Events in 2023

Health inequalities are unfair and avoidable differences in health across the population, and between different groups within society. Health inequalities arise because of the conditions in which we are born, grow, live, work and age. These conditions influence our opportunities for good health, and how we think, feel and act, and this shapes our mental health, physical health, and wellbeing. The COVID-19 shone harsh light on the pre-existing health inequalities which persist in our society. It has become increasingly clear that COVID-19 has had a disproportionate impact on many who already face disadvantage and discrimination. The impact of the virus has been particularly detrimental on people living in areas of high socio-economic deprivation, on people from Black, Asian and minority ethnic minority communities and those with a learning disability.

In England, there is a 19-year gap in healthy life expectancy (whether we experience health conditions or diseases that impact how long we live in good health) between the most and least affluent areas of the country, with people in the most deprived neighbourhoods, certain ethnic minority and inclusion health groups getting multiple long-term health conditions 10 to 15 years earlier than the least deprived communities, spending more years in ill health and dying sooner.

The Biomedical Sciences have a significant and pivotal role to play in narrowing the health inequalities gap through Research, Innovation and Life Sciences and its extensive reach across clinical practice within the NHS.

Implementing a new laboratory IT system and how to avoid the pitfalls

What’s in the new precompatibility guidelines?

An overview of the UKTLC collaborators and history of the UKTLC. An introduction to the new standards and the evidence supporting these and the findings of the 2022 UKTLC survey.

Digital imaging for remote viewing to enable reporting is becoming increasingly prevalent in the NHS cellular pathology services. Sea change levels of improvement in the technology that enables digital image acquisition, viewing, transfer and storage has allowed its widespread deployment and adoption and concomitant to this has been the development of software applications to enable the analysis of those digital images for a huge variety of reasons.

In my talk I will discuss the application of digital image analysis to the scans of the slides that we assess as part of our routine external quality assessment (EQA) workload. Both as aids to improve the information and the accuracy of that information e.g., in the assessment of the proliferation marker Ki-67 in breast cancer to improve its use as a prognostic marker, and as a tool to verify and quality control our own processes and EQA materials e.g., the measurement of reproducibility and homogeneity in tissue and cell line samples used in the assessment of PD-L1 immunohistochemistry staining in non-small cell lung cancer.

Histopathology has numerous stages in the production of a digital image and its subsequent use. Each of the stages can introduce variations that are compounded resulting in a net variation in image quality for nominally the same tissue. Humans are tolerant of variation so this variation in quality has minimal impact on outcomes, which are additionally validated by EQA services.

But AI is in some cases being negatively impacted by variation and highlights the need for quality metrics and subsequently standards for each stage, where possible. But currently there are few independent QC tools for digital histopathology. This presentation will present the results of our work in NPIC were we have developed QC tools for staining, digitisation and display in digital histopathology.

The principles of validation and verification have long been established and laboratories are generally familiar with these although there remain some issues which are commonly seen within verification reports during assessments. Some of these require some further attention and discussion, including consideration of sample type, verification across multiple sites and approaches used when upgrading analysers. Alongside these common issues, ISO 15189:2022 has now been issued with assessments to become mandatory to the new standard from January 2024 and whilst the principles of validation and verification are generally unchanged, there are some differences which will require review of internal procedures and approaches to verification. Awareness of these changes will form a part of the presentation, along with issues commonly seen, being hoped these will promote some thought as to how laboratories can consider the local approaches used.

Antimicrobial resistance is a major concern with mortality rates growing exponentially. Current ASTs used clinically can take 24-48hrs to report results, ensuing in initial treatment with broad spectrum antibiotics. The novel iFAST method can report results within 2 hours of exposure to an antibiotic. The main objective of this study was to measure the impedance signal of resistant and sensitive isolates of Staphylococcus aureus that had been exposed to cefoxitin. Sequentially collected bacterial isolates were accessed from the clinical microbiology laboratory to determine susceptibility.

50 methicillin resistant/sensitive isolates of S. aureus were taken from the middle of the clinical workflow and tested on the iFAST. The isolates were streaked onto blood plates and incubated at 37 degrees for 2 hours. The bacteria were then exposed to cefoxitin for 2 hours at the EUCAST breakpoint concentration of 8mg/L. Following exposure, the samples were measured on the iFAST.

The impedance cytometer measures the electrical signal of bacterial cells as they individually flow through a microfluidic channel, via electrodes driven by an AC current of multiple frequencies. This is interpreted as a read-out of cell volume and opacity. Exposure to antibiotics can change the electrical characteristics of the bacterial cell in size and opacity compared to the control sample. The number of exposed cells within the contour defined by the control sample can measure how the cells have altered in opacity and size following exposure.

iFAST results showed 100% concordance with disk diffusion sensitivity testing carried out by the clinical laboratory. The data showed different electrical impedance changes for both resistant and sensitive strains of S. aureus. Sensitive strains showed a decrease in cell size and resistant strains showed an increase in cell size following exposure to cefoxitin.

The bacterial impedance cytometer was able to rapidly differentiate between MRSA and MSSA isolates in concordance with current susceptibility testing in the clinical setting. The results help to show how the iFAST could reduce the time taken to provide critical and accurate antibiotic treatment to patients.

NHS England established the Genomic Medicine Service (GMS) in 2018 to realise the potential of genomics in healthcare. The NHS GMS built upon the existing NHS infrastructure and used learnings from the 100,000 Genomes Project to embed genomics through a world leading innovative service model from primary and community care through to specialist and tertiary care.

A consolidated national genomic laboratory network was established with seven GMS Alliances working together to support the clinical leadership and embedding of genomic medicine in end-to-end pathways more broadly and the working with other key clinical specialties. Equitable genomic testing is delivered through a single mandated National Genomic Test Directory for improved outcomes in cancer, rare, inherited and common diseases, and in enabling precision medicine and reducing adverse drug reactions.

Working in partnership with Genomics England the delivery of the whole genome sequencing service and ongoing key research initiatives are integral in developing the genomic service. Ongoing evolution of the service through cutting-edge science, research and innovation to ensure that patients can benefit from rapid implementation of advances is critical.

Eco-epidemiology of tick-borne encephalitis virus in the UK