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A modular approach to the Specialist Portfolios

Promoting and supporting training and education is an integral part of the work of UK NEQAS. As such the online Digital Morphology for CPD scheme (DM) was introduced some years ago as a companion to our glass-slide blood films for morphology (BF) EQA scheme. DM has been very successful and registration currently stands at just over 4,000 participants. DM recently underwent a major change when it was moved to a new platform and is now hosted on the UK NEQAS Haematology EQATE system.

The new EQATE platform offers significant flexibility over the old and allows for the development of additional modules, for example the recently introduced Haemosiderin cytochemistry EQA. Other new modules and features are proposed with some actively under design and testing. This presentation will look at how Digital Morphology and the EQATE platform have evolved, where we are with regards to the currently available modules, some of the challenges we face and a look at some future developments.

Sustainability is the balance between the environment, equity, and economy. It is well documented that our changing climate has severe implications for public and planetary health. As healthcare professionals, we have a responsibility to consider the way we practice and try to reduce any negative impacts of our practice.

This workshop looks at the carbon footprint of the lab and discusses what processes and practices can be adapted to reduce the carbon footprint of pathology practice. It explores the barriers to change and areas to target for improvement.

Vaccinations to Covid 19 virus have been at the forefront of news headlines. One of the issues highlighted was the risk of adverse reactions, both allergic and non-allergic. This caused an influx of queries to Allergy services regarding patients who had suffered potential allergic reactions and posed the question, 'how can they be investigated'?

The laboratory has limited commercial assays to the components and excipients of vaccines. However, tests can potentially be modified or developed in-house to provide evidence of a potential allergy. They could also be utilised to determine if an alternative vaccination can be used. The testing strategy may need to be adapted on a case by case basis.

There is the potential that this could be used to develop a service for allergic reaction investigation for all vaccine types.

Complement genetic testing

Complement testing

Controlled human infection models (CHIMs) allow researchers to deliberately infect volunteers with a carefully pre-defined viral inoculum and perform detailed investigations. These can examine both pre-existing immune responses and allow longitudinal sampling of multiple immunological compartments following infection. The unique nature of these CHIMs avoid the multiple confounding factors, which tend to limit conventional observational studies of naturally acquired viral infections in patients.

We have successfully established challenge models of influenza (H1N1 and H3N2), Respiratory Syncytial Virus (RSV) and SARS-CoV2, and used a variety of tools (such as multi-parameter flow cytometry, ELISpot, multiplex cytokine and chemokine arrays and transcriptomics) to characterise populations of low-frequency virus-specific CD4+ and CD8+ T cells in both peripheral blood and cells in the upper and lower airways from challenge participants. We have also been able to extend our infection models into vulnerable populations, such as older adults, and use these techniques to investigate fundamental questions about the kinetics, specificities, and functionality of the cell-mediated response in these clinically relevant populations.

Challenge models allow us to probe the immune response to respiratory viral infections in a uniquely detailed manner. These advantages also make challenge models an attractive approach to testing the efficacy of novel vaccines and vaccine platforms, potentially leading to new vaccines and therapeutics, able to generate robust anti-viral immunity, while avoiding the significant risks and costs associated with traditional Phase II/III vaccine trials.

The session will provide an overview of the qualifications that the IBMS offers in those who are carving out a career in Histopathology after they have achieved their specialist level qualification. It will outline the DEP and ASD in Histological Dissection, DEP in Immunocytochemistry and the ASD in Histopathology Reporting qualifications and other related qualifications.

It will explain who these qualifications are aimed and provide an outline of how they are assessed, how candidates can achieve these qualifications and what roles successful candidates can go on to undertake.

The Royal College of Pathologists has led an initiative to improve the transparency and standardise the operation of external quality assurance for providers of clinical diagnostic testing in the UK. This project has resulted in the development of the EQA Governance Framework, bringing together the current system of the National Quality Assurance Advisory Panels and the other stakeholders. Most diagnostic service providers are aware of the Panels, to which the EQA providers report performance concerns relating to UK laboratories, but perhaps are less certain on the criteria for reporting and the involvement of other oversight bodies, e.g., the Medicines and Healthcare Regulatory Agency and the Care Quality Commission.

The EQA Governance Framework has been developed through four separate workstreams. Workstreams 1 and 2 cover the governance and description of the process and have developed a portfolio of documents designed to support a standardised approach to the investigation and resolution of performance concerns with individual laboratories and method related problems.

Fundamental to the management of laboratory performance is the definition of unsatisfactory or poor performance, for qualitative and quantitative testing, in terms applicable to all pathology disciplines, and the action points at which the EQA provider will consider the escalation of a performance concerns to the oversight process. A challenging aspect of the work has been the development of procedures to recognise and manage method-related performance concerns, especially when working with global providers of testing platforms.

This long-term project is intended to strengthen the oversight of diagnostic testing, ensure the sharing of learning points and best practice and benefit patient safety.

Digital Morphology for CPD. What can we learn about morphology reporting from the past 15 years?