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CONGRESS 2023 - Development & Introduction of ISO 15189:2022
25/09/2023
ISO15189:2022 has undergone a major revision and was release in December 2022. David was one of the core drafting team responsible for the latest version and will discuss how the document was developed and agreed by the international community, why the changes were made and the purpose of the new standard.
Areas covered in this lecture will include the change in the format of the standard, why Point of Care testing is now part of the main assessment, if applicable and the increased empathies on risk and patient welfare.ISO15189 was revised and released in December.
Areas covered in this lecture will include the change in the format of the standard, why Point of Care testing is now part of the main assessment, if applicable and the increased empathies on risk and patient welfare.ISO15189 was revised and released in December.
CONGRESS 2023 - Digital cervical cytology: The Monklands experience
28/09/2023
Digital cervical cytology: The Monklands experience
CONGRESS 2023 - Dimorphine-assisted treatment programme
28/09/2023
Dimorphine-assisted treatment programme
CONGRESS 2023 - Ensuring fairness in training opportunities
26/09/2023
"Don’t worry, you’ll be next" – have you ever said, or heard this phrase when it comes to training opportunities?
Should you have a queue? Should you make promises? Or do you risk losing staff if you don’t?
This session will discuss considerations to ensure fairness in training opportunities, from an individual and organisational perspective. It will also look at how to ensure your opportunities and training are inclusive, and support diversity.
Should you have a queue? Should you make promises? Or do you risk losing staff if you don’t?
This session will discuss considerations to ensure fairness in training opportunities, from an individual and organisational perspective. It will also look at how to ensure your opportunities and training are inclusive, and support diversity.
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.