Events during September 2023

This presentation will include how her career progressed to a Point of Care Testing (POCT) role in the Wales Specialist Virology Centre. It will also cover what POCT is; the method of testing, who gets tested and why POCT is crucial in the efforts to achieve the WHO initiative to eliminate Hepatitis C in Wales.

Examples of what a day-in-the-life of a "POCT-er" consists of: mass screening projects, case studies, what has been learnt from testing in prison and in the community (homeless shelters and substance misuse services). The future of POCT: what's on the horizon?

Learn how infectious disease POCT services have evolved across Wales. Discover how Louise's role as a Biomedical Scientist has evolved to National infectious disease POCT lead. Discover how POCT projects are contributing towards the World Health Organisations Hepatitis C elimination targets and how we foresee future POCT services expanding.

The presentation provides an overview on potential benefits and risks of near-patient testing conducted by health care professionals, including testing of self-collected specimens.

Polio – why has it reappeared?

COVID – current issues

Monkeypox case management/infection control

Despite effective treatments and vaccines viral hepatitis remains a massive burden on global health affecting the poorest counties disproportionately. Effective treatments and diagnostics for hepatitis remain outside the reach of most people in resource-poor regions.

In contrast, UK strategies against viral hepatitis have been relatively successful, in particular the prospect of HCV elimination, which is already showing improved outcomes in liver health.

Effective strategies depend on high quality epidemiological data which is gleaned from a wide variety of sources including diagnostic laboratory reporting, sentinel surveillance programs and prospective screening of high-risk groups.

The key components preventing transmission of blood-borne viruses such as donor screening, surveillance of susceptible groups and vaccination are now further enhanced by retrospective case finding from historical data, opt-out screening in emergency departments and high intensity test-and-treat events in prisons.

Biomedical Scientists can make a valuable contribution towards viral hepatitis management by sharing local-level data, enabling practical testing solutions for marginalised groups and working closely with clinical teams.

Effective vaccine must deal with extreme HIV-1 variability and do so without guidance from natural immunity. For HIV-1, vaccines may need to induce both bNAbs and protective CD8+ killer T cells, the latter of which clearly impose a selective pressure on the virus and their protective potential should be harnessed by vaccines. However, not all antibodies and CD8+ T cells are protective; they must target vulnerable parts on HIV-1 proteins.

The central paradigm of the HIVconsvX T-cell vaccine strategy is focusing T cells on the functionally conserved regions of the HIV-1 Gag and Pol proteins, which are very similar among global isolates and harbour fewer escape mutations. At the epitope level, the remaining variability within the conserved regions is addressed computationally by using a bi-valent mosaic. Results of the first trials testing the HIVconsvX vaccine candidates confirmed that conserved sub-dominant and, therefore, underused T-cell epitopes taken out of the context of the whole virus or full-length viral proteins can induce robust and broad T-cell responses when delivered by an effective heterologous regimen such as ChAdOx1-MVA.

Progress towards an effective HIV-1 vaccine has been slow and riddled with many setbacks. However, systematic iterative development of vaccine components for both neutralizing antibodies and effective T cells informed by human data is beginning to pay off by bringing the first encouragements endorsing the field’s overall direction of travel.

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 aim for this session is to carry on with the patient’s journey to final diagnosis. This presentation will discuss how the valuable material obtained from ROSE clinics are utilised in making a diagnosis and provide prognostic/treatment related information.

With the use of a number of examples, this presentation will illustrate how cytology impacts on patient’s management pathway, and how a standardised reporting system could be useful in unifying diagnostic pathways and performing future work on audit and quality improvement.

Finally, the strengths and limitations of head and neck cytology from the perceptive of a histo/cytopathologist will be discussed