (7)3 Go over time in original career (7)

4 Encouragement repeated inMonty Python sketch (5)

5 Within a short afternoon, quietenslipping gear (9)

6 Juggling entertainer ain't out forrecord again (2-5)

7 One silo in New York collapsed witha loud bang (7)

8 Exigency of Greece, moneycirculated neglecting primaryorganizational economics (9)

13 Biochemical belonging to him;appreciation belonging to me (9)

14 Typhoon twister 99 lackingstrength (9)

17 Stratagems follow against currentpathogens (7)

18 Find out about undefinable diffuseclouds (7)

20 Duck lasers used up the creek? (7)21 Specialty uses zoology to remove a

little weight (7)23 Some twitchy perfectionist is

overexcited (5)24 Joined, ordered to start dyke

construction (5)

Situations Vacant | 23


To advertise your vacancy contact:ACB Administrative Office,

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

Deadline: 26th of the month prior to the month of publicationTraining Posts:When applying for such posts you should ensure that appropriate supervision and training support will be available toenable you to proceed towards HPC registration and the FRCPath 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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