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CONGRESS 2023 - Fetal Alcohol Spectrum Disorder- Clinical Chemistry to Clinical Practice
28/09/2023
The UK has the 4th highest prevalence rate of alcohol consumption in pregnancy in the world. Fetal Alcohol Spectrum Disorder (FASD) is the most common non-genetic learning disability in the UK with a prevalence rate of at least 5%, more than autism and ADHD combined. A high-profile public health campaign combined with effective antenatal and pre-conception care is urgently required.
Accurate and early identification of women at risk from alcohol consumption during pregnancy allows education and support to be targeted at those most in need. Self-report has limited sensitivity but is commonplace due to its acceptability and affordability. Biomarkers have the potential to provide an objective and reliable antenatal alcohol screening solution.
To explore the utility of blood biomarkers, we conducted a systematic review comparing the diagnostic accuracy of blood analysis and maternal self-report in detecting at antenatal alcohol exposure. We discovered that none of the biomarkers identified had both high sensitivity and specificity when compared to self-report. There was some evidence that a combination of biomarkers, or combining biomarkers with self-report, increases accuracy. Blood biomarkers examined were of limited use in screening for low and moderate alcohol consumption in pregnancy when compared to self-report. However, certain biomarkers, such as carbohydrate deficient transferrin (CDT) and phosphatidylethanol (PEth) may complement self-report and help improve the accuracy of diagnosis.
We applied these findings to practice with two studies comparing the prevalence of alcohol consumption in the first trimester of pregnancy using self-report and blood biomarker analysis. The booking bloods were from women under the care of Northumbria Healthcare NHS Foundation Trust (NHCT) and North Tees and Hartlepool NHS Foundation Trust (NTHFT).
Six-hundred routine blood samples were anonymously analysed from each location for the presence of Carbohydrate Deficient Transferrin (CDT), a validated marker of chronic alcohol exposure (normalising 2–3 weeks from abstinence) and Gamma-glutamyltransferase (GGT), a liver enzyme elevated for up to 8 weeks after alcohol exposure. At NHCT, CDT analysis revealed a prevalence rate of 1.4% and GGT a prevalence rate of 3.5% in the first trimester of pregnancy. Although those with elevated CDT generally had high levels of GGT, only one person was positive for CDT and GGT. The NTHFT data revealed a CDT prevalence rate of 1.7% (95% CI: 0.7–2.9) and GGT prevalence rate of 4.2% (95% CI: 2.6–5.9). No overlapping cases were identified, or a significant correlation was demonstrated between CDT or GGT. Although CDT and GGT analysis are not sensitive to low levels of alcohol, prevalence rates were similar in both areas, suggesting similar patterns of sustained alcohol use in pregnancy across the region.
We also took a full year's sample of data from the antenatal visits of women at NHCT, which documented the women's self-reported alcohol consumption. The percentage of women who reported alcohol intake in the first trimester was 0.8%, approximately half the rate of those identified by CDT. This compared to 74.1% of women who reported consuming alcohol before pregnancy, indicating the limited value of self-report in clinical practice.
Accurate and early identification of women at risk from alcohol consumption during pregnancy allows education and support to be targeted at those most in need. Self-report has limited sensitivity but is commonplace due to its acceptability and affordability. Biomarkers have the potential to provide an objective and reliable antenatal alcohol screening solution.
To explore the utility of blood biomarkers, we conducted a systematic review comparing the diagnostic accuracy of blood analysis and maternal self-report in detecting at antenatal alcohol exposure. We discovered that none of the biomarkers identified had both high sensitivity and specificity when compared to self-report. There was some evidence that a combination of biomarkers, or combining biomarkers with self-report, increases accuracy. Blood biomarkers examined were of limited use in screening for low and moderate alcohol consumption in pregnancy when compared to self-report. However, certain biomarkers, such as carbohydrate deficient transferrin (CDT) and phosphatidylethanol (PEth) may complement self-report and help improve the accuracy of diagnosis.
We applied these findings to practice with two studies comparing the prevalence of alcohol consumption in the first trimester of pregnancy using self-report and blood biomarker analysis. The booking bloods were from women under the care of Northumbria Healthcare NHS Foundation Trust (NHCT) and North Tees and Hartlepool NHS Foundation Trust (NTHFT).
Six-hundred routine blood samples were anonymously analysed from each location for the presence of Carbohydrate Deficient Transferrin (CDT), a validated marker of chronic alcohol exposure (normalising 2–3 weeks from abstinence) and Gamma-glutamyltransferase (GGT), a liver enzyme elevated for up to 8 weeks after alcohol exposure. At NHCT, CDT analysis revealed a prevalence rate of 1.4% and GGT a prevalence rate of 3.5% in the first trimester of pregnancy. Although those with elevated CDT generally had high levels of GGT, only one person was positive for CDT and GGT. The NTHFT data revealed a CDT prevalence rate of 1.7% (95% CI: 0.7–2.9) and GGT prevalence rate of 4.2% (95% CI: 2.6–5.9). No overlapping cases were identified, or a significant correlation was demonstrated between CDT or GGT. Although CDT and GGT analysis are not sensitive to low levels of alcohol, prevalence rates were similar in both areas, suggesting similar patterns of sustained alcohol use in pregnancy across the region.
We also took a full year's sample of data from the antenatal visits of women at NHCT, which documented the women's self-reported alcohol consumption. The percentage of women who reported alcohol intake in the first trimester was 0.8%, approximately half the rate of those identified by CDT. This compared to 74.1% of women who reported consuming alcohol before pregnancy, indicating the limited value of self-report in clinical practice.
CONGRESS 2023 - From the laboratory to headlines. How to validate laboratory methods to screen and measure novel drugs
28/09/2023
In the US, the death rate from drug overdoses more than tripled between 1999 and 2017, this was driven by increase use of opioids. This opioid epidemic had three phases: the first was dominated by prescription opioids such as oxycodone, the second by heroin, and the third by cheaper but more potent synthetic opioids such as fentanyl.
Despite a few outbreaks of synthetic opioids (such as fentanyl analogues) causing death is particular geographic areas, the UK has not faced the same epidemic as the US. However, over the past 2-3 years the UK has seen an increase in the detection of 2-benzyl benzimidazole (‘nitazene’) type opioids. These are found mixed with heroin or purchased online, typically sold as oxycodone. This talk will give a brief overview of novel opioids, discuss the potential for harm and highlight the analytical strategies to develop validated assays to detect and measure both novel opioids and other novel psychoactive substances.
Despite a few outbreaks of synthetic opioids (such as fentanyl analogues) causing death is particular geographic areas, the UK has not faced the same epidemic as the US. However, over the past 2-3 years the UK has seen an increase in the detection of 2-benzyl benzimidazole (‘nitazene’) type opioids. These are found mixed with heroin or purchased online, typically sold as oxycodone. This talk will give a brief overview of novel opioids, discuss the potential for harm and highlight the analytical strategies to develop validated assays to detect and measure both novel opioids and other novel psychoactive substances.
CONGRESS 2023 - Head & Neck Clinic – Sonographer’s perspective
27/09/2023
Head and Neck cancers account for approximately 3% of new cancer incidence in the United Kingdom (UK). The use of ultrasound guided fine needle aspirations within head and neck ultrasound, has become a vital resource for cancer diagnosis. Historically, it was common for head and neck patients requiring a fine needle aspiration, to have an insufficient tissue sample from their initial examination, leading to patient re-call for repeat investigation. Subsequently, this negatively impacted upon the patient pathway by delaying cancer diagnosis and treatment.
The utilisation of Rapid on-site Evaluation (ROSE) has proven to transform the diagnostic pathway by negating the need for repeat examinations and therefore improving the rate at which patients are diagnosed and treated.
This presentation focuses on the achievements that have been accomplished through great collaborative working between radiology and cytology within head and neck and the consequent patient benefits. It includes a summary of how the ROSE service has grown at Royal Cornwall Hospital to include the Cornwall ROSE research pilot and the values this has brought to the population.
Case studies will be included as examples of where ROSE has been paramount to a swift diagnosis.
Additionally, the advantages and disadvantages of working with ROSE will be discussed from a sonographer's viewpoint, highlighting the potential pitfalls.
References
1. Head and neck cancers statistics | Cancer Research UK [Internet]. [cited 2023 May 26]. Available from: https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/head-and-neck-cancers#heading-Zero
2. Breeze J, Poller DN, Gibson D, Tilley EA, Cooke L, Soar E, et al. Rapid on-site assessment of specimens by biomedical scientists improves the quality of head and neck fine needle aspiration cytology. Cytopathology. 2013 Oct;n/a-n/a.
3. Medina Chamorro FM, Calle JA, Stein JE, Merchancano L, Mendoza Briñez AM, Pulido Wilches AA. Experience of the Implementation of Rapid On-Site Evaluation in Ultrasound-Guided Fine-Needle Aspiration Biopsy of Thyroid Nodules. Curr Probl Diagn Radiol. 2018 Jul;47(4):220–4.
4. Aly AK, Ali MA, Sharma A, Gubbels MA, Zhao X, Ahmed A, et al. Rapid On-site Evaluation (ROSE) for Fine Needle Aspiration of Thyroid: Is It Helpful? SciMed J. 2021 Mar 1;3(1):1–7.
The utilisation of Rapid on-site Evaluation (ROSE) has proven to transform the diagnostic pathway by negating the need for repeat examinations and therefore improving the rate at which patients are diagnosed and treated.
This presentation focuses on the achievements that have been accomplished through great collaborative working between radiology and cytology within head and neck and the consequent patient benefits. It includes a summary of how the ROSE service has grown at Royal Cornwall Hospital to include the Cornwall ROSE research pilot and the values this has brought to the population.
Case studies will be included as examples of where ROSE has been paramount to a swift diagnosis.
Additionally, the advantages and disadvantages of working with ROSE will be discussed from a sonographer's viewpoint, highlighting the potential pitfalls.
References
1. Head and neck cancers statistics | Cancer Research UK [Internet]. [cited 2023 May 26]. Available from: https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/head-and-neck-cancers#heading-Zero
2. Breeze J, Poller DN, Gibson D, Tilley EA, Cooke L, Soar E, et al. Rapid on-site assessment of specimens by biomedical scientists improves the quality of head and neck fine needle aspiration cytology. Cytopathology. 2013 Oct;n/a-n/a.
3. Medina Chamorro FM, Calle JA, Stein JE, Merchancano L, Mendoza Briñez AM, Pulido Wilches AA. Experience of the Implementation of Rapid On-Site Evaluation in Ultrasound-Guided Fine-Needle Aspiration Biopsy of Thyroid Nodules. Curr Probl Diagn Radiol. 2018 Jul;47(4):220–4.
4. Aly AK, Ali MA, Sharma A, Gubbels MA, Zhao X, Ahmed A, et al. Rapid On-site Evaluation (ROSE) for Fine Needle Aspiration of Thyroid: Is It Helpful? SciMed J. 2021 Mar 1;3(1):1–7.
CONGRESS 2023 - HPV Entrapment Syndrome: a difficult problem in the Triage Pathway
28/09/2023
The management of low grade smear abnormalities has posed problems for over 30 years and these will be described in some detail leading on to the most recent difficulty caused by the HPV Triage Pathway in the Cervical Screening Programme. The concept of HPV Entrapment Syndrome will be introduced and management strategies to deal with this difficult problem will be discussed. As well as explaining what HPV Entrapment means, there will be a detailed case presentation of a typical patient followed by a review of some of the numerous smear abnormalities that prevented her from leaving the Triage Programme.
CONGRESS 2023 - Improving employability through simulation learning
26/09/2023
Authentic learning experiences and simulations are an established approach to healthcare education known to prepare students for the world of work. A recent study showed that 93% of employers believed that biomedical science graduates failed to meet employability requirements due to lack of practical and technical skills (Hussain and Hicks, 2022). Whilst placements can bridge these gaps, opportunities are limited and unpaid, restricting accessibility. Organising careers events and collaboration with The School of Health and Society, external employers, the Careers and Enterprise team and key stakeholders has enhanced the curriculum content to meet the needs of employers.
Development of the mentorship group, Biomedical Science Careers Support at the University of Salford has enabled successful career development for students. Collaborating with The School of Health and Society, the implementation of an interprofessional education event will be embedded into the curriculum. A recent project involving the introduction of Pathology specimen reception and blood transfusion simulations, allowed students to practice workplace skills, while enabling aspects of the profession to be taught that would otherwise have been impossible to teach. Introducing scenarios coupled with authentic workplace dilemmas including health and safety, quality, and problem solving, not only helps satisfy degree accreditation, but facilitating reflection also feeds into a requirement for HCPC registration and continuous professional development. Related to this, the Biomedical Science mentorship group has also introduced the trial of a ‘portfolio club’. Here students were supported by the teams IBMS portfolio verifier to begin collecting evidence towards their IBMS Registration Training Portfolio.
The impact of these activities has already been demonstrated, for instance 100% success rate with placement applications for those students who engaged in this extracurricular club. Data collected from surveys from participants and feedback from employers forms an evidence base to demonstrate the success of authentic learning experiences and improving employability. The added value of academics from professional backgrounds and cross University collaboration can be expanded to encompass further areas of biomedical science and healthcare careers, with progression to include patient contact and pre-placement professionalism training. These authentic learning experiences and simulations can be sustainably integrated into various areas of the curriculum to bridge the skills gap and improve employment opportunities to all graduates.
Development of the mentorship group, Biomedical Science Careers Support at the University of Salford has enabled successful career development for students. Collaborating with The School of Health and Society, the implementation of an interprofessional education event will be embedded into the curriculum. A recent project involving the introduction of Pathology specimen reception and blood transfusion simulations, allowed students to practice workplace skills, while enabling aspects of the profession to be taught that would otherwise have been impossible to teach. Introducing scenarios coupled with authentic workplace dilemmas including health and safety, quality, and problem solving, not only helps satisfy degree accreditation, but facilitating reflection also feeds into a requirement for HCPC registration and continuous professional development. Related to this, the Biomedical Science mentorship group has also introduced the trial of a ‘portfolio club’. Here students were supported by the teams IBMS portfolio verifier to begin collecting evidence towards their IBMS Registration Training Portfolio.
The impact of these activities has already been demonstrated, for instance 100% success rate with placement applications for those students who engaged in this extracurricular club. Data collected from surveys from participants and feedback from employers forms an evidence base to demonstrate the success of authentic learning experiences and improving employability. The added value of academics from professional backgrounds and cross University collaboration can be expanded to encompass further areas of biomedical science and healthcare careers, with progression to include patient contact and pre-placement professionalism training. These authentic learning experiences and simulations can be sustainably integrated into various areas of the curriculum to bridge the skills gap and improve employment opportunities to all graduates.
CONGRESS 2023 - ISO 15189:2022 and the impact upon delivery and maintenance of effective quality management within Point-of-Care Testing
25/09/2023
ISO15189:2012 had reached its periodic review date and there was international consensus that it needed revision. The new version was published on 6th December 2022 and there are some key changes which include an emphasis on a patient-focused approach and to promote the welfare of patients - i.e. putting the patient at the heart of the service. There is also more emphasis on a risk based approach to the Quality Management system. In addition ISO 22870 (POCT) has been incorporated into ISO 15189:2022.
This presentation will review POCT definitions, highlight key considerations for currently accredited POCT services and also for organisations considering applying for accreditation to include (or extend) POCT in their scope.
POCT is referenced implicitly throughout ISO 15189:2022 and with additional distinct requirements as an Annex A.
The presentation will discuss generic POCT services, and highlight considerations on both current POCT services and also emphasise considerations for planning new POCT services, and that overall, when compared with ISO 22870:2016, things have not changed as much as one would think. Principles are similar, and POCT could even be considered as another specialty within pathology, regardless of where it is or managed from.
This presentation will review POCT definitions, highlight key considerations for currently accredited POCT services and also for organisations considering applying for accreditation to include (or extend) POCT in their scope.
POCT is referenced implicitly throughout ISO 15189:2022 and with additional distinct requirements as an Annex A.
The presentation will discuss generic POCT services, and highlight considerations on both current POCT services and also emphasise considerations for planning new POCT services, and that overall, when compared with ISO 22870:2016, things have not changed as much as one would think. Principles are similar, and POCT could even be considered as another specialty within pathology, regardless of where it is or managed from.