Comments Payne on Slow Yoga Coronary Heart Disease

ACBNewsACBNewsThe Association of Clinical Biochemists • Issue 467 • 20th March 2002

Payne on

Slow Yoga

Coronary

Heart

Disease in

Wales

College

Exam

Inspectors’

Comments

Payne on

Slow Yoga

Coronary

Heart

Disease in

Wales

College

Exam –

Inspectors’

Comments

Ace of HeartsTroponin I2nd Generation for total stability

0 24 480,0

20

40

60

80

100

120

Hrs at 37°C

cTnl

mea

sure

d, %

AIA

Other methods

Stability of cTnI

AIA-21

AIA-600 II

EUROGENETICS UKEurogenetics UK LtdThe Business CentreEdward Street, RedditchB97 6HATel 01527-59 29 01Fax 01527-59 29 02

When crucialdecisions have to bemade with life-threateningconsequensesyou have to be sure thatyou can rely on the resultsobtained and, just asimportant, theSTABILITY as well.

hanks to a wise choice of antibodies, Tosoh has succeeded in solvingthe problem of degradation of the Troponin I molecule and offer

you an EQUIMOLAR cTnI test.

This approach allows you a 2nd Generation SENSITIVITY of 0.02 ng/ml(functional sensitivity of 0.05 ng/ml).

This test is based on the unitary dry chemistry concept – AIA-Pack –where results can be produced in less than 18 minutes for cTnI, Myoglobinand CK-MB

T

About ACB NewsThe monthly magazine

for Clinical Science

The Editor is responsible for the finalcontent. Views expressed are not necessarily those of the ACB. EditorDr Jonathan BergDepartment of Clinical BiochemistrySandwell District General HospitalWest BromwichWest Midlands B71 4HJTel: 07973-379050/0121-607-3261Fax: 0121-765-4224Email: [email protected]

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

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

Focus Handbook EditorDr Sandra RainbowCentral Middlesex HospitalEmail: [email protected]

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

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

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

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

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

Printed by Piggott Printers Ltd, CambridgeISSN 0141 8912© Association of Clinical Biochemists 2002

March 2002 • ACB News Issue 467 • 3

ACBNewsNumber 467 • March 2002

General News 4

Disposable Laboratory Tips 7

MRCPath Short Questions 8

Education 10

A Personal View 14

Meeting Reports 16

New Members 18

Forthcoming Meetings 20

Situations Vacant 22

Front cover: Dunvegan Castle, Isle of Skye

ƒocus2002GLASGOW • SCOTLAND • 21-24 MAY

The Association of ClinicalBiochemists National Meeting

SECC, Glasgow Tel: 01223 404830 Fax: 01223 404841

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

4 • ACB News Issue 467 • March 2002

General News General News General News General News General News

The Woman in

Black

A night at the Theatre Royal onWednesday 22nd May is one of thesocial events on offer at this year’sFocus in Glasgow.

Spend a spine-chilling evening at Glasgow’s premier theatre as the adaptation of Susan Hill’s best- selling novel is played outbefore you.

Unanimously acclaimed by thecritics, this West End production ontour for the first time, combines theintensity of live theatre with a cine-matic quality inspired by the worldof film noir. ■

Rule 12 of the Federation ofClinical Scientists states that “theChairman, Secretary and AassistantSecretary shall be elected for amaximum period of five years andwill be eligible for re-election at theend of that period.”

As five years have elapsed sincethe election of the Secretary of theFCS, members are accordinglyinvited to submit nominations forthis post. The current Secretary, MrGeoff Lester, is willing to stand forre-election.

Nominations, including the

names of proposing and secondingmembers and an undertaking bythe nominee faithfully to undertakethe duties of the post, should beforwarded to the FCS Chairman:Mr Alan Penny, Department ofClinical Biochemistry andImmunology, Leeds TeachingHospitals NHS Trust, 26 ClarendonRoad, Leeds LS2 9NZ.

Nominations should arrive nolater than 31st March 2002.

In the event of more than one nomination, a ballot of memberswill be arranged. ■

ACB Exhibition Man Brian’s Untimely Death

Get Into Focus Right Now!With this issue we have distributed the Invitation to Participate for Focus 2002 in Glasgow. Now is the time to get your registration form back. Remember that you can also register electronically

on the website www.focus-acb.org

Federation of Clinical Scientists

Secretary

Brian Flynn, with typical style, overseeing the breakdown of Focus 2001 at ExCeL

ACB News is extremely sad to reportthe untimely death of Brian Flynnfrom Conquest Hospital in Sussex.Brian was a true enthusiast who wentabout life in a professional mannerand always with a smile. This wasclearly demonstrated in his work onFocus exhibitions.

Brian helped with a number ofexhibitions including those inBrighton as well as the WorldCongress in 1996 at Wembley. Morerecently, Brian was in control of thebuild-up and break-down of lastyear’s Focus exhibition at ExCeL.

Brian died a few weeks after being diagnosed with cancer. ■

the concept of diseaseƒocus2002

Followed by

21 - 24 May 2002

SECC, Glasgow, Scotland

ROCHE MODULAR ANALYTICS

Take the next step towards the future of Laboratory

processing with a MODULAR ANALYTICS E

combination–providing you with a tailor-made

Heterogeneous Immunochemistry testing solution,

fulfilling your needs for flexibility, expandability

and reliability; coupled with an extensive menu of

available assays.

The E170 module for MODULAR ANALYTICS

is part of the MODULAR SYSTEMS family, which

has an established track record of reliability and

operational efficiency with its 3 lane processing,

bi-directional sample transport system and Intelligent

Process Management.

What do you want to achieve today?

Take the next step towards the future

For more informationCall Sue Tilbury

01273 [email protected]

Simply Modular


General News General News General News General News General News

Dr Brian Payne, retired chemicalpathologist from St James’sUniversity Hospital, Leeds, hasbeen turning his hand to book-writing again. However,instead of academic articles oncalcium and books on statistics,Brian’s latest outpouring has beento apply scientific principles to thetechnique of slow yoga.

Brian began practising traditionalYoga in 1967 and his researchfindings include incorporatingresistance training into slow yoga,thereby bringing additionalbenefits.

Slow Yoga for Advanced Fitness,Strength and Health by Brian Payneis one of the top-selling books onslow yoga on www.amazon.co.ukwhere you can purchase it at a 20%discount for just £8.79. ■

Slow Yoga by Brian Payne ISBN 0285636200

Bookshop price £10.99

Brian Payne and the Science of

Slow Yoga

Grade A Trainees’ Representative

to Federation of Clinical ScientistsThe Federation of Clinical Scientists (FCS) is the arm of the ACB dealing with employment andindustrial relations issues on behalf of the profession. The FCS Committee and Executive takethe views of all grades very seriously and is particularly keen to foster close dialogue withtrainees and respond to their particular needs.

A vacancy has now become available for a representative of Grade A trainees to join the FCSCommittee. The representative could be a Grade A trainee or possibly recently appointedGrade B who can still speak from the perspective of Grade As.

This would is an excellent opportunity for the representative to present the views of traineesto the FCS. They would be expected to attend three FCS Committee meetings at Tooley Street,London, possibly attend the FCS training meeting in Manchester and feedback to the TraineesCommittee meeting at the ACB National Training Courses (two per annum) to foster two waycommunication. Many, now well known, members of the profession have occupied the postwhich affords an almost unique insight into the affairs of our profession and current issues inthe wider NHS.

If you are interested in taking on this role please inform Ian Phillips (Chair, Trainees Committee)on 023-8079-6442. If you require any further information please contact either Mr Alan Penny(FCS Chairman) on 0113-206-4818 or Mr Geoff Lester (FCS Secretary) on 0117-970-1212 ext 2783.

ACB Training Day

Glasgow

Monday 20th May

This year’s topics are:• Evidence-based laboratory

medicineDr D B Freedman

• Hypoglycaemia and paediatric medicineDr J Kirk

• The hypothalamic-pituitaryadrenal axisDr J H Barth

• Changing times: the new cardiovascular risk factorsDr M Dominiczak

Book using the registration formon the Focus website:

www.focus-acb.org

Please book as soon as possible. ■


Tips Disposable Laboratory Tips Disposable Laboratory Tips

"Not The Invisible Man Gloria . . .

a lack of candidates!"


MRCPath Short Questions MRCPath Short Questions MRCPath Short

Question No. 14A 0.5 mL sample of urine is extracted into dichloromethane. An aliquot of the extract isanalysed by HPLC and found to give an apparent original concentration of 320 nmol/Lof analyte Y. 100 mL of Y standard with a concentration of 880 nmol/L is added to afurther 0.5 mL sample of the same urine and the sample mixed. 0.5 mL of the mixedsample is then processed as before, giving a measured concentration of 405 nm/L.Calculate the recovery of analyte Y.

MRCPath May 2001

Deacon’s ChallengeNo. 13 AnswerYour on-call laboratory service uses 30 different methods, each of which has a 1% probability of failing QCcriteria during the course of a night. Assuming that QC of any method is independent of that of the othermethods, what is the probability that on any one night all methods will pass the QC criteria?

MRCPath May 2001

The probability of a channel failing QC is 1% = 0.01

There are only two possible outcomes: pass or fail.

Therefore the probability of a channel passing QC is 1 - 0.01 = 0.99

This problem is analogous to flipping a coin. The joint probability of two independent events is the product of their individual probabilities.

Thus if a coin is tossed once the probability of ‘heads’ is 0.5. If the coin is tossedagain then the probability of it landing ‘heads’ on both occasions is 0.5 x 0.5 =0.25. Similarly if the probability of one channel passing QC is 0.99, then the probability of two channels passing is 0.99 x 0.99 = 0.98. The chance of three different channels passing is given by 0.99 x 0.99 x 0.99 = 0.97 i.e. (0.99)3. The general rule is:

Probability of event occurring on n occasions = (probability of event occurring on asingle occasion)n

Therefore the probability of 30 channels passing QC = (0.99)30 = 0.74

If your calculator does not have the facility to calculate x y then the result can be easilycalculated using logs:

Log10 (probability of 30 channels passing) = 30 x Log10 0.99

= 30 x 0.00436 = -0.131

Probability of 30 channels passing = antilog (-0.131) = 0.74

Quidel (UK) Limited, Forestry House, Stadhampton RoadGreat Haseley, Oxon OX44 7PF, United KingdomT 01844 278400 F 01844 278877 E [email protected]

AND MORE . . . including diagnostic kits for: Bone and Connective tissue markers ·Calcium metabolism · Hormones andSteroids · Anaemia markers · Eicosanoids ·Cyclic Nucleotides · Growth factors ·Angiogenic factors · Cytokines (Sandwichformat) · Cytokines (Competitive format)

All these assays are nowavailable from Quidel

BoneTRAPMetra Dpd

25(OH) Vitamin DSerum & Urine NTx

P INP & P III NPMetra BAP

sTfR

www.quidel.uk.com


Education Education Education Education Education Education

Paper 1Q1 Describe how you would assess the costs of a new test and control

these costs once the test has been introduced.All candidates attempted this question. In general, however, answerslacked structure and comprehensiveness, suggesting that the majorityof candidates had not specifically prepared themselves to answer aquestion on this topic. Many were confined to a consideration ofstaffing and consumables costs only. There was little mention ofcosting packages and their applications. Few candidates appreciatedthat overall costs could be influenced by the level of service provided(i.e. infrequent batches versus 24h availability). Approaches to con-trolling costs often failed to mention how agreed protocols, clinicalaudit and evidence-based medicine might be used. It is irritating tosee candidates still describing their biomedical scientist colleagues as‘technicians’, a fault that was particularly prevalent in the answers tothis question.

Q2 Outline the analytical principles behind automated random accessimmunoassay systems. Discuss the quality issues raised by theadoption of such systems.All but one candidate attempted this question. Too many candidatessimply discussed the basic principles of immunoassay and some sup-ported their answers with descriptions of RIA and IRMA only! Thusthere was insufficient attempt to show how these principles havebeen adapted (compromised?) in automated systems. Most candidatesillustrated their answers with analytical problems related to specificanalytes (e.g. low-level steroid assays) but few extended the qualitydiscussion to include wider issues such as turnaround times. Someanswers suggested a rather non-critical approach to the use of EQASdata in judging analytical performance.

Q3 Discuss critically the methods used for the detection and quantitation of urinary free light chains (Bence Jones protein).The question was poorly answered overall. Many candidates simplydescribed the procedures used in their own laboratory with littlecritical appreciation of performance. Most failed to discuss quantitative immunoassay procedures, manual or automated, or theanalytical issues raised by their use such as standardisation, monoclonal v. polyclonal light chains etc.

Part 1 Examination inChemical Pathology: September 2001 Examiners’ Report

Here of tremendous use

to everyone coming up to

exams are thehelpful

comments fromthe RCPath

examiners on last September's

written paper



Q4 Discuss, with examples, the ways in which drugs can affect the results of clinicalchemistry investigations.Candidates at this level should be able to produce a satisfactory answer to thisquestion and indeed the majority were of pass standard. Most candidates were awareof both the in vivo and in vitro aspects although the latter were less well discussed andlacked sufficient relevant examples. Some answers drifted off the question and usednon-drug related examples such the effect of ketones on alkaline picrate proceduresfor creatinine. The structure of most answers would have been improved by attempt-ing to categorise the mechanisms of interference rather than presenting a randomassortment of examples

Q5 Write short notes on:i) Interleukin 6ii) Leptiniii) Insulin-like Growth Factor (IGF) binding proteins

This was the least popular question on Paper 1. The quality of answers was veryvariable with some candidates seeming to know little on these subjects. This wasparticularly true of iii) where some candidates discussed IGF instead of the bindingproteins. Most candidates produced adequate information on interleukin 6.

Paper 2

Q1 Either: Discuss the investigation of a patient found to have a serum calcium of 1.6mmol/L. Outline the differential diagnosis and appropriate management foreach diagnosis.This was a popular question but most answers were of a mediocre standard. Manycandidates simply produced a textbook list of causes of hypocalcaemia and pro-ceeded to discuss them with little feel for logical investigation or of their relative fre-quency in clinical practice. Few candidates focussed on the degree of hypocalcaemiaindicated (1.6 mmol/L). Some failed to even mention renal failure as a cause and therole of PTH measurements in directing further logical investigations was poorly appreciated. Management wasvery superficial in many answers and often characterised by loose terminology in relation to vitamin D and its metabolites.

Or: Discuss critically the methods used for the assay of magnesium in body fluids.Few candidates attempted this question and those that did simply described variousapproaches in a non-critical manner. There were too many errors in method princi-ples and little mention of assay in fluids other than serum/plasma.

Q2 Write short notes on:i) Adrenoleukodystrophyii) Lesch-Nyhan syndromeiii) Gilbert’s syndrome

All but one candidate attempted this question. Many answers were of poor quality,containing major errors as well as omissions, or were confined to generalisations.



Much time was wasted describing and drawing metabolic pathways that werenot needed or utilised in answering the question. For example, a detaileddescription of the complete catabolic pathway from haemoglobin to urobilino-gen, as given by several candidates, is not essential for the answer on Gilbert’ssyndrome. In contrast, most answers failed to mention the current understand-ing of the genetic basis for this condition. Other common factual errorsrelated to the mode of inheritance and the status of pre-natal diagnosis forthese disorders.

Q3 Discuss the biochemical disturbances caused by, and clinical consequences of, lead poisoning.This was a straightforward question for which many answers were disappoint-ing. Most candidates focussed entirely on the haematological consequences(although not all knew the biosynthetic enzymes affected by lead) and severalfailed to mention renal and neurological aspects. There was little mention ofthe relative susceptibility of children and adults to lead exposure.

Q4 Discuss the biochemical investigations which will assist in determining thediagnosis in a patient presenting with suspected steatorrhoea.There were several comprehensive and well-balanced answers to this questionthat was attempted by all candidates. Others failed to provide a current opinionon the assessment of pancreatic exocrine function and were confused over theprinciple behind the tests involved, particularly the PABA and Pancreolaurylprocedures. Faecal elastase surely deserved a mention in this question but wasomitted by several candidates! In contrast, most discussed faecal fat estimationsin a lengthy but non-critical manner. It is likely that the investigations usedwould be dependent on patient age but few acknow-ledged this as background.

Q5 Describe the ways in which free radicals disrupt biological processes.Describe how free radical damage can be monitored.Although the least popular question on Paper 2, it produced some very satisfac-tory answers. The impression given was that candidates either knew a greatdeal or very little about this subject. A common omission was the failure tomention free radical-induced DNA damage and its consequences. Candidatestended to concentrate on one or two analytical methods rather than describesystematically the different types of method, including free radical assays,measures of antioxidant activity and indices of free radical-mediated damage.

General CommentsA fundamental lack of knowledge continues to be the simple explanation for manyunsatisfactory answers with few candidates able to go beyond a simple descriptionto the type of critical analysis expected at this level. Too many attempted to answerthe questions set by adopting a ‘listing’ of relevant factors, diagnoses, methods etc.with little structured discussion. This approach does little to convince examinersthat the candidate has an adequate understanding of the key concepts. A failure tobe aware of analytical principles for common analytes is another persistentproblem.

The overall impression is that candidates fail to utilise their daily duties as anopportunity to develop a critical awareness of the application of their subject. ■

Simply go to

www.dpcweb.comDiagnostic Products Corporation - UK • Glyn Rhonwy • Llanberis • Gwynedd • LL55 4EL • Tel: 01286 871 872 • Fax: 01286 871 794

DPC - at the heart of your testing needs!


A Personal View A Personal View A Personal View A Personal View

September 1998

I feel completely out of my depth. I know that I entered this fascinatingworld of clinical biochemistry with a decidedly non-biochemical back-ground, but I didn’t expect it to be this hard. It feels like people arespeaking a different language - for a start everything is abbreviated: TFTs,747, ACS, HbA1c, MI, U&Es, from laboratory tests to analysers andmedical conditions. When people speak to me it’s not just one word Idon’t understand, it’s whole sentences!

November 1998MSc lectures again today. I can’t believe I’m going to say this but it’s a goodjob part of my training involves this MSc course. The lectures, combinedwith a department that firmly believes their trainees should spend a gooddeal of time in the main laboratory, mean that I am actually beginning tounderstand what people are talking about. Having said that, how on eartham I ever going to remember all these facts? There are too many thingsbeginning with the letter ‘C’. I’m bound to mix them up. Has Cushing’sgot anything to do with cortisol or is it aldosterone, and what aboutConn’s? Today I forgot the essential requirement to get me through thelectures, something with lots of sugar in it, and hence I started to doze offin the middle of one of the analytical lectures. The aged biochemist theninsisted on telling us in great detail how things were in the 1950s butunfortunately he didn’t seem to be quite so clued up about what goes onin a modern clinical chemistry laboratory.

December 1998My interview for the post of trainee biochemist went past in a bit of a blur,but two things did stick in my mind. First. that as a new trainee it wouldbe my job to organise the departmental Christmas party and secondly, thatI should not expect to get a job within the department after completion ofmy training. Well, I’m planning the party at the moment, which is noproblem. But the idea of the department putting three years time andeffort into my training and then apparently having no intention of keepingme on does seem a bit bizarre!

February 1999I spent this morning sitting with the duty biochemist. It was a goodchance to see if what I have been learning in my lectures bears any

Extracts from theDiary of a TraineeBiochemist


A Personal View A Personal View A Personal View A Personal View

resemblance to real life. It does. There was a patient with hypernatraemiaand hypokalaemia so we phoned up the GP to query Cushing’s. I wastotally amazed when I realised I actually understood what was going on. Ifeel much more useful now – after all this is what biochemists are for isn’tit? I went to an ACB meeting this afternoon. This was a chance to furthermy knowledge and enjoy free biscuits. The meeting was about tumourmarkers and I actually thought it was really interesting. Not everyone didthough; as usual the same man dozed gently throughout. It’s hilariousbut it just goes to show that some biochemists really are dinosaurs!

May 1999Just got back from Focus. One of the great things about being a trainee isthat I got to go to the whole week. After spending the last few monthsreading books by acclaimed names in biochemistry such as Rick Jones,William Marshall and Gordon Challand, suddenly I actually saw these biochemical geniuses up on stage playing the guitar, having a drink and acigarette, and generally chilling out. And of course, apart from all theentertainment, there was an extensive scientific programme and an oppor-tunity to meet the other trainees in the country.

June 1999Spent the afternoon looking at my MSc project data and trying to decidewhether any of it was significant. Why is it that when I do research I getthe opposite results to what everyone else has reported in the literature?My results must be right I’m sure. Perhaps I will prove everyone elsewrong and be recognised as the scientific whiz kid that I am… Anyway, Iam determined to get my project finished this week, impress my supervi-sor and imprint on everyone’s mind that biochemists are not a waste ofspace and really are of great value to the NHS.

August 1999Finally finished my project. This month my training is to be dividedbetween (more) routine lab work and spending time with the duty biochemist. Don’t know which MLSOs I am going to be working with yet.That makes a big difference. I really hope it’s not that unapproachable ladywho runs the AutoDelfia. She is so possessive and doesn’t believe biochemists have the necessary skills or ability to be in the vicinity of ‘her’analyser let alone use it. It’s really frustrating because some of the MLSOsdo put time and effort into my training. Why on earth doesn’t my supervisor recognise this and try to co-ordinate my training with thesespecific people.

September 1999Well, I’m a year older and wiser, and as a result I’ve been rewarded with apay increase of 1 point. After 6 years at university and 1 year of training, Inow earn the grand total of £14,000. My friends think I’m mad.Sometimes so do I! I have enjoyed the variety of my work this year and Ican’t believe how much I’ve learnt. Unfortunately, I also realise how muchI’ve still got to learn before I’d have a cat in hell’s chance of even contemplating the dreaded MRCPath! ■


Meeting Reports Meeting Reports Meeting Reports Meeting Reports

Tackling Coronary

Heart Disease in WalesReported by Rachel Still, Princess of Wales Hospital, Bridgend

Report of ACBWales Region

AutumnMeeting held

on 18thOctober 2001

The ACB Wales Region Autumn Meeting was held at BronglaisHospital in Aberystwyth, and 40 delegates made the journey to thisbeautiful part of Wales. The programme was highly topical, and

had been chosen in order to enable discussion of the National StandardsFramework and Welsh Assembly document “Tackling CHD in Wales –Implementation through Evidence” with regards to clinical biochemistry.

The NSF: will it make any difference?Dr Stephanie Matthews from Llandough Hospital, Penarth, began with anextremely useful overview of the NSF document itself. The standardswhich will have direct impact on the laboratory were identified andreviewed. Implications for the laboratory included screening for hyperc-holesterolaemia (primary and secondary prevention), measurement oftroponin T, potential analysis of BNP in heart failure (this is not men-tioned in the English NSF document), and measurement of LDL in allpatients who should be on a coronary heart disease management system.The importance of familial hypercholesterolaemia and identification ofchildren with FH has also been identified. It is clear that there are impli-cations for increased workloads in laboratories as a result of the NSFdocument but, unfortunately, increased funding for this is not implicit.

Dr Paul Collinson (St. George’s Hospital, London) followed with anentertaining and educational talk on the use of troponins in risk stratifica-tion. In conjunction with the ECG, cTn may be used on admission toidentify high-risk patients, and to identify those patients who may berapidly discharged. He suggested that we should all establish the func-tional sensitivities of our troponin assays: a troponin T greater than 0.01g/L but less than the functional sensitivity indicates possible cardiacdamage, whilst a concentration of greater than 0.05 g/L is consistentwith definite cardiac damage. The statement that ideally we should bemeasuring cardiac-specific troponin at 0, 4 and 12 hours after admission,drew an immediate reaction from the audience as we all instantlyreflected on our unfortunate budget constraints.

BNP . . . the Herald of Diagnosis of

Heart Failure?The third speaker, Dr. Mike Penney (Royal Gwent Hospital, Newport),gave an invaluable introduction to the subject of natriuretic peptides. Hereviewed the general physiology, highlighting factors which can affect theinterpretation of ANP and BNP, particularly age, exercise and dietarysodium. He discussed the results of two recent papers (in the Lancet andBMJ) which both concluded that the strength of BNP is in its high


Meeting Reports Meeting Reports Meeting Reports Meeting Reports

negative predictive value. However, these two papers used vastly different cut-offlevels, emphasising the need to scrutinise the units used in different studies. DrPenney concluded by outlining the current problems with the introduction ofBNP or pro-BNP as a routine test. The issue of “what exactly are we measuring?”is crucial, as there are as yet no international standards and no external qualityassurance controls. In addition, there are the practical issues of unknown effects ofdrugs, exercise and renal failure, possible instability of the peptides, and lack ofage-related reference ranges. Currently, there is insufficient evidence to concludewhether measurement of BNP or pro-BNP in heart failure will be cost-effective ornot.

The afternoon session began with a presentation by Dr Andrew Hartland fromWalsall Manor Hospital. Dr Hartland has been involved with measurement ofBNP using a point of care instrument as a potential screening test to rule out leftventricular dysfunction. Whilst the negative predictive value was initially 50%,this was increased to 91% if all patients on ACE inhibitors were excluded. This isan area which is to be further investigated.

Dr David Oleesky, from Cardiff, started the subsequent All-Wales ClinicalBiochemistry Audit meeting by presenting results of an audit on reporting oflipids. Draft standards were then presented for the investigation of renal stonedisease (Mr Gareth Davies, Wrexham), followed by discussion of results of anaudit of ammonia analyses (Ms Helen Losty, Cardiff). Dr Rhys John (Cardiff) pre-sented draft standards for the investigation of macroprolactinaemia, and Mr IanHanning (Hull) presented draft standards for thyroid function testing.

On behalf of the delegates, I would like to thank the speakers for such infor-mative presentations, and Roche Diagnostics and Axis-Shield for supporting themeeting. Finally, I would like to thank Mr Gethin Roberts and Mr Trevor Baines,who organised such a useful and enjoyable meeting. ■

Annual General

MeetingsTuesday 21st May 2002

Lomond Theatre, Loch Suite, Scottish Exhibition

& Conference Centre, Glasgow

The forty-ninth Annual General Meeting of the Association of Clinical Biochemists will take place in Glasgow

at the Scottish Exhibition & Conference Centre

The Federation of Clinical Scientists’ Annual General Meeting commences at 17.15 and the Association of Clinical Biochemists’

Annual General Meeting commences at 18.00.


New Members New Members New Members New Members New Members

The following is a list

of people recently

admitted to various

types of ACB

Membership by

recent meetings of

ACB Council

Dr M Ahmed Department of MedicalBiochemistryUniversity Hospital of WalesHeath Park Cardiff CF4 [email protected]

Dr C Chaloner Booth Hall Children’s HospitalCharlestown RoadBlackley Manchester M9 [email protected]

Ms B Davies Dept of BiochemistryUniversity of Surrey/Royal Surrey County HospitalGuildford GU2 [email protected]

Dr E T Davies Dept of Immunology King’s Healthcare Rayne Institute123 Coldharbour Lane London SE5 [email protected]

Dr K A Deans Dept of BiochemistryVictoria Infirmary Langside Road Glasgow G42 [email protected]

Ms Jane French Institute of Research andDevelopment UK NEQAS Vincent Drive, EdgbastonPO Box 3909 Birmingham B15 2UE [email protected]

Mr D Gunputh Dept of Biochemistry King’s College Hospital Denmark Hill London SE5 9RS [email protected]

Dr J S Hamilton Dept of Clinical BiochemistryRoyal Victoria Hospital Kelvin Building Grosvenor Road Belfast BT12 [email protected]

Miss B E Harland Dept of Biochemistry Manchester Royal Infirmary Oxford Road Manchester M13 [email protected]

Mr R A Harvey Dept of Clinical Biochemistry Royal Free Hospital Pond Street London NW3 [email protected]

Dr R G Kendall Abbott Diagnostics DivisionAbbott House Norden RoadMaidenhead SL6 [email protected]

Miss F A Meakin Dept of Clinical ChemistryHammersmith Hospitals NHS Trust Charing Cross Hospital London W6 8RF

Mr M Redpath Dept of Clinical BiochemistryManchester Royal Infirmary Oxford Road Manchester M13 9WL [email protected]

Miss C A B Reed Dept of Biochemistry North Bristol NHS Trust Lewis LaboratoriesSouthmead Hospital Bristol BS10 5NB [email protected]

Dr A Sarker Dept of Clinical BiochemistryAddenbrooke’s Hospital Hills Road Cambridge CB2 [email protected]

Dr C A M Taylor Department of BiochemistryRoyal Lancaster Infirmary Ashton Road Lancaster LA1 [email protected]

Dr M S Walker Genesis Diagnostics Ltd Eden Research Park Henry Crabb Road Littleport CB6 [email protected]


New Members New Members New Members New Members New Members

Miss J M Walker Dept of Clinical Biochemistry Salford Royal Hospitals NHSTrustHope Hospital, Stott Lane Salford M6 [email protected]

Miss H Y Wu Dept of Chemical PathologySt Thomas’ Hospital Lambeth Palace Road London SE1 [email protected]

Dr A P Yates Dept of Clinical ResearchManchester Royal Infirmary1st Floor Clinical Sciences Bldg Oxford Road Manchester M13 [email protected]

Dr S C Endenburg Slingeland Ziekenhuis KlinischChemisch En HematologischLab Postbus 169 7000 Ad Dortinchem The [email protected]

Dr A Wu Dept of Pathology &Laboratory Medicine Hartford Hospital 80 Seymour Street Hartford 6102 [email protected]

Mrs K A Chotai Kennedy Galton CentreNorth West London HospitalsNHS Trust, Watford Road Harrow HA1 3UJ

Miss P S White Regional Genetics LaboratoryBirmingham Women’sHospital Edgbaston Birmingham B15 [email protected]

Dr L J Allison Scottish E Coli 0157 Ref LabDept of Clinical MicrobiologyWestern General HospitalCrewe Road Edinburgh EH4 [email protected]

Dr J P Maxwell Institute of PathologyRoyal Group of Hospitals TrustBelfast BT12 [email protected]

Miss G A Hutchings University of Manchester Manchester

Mr A Kalansooriya Dept of Pharmacy &Pharmaceutical ScienceDeMontfort University Hawthorn Building Leicester LE1 9BH

Mr J Ochando Dept of Pharmacy &Pharmaceutical ScienceDeMontfort University Leicester LE1 [email protected]

Mr A Adelugba Biochemistry Laboratory Bon Secours Hospital Dublin 9 [email protected]

Mr G Avery Abbott Diagnostics Abbott House Norden Road Maidenhead SL6 [email protected]

Mrs J A Gunn Dept of Clinical BiochemistryNorfolk & Norwich HospitalBrunswick Road Norwich NR1 3SR

Mr D Jordan Pathology DepartmentHospital of St John & StElizabeth 60 Grove End Road London NW8 [email protected]

Miss A Molyneaux Medical Devices AgencyHannibal House Elephant & Castle London SE1 [email protected]

Mr R Monk Department of Biochemistry Trafford General HospitalMoorside Road Davyhulme M41 [email protected]


Forthcoming Meetings Forthcoming Meetings Forthcoming Meetings

Tumour Markers

Postgraduate CentrePrince Charles HospitalMerthyr TydfilWednesday 17th April 2002ACB Wales Region Spring Clinical and Audit Meeting

Morning Session: Tumour MarkersLectures will cover the following topics:

• HCG and AFP updateDr C Sturgeon

• HCG kineticsMr H Mitchell

• Monitoring residual diseaseDr A Rowbottom

• Update on PSADr M J Duffy

• Update on CA125Speaker TBA

Afternoon Session: All Wales Clinical BiochemistryAudit Group MeetingChairman: Dr K Griffiths, Bangor1415-1445 Study of screening methods for

gestational diabetesDr F Hanna, Merthyr Tydfil

1445-1500 Draft standards for lipid reportingDr D Oleesky, Cardiff/Caerphilly

1500-1525 Audit of lactose tolerance/breath testingDr S Matthews, Llandough

1525-1545 Re-audit of urine microalbumin analysesMr A Thomas, Cardiff and Dr C Davies,Cardiff/Newport

1545-1600 Draft standards for ammonia analysesMs H Losty, Cardiff

The audit meeting is free and open to all interestedhealth care professionals.

RCPath/IBMS CPD accreditation applied for.Registration fee: ACB members £10, Non members £15(including lunch). Please make cheques payable to‘ACB Wales Region’.

For further details and registration contact:Dr D M Cassidy, Department of Clinical Biochemistryand Metabolic Medicine, Prince Charles Hospital,Merthyr Tydfil, CF47 9DT. Tel: 01685-728262.Fax: 01685-721911.Email: [email protected]

Clinical Cases in Clinical

Biochemistry

and Presidential Address

The Royal Society of Medicine1 Wimpole StreetLondon W1G 0AETuesday 2 April 2002 at 2.00 pmMeeting of the Pathology Sectionof the Royal Society of Medicine

2.00 pm Registration and coffee 2.30 pm Clinical cases 4.00 pm Tea 4.30 pm Presidential address:

Education in Pathology Dr James Hooper, President, RSM Section of Pathology

5.15 pm AGM 5.30 pm Close of meeting

CME/CPD: 2 credits. Fellow: £10. Non-Fellow: £15.Student/Trainee Free.For further details, please contact: Claire Bowen,Academic Department, Royal Society of Medicine,1 Wimpole Street, London W1G 0AE. Tel: 020-7290-3859. Fax: 020-7290-2989Email: [email protected]

Paediatric Nephrology

CSB Lecture TheatreSt James’s University Hospital LeedsWednesday 8th May 2002Special Meeting to Honour the Retirement of Dr Trevor Brocklebank

MorningChairman: Dr Mick Henderson10.00 Registration and Coffee10.45 Ion channels and renal tubular defects

Dr Stan White, Sheffield11.25 Renal tubular acidosis

Dr Mike Penney, Newport, Gwent12.05 Hypophosphataemic rickets

Dr Nick Shaw, Birmingham12.45 Lunch


Forthcoming Meetings Forthcoming Meetings Forthcoming Meetings

AfternoonChairman: Dr Trevor Brocklebank14.00 Paediatric Dialysis, medicine by numbers

Dr Steve Smye and Dr Elizabeth Lindley, Leeds14.40 Steroid responsive nephrotic syndrome

Dr Nick Webb, Manchester15.20 Testimonial for a paediatric nephrologist

Prof Sandy Davison, Leeds

For further information please contact: Dr MickHenderson, Department of Chemical Pathology, LeedsLS9 7TH. Tel: 0113-206686. Fax: 0113-2065971Email: [email protected]

ACB (N.I. Region) and

Association of Clinical

Biochemists in Ireland

Scientific Meeting

Postgraduate CentreBelfast City HospitalFriday 12th April 2002

10.30 Registration and coffee11.00 Opening remarks

Dr Pooler Archbold, Chairperson, N.I. Region ACB

Chairperson: Dr Peter Sharpe, Craigavon Area Hospital11.05 Calcium and the kidney

Dr John Harty, Daisy Hill Hospital, Newry11.45 Immunoglobins and electrophoresis:

what’s the future?Dr Joanna Sheldon, St George’s Hospital, London

12.25 Clinical case presentation“Biochemical markers in muscle disease”Dr Muhammad Adrees, Adelaide and Meath Hospital,Dublin

12.50 Lunch

Chairperson: Dr Pooler Archbold, Belfast City Hospital14.00 Effects of environmental exposure to trace

elementsDr Andrew Taylor, Royal Surrey County Hospital,Guildford

14.40 How to approach the unusual/unexpectedthyroid hormone resultDr Gerard Boran, Adelaide and Meath Hospital, Dublin

15.20 Clinical case presentationDrs Maurice O’Kane and Mark Lynch, AltnagelvinHospital, Londonderry

15.50 Close of meeting and coffee

Further information available from: Dr Peter Sharpe,Department of Clinical Biochemistry, Craigavon AreaHospital, Craigavon, BT63 5QQ. Tel: 028-38612657.Email: [email protected]


Situations Vacant Situations Vacant Situations Vacant Situations

Principal Clinical Biochemist, Grade B (22 - 24)In this newly created role, based in Mid and NorthHampshire, you will have the opportunity to workfor the North Hampshire Hospital, Basingstoke andthe Royal Hampshire County Hospital, Winchester,at the very outset of this exciting and challengingjoint venture.

Deputising for the heads of the biochemistrydepartments at both sites, you will also be encouragedto develop and maintain areas of special interest.Housed in modern, purpose-built laboratories, both departments are well equipped, use the samecomputer system and offer a busy and friendlyenvironment in which you will find full support to establish this position.

To succeed, you will need a professional approachcombined with broad experience in clinical biochemistryand possession of MRCPath.

Both hospitals are situated in attractive parts ofHampshire - close to London, the south coast and theNew Forest, where your work hard, play hard, workethic will make the most of the excellent leisurefacilities and amenities they offer.

Interested? Please contact Mr Mike Powell,tel: 01256 313285 or Dr Heather Barbour, tel: 01962 824455for further information or to arrange an informal visit.

For an application pack, please contact Julia White,Personnel Department, The Donald BurrellCentre, The North Hampshire Hospital,Aldermaston Road, Basingstoke, HampshireRG24 9NA, email: [email protected]: 01256 313195 (answerphone out of officehours), quoting Ref: PP1005.

Closing date: 17 April 2002.

Gateshead HealthNHS Trust

NHSQUEEN ELIZABETH HOSPITAL

PATHOLOGY DIRECTORATE

Locum Biochemist/Chemical PathologistSalary commensurate with experience Ref: 3514/02AThis post will become available from 1st March 2002 due to the departure of the Medical Chemical Pathologist. You will be required to support the Consultant Biochemist (Dr Graham Handley) until a substantive replacement isappointed and will be for a period of 3 months initially.

The post will be remunerated at a level commensurate with experience and will be agreed at interview. This will be paid pro-rata if not full time.

You must have the appropriate qualifications, be used to working in an NHS laboratory setting, be state-registered,be able to use the laboratory IT system (after suitable training) and have a proven record of team working.

For informal enquiries/discussions please contact Dr Graham Handley on (0191) 403 2273.

Application forms and job descriptions are available from Personnel Department, Queen Elizabeth Hospital,Sheriff Hill, Gateshead, Tyne & Wear NE9 6SX. Closing date: 3rd April 2002. Applicants who havenot heard by 3rd May 2002 are to assume they are unsuccessful.

Gateshead Health NHS Trust is working towards equal opportunities and is happy to consider flexible working arrangements. A no smoking policy operates for all staff.

www.sector1.net for more vacancies within this organisation POS I

T IVE ABOUT

• D I S A B L E DPE

O P L E


Vacant Situations Vacant Situations Vacant Situations Vacant

UNIVERSITY OF LONDON

MSc Clinical BiochemistryApplications are invited for this two year, part-time inter-collegiate course beginning in September 2002.

Candidates should have a first or second class honours degreein chemistry, biochemistry or a related subject, or hold a medicalqualification registrable in the United Kingdom. Candidateswithout these qualifications may be considered providing theyhave relevant work experience. Students will usually be expectedto have at least one year’s experience in clinical chemistry, butwell-qualified candidates working in a clinical chemistry laboratory for less than one year will be considered.

Candidates must hold posts in suitable laboratories for theduration of the course and must be in a position to attendlectures and seminars at a London medical school onWednesday afternoons (2-7pm) during the university terms.Students will be registered as internal students of the Universityof London. The degree is awarded on the basis of examinationsheld at the end of the course, a project and assessment of thepractical work set throughout the course.

The course provides an excellent grounding for those individuals wishing to progress to the MRCPath in ChemicalPathology.

For further details and application forms write to: Dr Gill Rumsby, Department of Chemical Pathology, UCL Hospitals, Windeyer Building, Cleveland Street, LondonW1T 4JF. Tel: 020-7679-9229; Fax: 020-7679-9496; email: [email protected] date for receipt of applications will be 1st June 2002.

NHS Scotland

TRAINEE CLINICALBIOCHEMISTS ‘A’ (2)

£14,657 paWe require honours graduates in chemistry or biochemistry,or those graduating this year, to join the National HealthService in Scotland. You should have, or expect to gain, a first or upper second class honours degree – an appropriate higher degree is an advantage but not essential.The three year training programme will include attendanceat the Master of Science in Clinical Biochemistry andMolecular Biology course at the University of Surrey on ablock release basis – with travel, accommodation andfees supported in full by the Scheme – participation intraining courses conducted by the Association of ClinicalBiochemists, and attendance at regional and nationalconferences. Practical training in laboratory, clinical andother aspects of laboratory medicine will take place in theRoyal Infirmary of Edinburgh or the new Wishaw GeneralHospital, Lanarkshire. The training will be subject to formal annual appraisal.The details of the training scheme can be discussed withDr C G Fraser, Co-ordinator of the Scottish Program on01382 632512.Further details and application packs areavailable from the Personnel Dept, PerthRoyal Infirmary, tel: 01738 473285, quotingref: SW/16/02. Closing date for completed applications: 29th March 2002.



NHS TrustBirmingham Children’s Hospital NHS

CONSULTANT CLINICAL BIOCHEMISTGrade C with 3 enhancement points (spine points 26-34)

The Birmingham Children’s Hospital NHS Trust is seeking an enthusiastic Clinical Scientistwho wishes to play a key role in one of the UK’s major paediatric centres. The appointeewill be Deputy Head of Department with responsibility for providing the General ClinicalChemistry Service (including POCT) at the Diana, Princess of Wales Children’s Hospital.Candidates will be state registered scientists with MRCPath or MCB and expertise in IT for laboratory medicine.

The Children’s Hospital is a tertiary referral centre and has a wide range of clinical specialities including a supra regional service for liver disease/liver transplantation, oncology, nephrology, and a 20 bedded PICU. The hospital relocated to the city centre in1998 following a major £30 million refurbishment programme of the former GeneralHospital. All laboratory disciplines are on site in excellent accommodation within a singleblock and are CPA accredited. The Clinical Chemistry Department is well equipped andprovides a wide range of investigations including the Regional Neonatal Screening andInherited Metabolic Disorders Services. There is excellent training for staff and the department has a Higher Specialist Trainee Clinical Biochemist post and a SpecialistRegistrar Paediatric Chemical Pathologist post.

The successful applicant will have a wide range of Clinical Chemistry experience at a seniorlevel - previous paediatric experience is NOT essential. The postholder will lead the department in specific areas and be expected to develop services and take advantage of the excellent opportunities for research, teaching and clinical audit in the Trust. This post willsuit a senior clinical biochemist looking for the challenge and interest which PaediatricClinical Chemistry provides.

Informal discussions and visits are encouraged, please contact either: Dr Anne Green, Consultant Clinical Biochemist on 0121 333 9922, email anne.green @bhamchildrens.wmids.nhs.uk or Dr Jim Gray,Programme Director - Microbiology Department on 0121 333 9815, email: jim.gray@bham childrens.wmids.nhs.uk

For an application form and job description please contact the PersonnelDepartment, Birmingham Children’s Hospital NHS Trust, Ladywood House,Whittall Street, Birmingham B4 6NL, tel 0121 333 8352 (24hrs), or email:[email protected]

Please quote reference TM743/02; closing date for completed applications 19th April 2002.

Department of ClinicalChemistry

We are committed to Equal Opportunities and actively discourage smoking at work.


Vacant Situations Vacant Situations Vacant Situations Vacant

The Oxford Radcliffe Hospitals is one of the largest teaching Trusts in the country. The Trust incorporates the Radcliffe Infirmary, the Churchill and John Radcliffe Hospitalsin Oxford and the Horton Hospital in Banbury. Nationally and internationally renownedfor its services, quality of staff and academic departments, the Trust provides generaland specialist services for the people of Oxfordshire and the surrounding area.

THE JOHN RADCLIFFE HOSPITALOxford

DEPARTMENT OF CLINICAL BIOCHEMISTRY

Clinical Biochemist£20,059 – £23,463 p.a. (scale 08 - 12 depending on experience)This post will provide opportunities to develop expertise in all aspects of clinical biochemistry, with a particular commitment to the Paediatric Clinical Biochemistry service.Involvement in audit and appropriate research and development will be encouraged.

You should have recently completed Grade A Clinical Biochemistry training in anapproved post, and will be keen to pursue a programme of Higher Specialist Training inpreparation for the MRCPath Part 1 examination. Opportunities to attend appropriatetraining courses will be provided.

We are an innovative and friendly departmental team. The department has full CPAaccreditation and offers a comprehensive service to four acute hospitals in Oxford andto General Practitioners, with a catchment population of approximately 500,000.

We encourage informal visits. To arrange this or for further information or to arrangean informal visit, please contact Dr Richard Taylor on 01865 220477 or Dr John McVittieon 01865 220476.

HOW TO APPLY

Application forms and job descriptions are available from the Human ResourcesDepartment, The John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DUor telephone 01865 221175 (24 hour jobline) quoting reference: BIOCHEM77.

Closing date: 17th April 2002.

For further opportunities please visit: www.oxfordradcliffe.nhs.uk

Whatever your career aspirations we can offer you a range of opportunities in a supportive, friendly environment. Equality of opportunity is assured and our no smoking policy advances a healthier environment.



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 publicationThe editor reserves the right to amend or reject advertisements deemed unacceptable to the Association.

Advertising rates are available on request

Looking For ABetter Way To

Manage ChemistryLab Processes?

G e n e r a l C h e m i s t r y I m m u n o d i a g n o s t i c s C e n t r i f u g a t i o n H e m a t o l o g y D i s e a s e M a n a g e m e n t

H e m o s t a s i s L a b A u t o m a t i o n C l i n i c a l R e s e a r c h D a t a M a n a g e m e n t F l o w C y t o m e t r y P r i m a r y C a r e

Look No Further.

Introducing The New SYNCHRON® PRO Family. Analyzers For Process Improvement In Every Chemistry Lab.

© Copyright 2001 Beckman Coulter, Inc.

Serum indices help ensure accurate test results.On-board autodilution eliminates errors andimproves workflow. And, closed-tube sampling—anLX20 PRO exclusive—accelerates processing whilemaintaining sample stability and worker safety.So when you’re looking for process improve-ments, look to the advanced SYNCHRON PROfamily and The Power Of Process™ fromBeckman Coulter. To learn more,visit us on the Web atwww.beckmancoulter.com,

or contact your Beckman Coulter representative today.

S I M P L I F Y • A U T O M A T E • I N N O V A T E

Beckman Coulter United Kingdom Limited, Oakley Court, Kingsmead Business Park, London Road, High Wycombe, Bucks HP11 1JUTel: 01494 441181 Fax: 01494 463843 www.beckmancoulter.com

What is your lab profile? Do you operate a core lab, satellite labs or both? High-volume or low?Are you primarily concerned with improvements in sample handling, analytical performance, data

management or all three? Whatever your situation, the new,improved SYNCHRON PRO family of chemistry analyzers can help you

achieve higher levels of productivity.Today’s SYNCHRON PRO analyzers deliver a

host of new features that simplify and automateprocesses in your lab. For example, clot detection improvesanalytical performance and helps maximize system uptime.

Your lab can find new levels of safety and productivity with closed-tube sampling—now available on

the SYNCHRON LX® 20 PRO.

TM

www.abbott.com

Abbott Diagnostics

One source.One source.

“Over 98%of NHS hospitals use

Abbott products every day”

Abbott Diagnosticswww.abbott.com

“Our automated immunoassayplatforms provide an extensive

range of123 Analytes” “Over 98%of NHS hospitals use

Abbott products every day”

“Over 1,000,000 patient results are reported on the AxSYM

system every day of the year”“Our automated immunoassayplatforms provide an extensive

range of123 Analytes”

“Over 1,000,000 patientresults are reported on the AxSYM

system every day of the year”

Comments Payne on Slow Yoga Coronary Heart Disease

Documents

Transcript of Comments Payne on Slow Yoga Coronary Heart Disease