ONEONE TOTO OONENE TRANSFUSIONTRANSFUSION SCSCIENCEIENCE LAB EQUIPMENTEQUIPMENT

DAVE SPIKEYSPIKEY DUFFY BLOODBLOOD GGROUPROUP THETHE TETESTST TUBTUBEE From hhaematologyaematology An intintroductionroduction TheThe hhistoryistory anandd tthehe iinn BoBoltonlton to comecomedydy to the Duff y blood ssymbolicymbolic power of this starstardomdom on TV: p.p.1616 group system: p.p.2222 iconic piecepiece ofof kit: p.p.2828 H IMDCLSINIT AUGUST 2018 THE BIOMEDICAL SCIENTIST THE BIOMEDICAL SCIENTIST THEBIOMEDICALSCIENTIST.NETTHEBIOMEDICALSCIENTIST.NET AAUGUSTUGUST 2018

PATHOLOGY NETWORKS WhatWhat pprogressrogress hhasas bbeeneen made oonn thethe cconsolidationonsolidation ttoo 2929 networksnetworks and whatwhat happenshappens next?next?

P01 IBMS Aug18_Cover_v9gh.indd 7 19/07/2018 16:41 Increases sensitivity of immunochromatography with silver amplification detection technology

What’s your strategy for combating this year’s winter season?

IMMUNO AG1 is a rapid diagnostic system for influenza and RSV that can help you fight back

Densitometry Analyser

A Complete POC Solution – Combining Dry Chemistry and Haematology

Automated Clinical Chemistry Analyzer

www.fujimed.co.uk | [email protected] | 01234 326780

BIO.08.18.002.indd 2 18/07/2018 10:13 AUGUST 2018 THE BIOMEDICAL Contents SCIENTIST 3

EDITORIAL 5 Biomedical scientists have a lot to off er outside the laboratory

NEWS IBMS.ORG AUGUST 2018 7 News in numbers CONTENTS 8 Research, funding, developments and clinical updates 13 Product advances and launches 34 British Journal of Biomedical Science: Synopsis of all the papers OPINION featured in the third issue of 2018 14 The big question: Does biomedical science still represent a career for life? ADVICE 16 One-to-one: Dave Spikey may 36 How to… prepare to meet be a famous comic and actor potential employers now, but in the late sixties 38 Biomedical Science Day: he was starting a biomedical A round up of the events science career

MY IBMS SCIENCE 40 Institute news: The latest 18 Consolidation of COVER from the IBMS pathology networks: FEATURE 43 Journal-based learning: Progress made on the CPD exercises based on 29 networks and a look at journal articles the next steps and future plans 16 44 CPD update: Training courses, 22 Duff y Blood Group System: events and activities Laboratory Manager Martin 45 Maley gives an introduction Here to help: Advice for those undertaking IBMS examinations 24 The big story: A brief review of the development, analysis and clinical application of important 22 tumour markers MY LAB 28 The test tube: Review of the 50 Norbert Sene gives a history and symbolic power guided tour of Gibraltar’s

COVER PHOTOGRAPHY: RICHARD GLEED of this iconic piece of lab kit 24 Department of Pathology

EDITOR RECRUITMENT ADVERTISING Neither the publisher nor the IBMS is able to Rob Dabrowski Katy Eggleton take responsibility for any views or opinions SENIOR DESIGNER expressed in this publication. Readers are Gary Hill ISSN 1352-7673 advised that while the contents are believed PUBLISHED BY PICTURE EDITOR © 2018 Institute of to be accurate, correct and complete, no Redactive Publishing Ltd Akin Falope Biomedical Science reliance should be placed upon its contents Level 5, 78 Chamber Street, London, E1 8BL being applicable to any particular PUBLISHING DIRECTOR +44 (0)20 7880 6200 redactive.co.uk PRINTED BY circumstances. Any advice or information Aaron Nicholls Warners Midlands plc published is done so without the Institute, PRODUCTION The Maltings, Manor Lane its servants or agents and any contributors Rachel Young Recycle your magazine’s Bourne, Lincolnshire PE10 9PH having liability in respect of its content. DISPLAY ADVERTISING plastic wrap – check your local James Rundle-Brown LDPE facilities to fi nd out how.

P03 IBMS Aug18_Contents_v1gh.indd 3 20/07/2018 11:03 COMPLETE autoimmunity IFA ƵƚŽŵĂƟŽŶ

SLIDESLIDE SlideSlide MOUNTINGMOUNTING ProcessingProcessing tŚŽůĞtĞůůtŚŽůĞtĞůů ImagingImaging SampleSample LoadingLoading AnalysisAnalysis

RReporteport & ƌĐŚŝǀĞƌĐŚŝǀĞ

• TotalTotal walk awayaway ssystemystem • Unparalleled image quality • ^ĐƌĞĞŶŽƵƚŶĞŐĂƟǀĞƐǁŝƚŚĐŽŶĮĚĞŶĐĞ

THE EVOLUTION OF STANDARDISATION

Find out more at: www.menarinidiag.co.uk Telephone: 0118 944 4100

BIO.08.18.004.indd 4 18/07/2018 10:14 AUGUST 2018 THE BIOMEDICAL Sarah May SCIENTIST 5

few months ago I accompanied my mother to an outpatient appointment and, as usual, I asked various pertinent questions of the consultant to ensure I was SCIENTISTS clear about her follow-up and actions required. AUnfortunately, my attitude to clarity, accuracy and planning wasn’t shared, and I have just spent the past week discovering DELIVER a trail of misinformation that has resulted in my mother having to be referred back The NHS is missing out on to the consultant. My frustration is without limit. what biomedical scientists I am sharing this with you because, as have to off er beyond the a profession, we understand the need for clear, well-communicated messages; a door of the laboratory. good unambiguous instruction or statement means we all know where we stand and can act or plan accordingly. include “considerable analytical and that have been associated with the I was, therefore, very pleased with the problem solving skills”, “an affi nity for revised train timetables could have been rewrite of the Institute’s guidance on accuracy and maintaining high anticipated and avoidance actions built communicating results; it covers every standards” and “favouring practical into the plans. eventuality and provides good, clear action”. Sound familiar? Now there is something else I would advice. It is a pity that our attention I think the various management boards like to share with you: apparently I have to detail wasn’t mirrored in the in our hospitals and trusts are missing out a tendency to catastrophise. Yes, I can aforementioned outpatient encounter. on what biomedical scientists have to spot a potential disaster a mile off and This leads me on to the results of an off er beyond the door of the laboratory. I extrapolate that potential to any one of a exercise undertaken by the executive believe that we share certain professional number of ghastly outcomes unless I take team at the Institute that consisted of characteristics and, while we may not all appropriate preventative action. Perhaps a personality test and team role feedback. be the best “baby-kissers”, and were not I’d better give Govia Thameslink a call... As with any team, we are a mixture of showcased as health service heroes in personalities and our strength is in our the NHS 70th birthday celebrations, complementary diff erences. What was so we possess skills that are essential to striking is that I share my “type” with my planning and delivering sound strategies. closest colleagues and we apparently In fact, if Govia Thameslink employed operate with a biomedical scientist “group biomedical scientists among its planning Sarah May mindset”. The attributes we possess staff , it’s possible the service problems Deputy Chief Executive

Institute of Biomedical Science is the PRESIDENT EDUCATION AND TRAINING FOLLOW THE INSTITUTE professional body for the biomedical Alison Geddis CSci FIBMS [email protected] science profession. CHIEF EXECUTIVE EXAMINATIONS Join us on Jill Rodney [email protected] INSTITUTE OF BIOMEDICAL SCIENCE facebook.com/ 12 Coldbath Square DEPUTY CHIEF EXECUTIVE MEMBERSHIP biomedicalscience London, EC1R 5HL Sarah May CSci FIBMS [email protected] Follow us on Twitter United Kingdom EXECUTIVE HEAD OF EDUCATION CHARTERED SCIENTIST +44 (0)20 7713 0214 Alan Wainwright CSci FIBMS [email protected] @BiomedScience +44 (0)20 7837 9658 EXECUTIVE HEAD OF MARKETING Email: [email protected] AND MEMBERSHIP Find us on Web: www.ibms.org Lynda Rigby LinkedIn

P05 IBMS Aug18_Ed Leader_v2gh.indd 5 20/07/2018 11:04 BIO.08.18.006.indd 6 18/07/2018 10:15 NEWS THE BIOMEDICAL In numbers SCIENTIST 7

SCIENCE NEWS The NHS: Then vs IN NUMBERS now 80% “Cancer in £149.2bn£ bnn The amount spent on health is now elderly to surge” 12 times more than it was when the The number of elderly NHS started. This is the case after people in the UK diagnosed inflation is taken into account. with cancer each year is set In real terms, the increase is from to rise by 80% in less than £12.9bn in 1949-50 to 20 years, a report predicts. £149.2bn in 2016-17. Cancer Research UK estimates that by 2035 about 234,000 over-75s will get cancer each year – up from 130,000 at present. RIP: 456 At least 456 patients died after being given powerful painkillers inappropriately at Gosport War Memorial Hospital, a report has A think tank report comparing the NHS with found. An independent panel said that, taking into account missing records, a further 200 patients 18 similar nations finds it is performing below average on 8 of the 12 most common causes of death. These are: may have suffered a similar fate. ● Breast cancer ● Colorectal Hay fever cancer The percentages ● Lung cancer of those from the ● Pancreatic UK who believe cancer that they suffer ● Lung disease from hay fever: ● Respiratory Excellent infections (such as Good pneumonia) ● Stroke 31%Adults overall Average ● Heart attacks. 33%Women Below average 28%Men

p07 IBMS Aug18_News In Numbers_v2gh.indd 7 20/07/2018 11:05 THE BIOMEDICAL NEWS 8 SCIENTIST Science NEWS SCIENCE

HAEMATOLOGY “EXERCISE MAKES THE BLOOD BRAIN TUMOURS OF OBESE PEOPLE HEALTHIER” Poliovirus therapy for recurrent Exercise can reduce infl ammation in obese people by changing the characteristics of their blood, according to new research. glioblastoma The blood cells responsible for causing infl ammation are formed from stem cells within the body. A genetically modifi ed poliovirus therapy shows This new research is the fi rst to show that exercise alters the signifi cantly improved long-term survival for patients characteristics of these blood-forming stem cells and reduces the with recurrent glioblastoma. number of blood cells likely to cause infl ammation. The therapy, developed at Duke Cancer Institute in the These fi ndings provide a new explanation of how exercise may US, has a three-year survival rate of 21% in a phase 1 improve health in adults with obesity. clinical trial. In comparison, just 4% of patients at Duke Young, lean adults and young, obese adults were recruited for with the same type of recurring brain tumors were alive this study. Comprehensive physiological characterisation of all at three years when undergoing the standard treatment. participants occurred before and after completion of a six-week Darell D Bigner, senior study author, said: exercise programme. “Glioblastoma remains a lethal and This consisted of three bicycling or treadmill running sessions devastating disease, despite advances in per week, with each session lasting approximately one hour. surgical and radiation therapies. There is Blood was collected before and after the exercise training a tremendous need for fundamentally intervention to quantify blood-forming stem cells. diff erent approaches. With the survival The results demonstrate that exercise reduced the number of rates in this early phase of the poliovirus blood-forming stem cells associated with the production of the therapy, we are encouraged and eager type of blood cells responsible for infl ammation. to continue with the additional studies.” bit.ly/BS_AugNews01 bit.ly/BS_AugNews02

PROOF-OF-PRINCIPLE BLOOD SIGNATURE COULD IMPROVE EARLY TB DIAGNOSIS

A gene signature in the contacts over two years to see study shows a potential signatures in larger bloodstream could reveal who developed active TB. new direction for groups of people, with whether someone is going to They found that those who TB detection. the aim of being able develop active tuberculosis remained healthy showed no Anne O ’ Garra, to offer validated (TB ) m onths before any sustained gene signature, while senior author of tests to patients symptoms begin. six of the nine who went on to the paper, said: within the Such a signature has now develop active TB showed a “ This study was a next decade.” been developed by a team led strong, sustained signature. promising proof-of- The research by the Francis Crick Institute This is the fi rst study to link principle, offering new was carried out in and University of Leicester. the presence of signature and insights into how to develop collaboration with The research looked at 53 TB the onset of early TB before the gene signatures for active TB. BIOA STER and bioMér ieux and patients in Leicester and patient has symptoms. “The next step will be to the University of Cape Town. followed 108 of their close This small proof-of-principle develop and test different gene go.nature.com/2MJYYVI

P8-11 IBMS Aug18_News_v2gh.indd 8 20/07/2018 11:05 P8-11 IBMS Aug18_News_v2gh.indd 9

IMAGES: ISTOCK/SHUTTERSTOCK/ UNIVERSITY OF BASEL/SCIENCE PHOTO LIBRARY from theUniversityofFlorida esearchers spreading Zika.R which wasresponsiblefor cousin totheAedesaegypti, widespread inNorthFlorida. believe theviruscouldbe confirmed caseandresearchers confirmed inFlorida. humans, withacasenow jump frommosquitoesto Keystone virushasmadethe FIRST KEYSTONEHUMANINFECTION Translational Medicine. apart from theoriginaldataset.” are able toobtainusingthisapproach ondatacollected years into acommercially available test. would like toseemoveforward intoclinical trialsandultimately reported 88%accuracy. based onmetabolites inablood sample. algorithm topredict ifachildhasautismspectrumdisorder, detection doesnotusually happenuntilthechildisfour yearsold. from ablood test. It may soonbepossible todeterminewhether achildhasautism BLOOD TESTFORAUTISM VIROLOGY BIOENGINEERING bit.ly/BS_AugNews03 It isspreadbyamosquito -oldboyisthefi A 16-year The study hasbeenpublished inthejournalBioengineering and “The mostmeaningfulresult isthehighdegree ofaccuracywe Juergen Hahn,leadauthor,said:“Thisisanapproach thatwe The testswere carriedouton303children ingroups and However, scientistshave beentriallinganewtestthatusesan At present, itisdeterminedbyclinicalexamination,meaning rst Clinical InfectiousDiseases. been publishedinthejournal for theKeystonevirus. outbreak. Buthetestedpositive his casewasseenduringaZika us,as suspected hehadZikavir Central Florida. an urgentcareclinicinNorth in theteenagerafterhevisited identified theKeystonevirus bit.ly/BS_AugNews04 A reportofhiscasehasnow Medical professionals

eating aMediterraneandiet WHAT’S HOT AND WHAT’S NOT The NewEnglandJournal awareness amongyoung MEDITERRANEAN 013papershowingthat 20 retraction, amendedand shows similaritiestoour of Medicinehaspulleda highlights alowlevelof through high-resolution fossil fromSouthAfrica disease. Itissuedarare reduced cardiovascular republished thearticle. University ofWaterloo A newstudyfromthe four-million-year-old hygiene precautions own whenscanned people aroundthe imaging systems. TEENAGERS The craniumofa e uiredwhen req handling food. FOSSILS DIET NOT NOT HOT spoken words. discriminating between into animprovementin pitches, whichtranslates distinguish different sabilityto children’ specific effectonyoung piano lessonshavea New researchindicates PIANO LESSONS medical microneedle. to createapainless inspiration fortheirwork uitoesarethe mosq State Universitysaythat hio Researchers atO MOSQUITOES directly tooralulcers. administers steroids of themouthand that stickstotheinside developed aplaster Scientists have MOUTH ULCERS HOT HOT NOT Science NEWS THE BIOMEDICAL SCIENTIST 20/07/2018 11:05 9 THE BIOMEDICAL NEWS 10 SCIENTIST Science

MICROBIOLOGY BACTERIA PROVOKE “WARFARE”

As well as producing toxins that directly especially when the provoking strain is kill their competitors, bacteria can release shielded from, or resistant to, their toxins. toxin “provoking agents” that make other Lead author Diego Gonzalez said: strains increase their aggression levels by “By provoking other strains to attack boosting their toxic response. each other, the toxin of the provoker In a new study, led by Imperial College is more eff ective than what would be London and the University of Oxford, expected based on its real toxicity.” researchers used a combination of bit.ly/BS_AugNews05 Some bacteria can release toxins that experiments and mathematical models to provoke their neighbours into attacking see what happens when bacteria provoke each other, says a new study. their competitors. The authors state that this is a tactic When used against a single competitor, that could be exploited to fi ght infections. they found that provocation backfi res: the Bacteria often engage in “warfare” by provoked strain mounts a strong toxic releasing toxins or other molecules that counter-attack and harms the provoking damage or kill competing strains. strain. When three or more strains are This war for resources occurs in most present, provocation causes competing bacterial communities, such as those strains to increase their aggression and living naturally in our gut, or those that attack each other. This can lead to the cause infection. competitors wiping each other out,

HUMAN BIO MOLECULES NHS FINANCES Monitoring biomarkers live “INEFFECTIVE OR RISKY” A new technique has been developed biomarker concentrations over time. that may be the solution for the live It is based on the fact that tiny particles PROCEDURES CUT monitoring of biomarkers. in liquid are continuously in Brownian This sensing technology enables the motion because water molecules collide NHS patients in England will not super-sensitive measurement of with them. be eligible for a range of procedures The researchers, from Eindhoven deemed “ineff ective or risky” under University of Technology, bound the new cost-cutting measures. particles through a nanostrand to a The 17 routine procedures include glass plate, causing the particles to tonsil removal, breast reduction and wiggle back and forth. varicose vein surgery, among others. The biomarker to be measured The treatment will be off ered only binds temporarily to specifi c adhesive if it is judged to be of “compelling” molecules that are fi xed to both the benefi t and there are no alternatives. particles and the plate. NHS England said the move would When a biomarker molecule attaches aff ect about 100,000 people every itself to both a wiggling particle and to the year and would free up an plate, the particle suddenly becomes estimated £200m. attached, which greatly reduces its mobility Patients at risk of – until the biomarker is released again. serious harm from The mobility of the particles, which are their condition will coupled to the transparent glass, could be continue to be easily observed by the researchers with light. off ered treatment, go.nature.com/2zgnewW it was confi rmed.

P8-11 IBMS Aug18_News_v2gh.indd 10 20/07/2018 11:06 NEWS THE BIOMEDICAL Science SCIENTIST 11

FIRST-LINE TREATMENT PROSTATE CANCER DRUG GIVEN INITIAL “NO” FOR NHS

A prostate cancer drug has been provisionally rejected as a fi rst-line treatment on the NHS in England. GENOMIC RESEARCH The draft recommendation from the NICE means abiraterone (Zytiga) won’t be HOW TO STOP CHOLERA made routinely available for men with newly diagnosed prostate cancer that has spread to other parts of the body. Stopping cholera spreading between Disease Research in Bangladesh. As it stands, the NHS in England can members of the same household They sequenced the genomes of all 303 only prescribe abiraterone for these men could be key to reducing cases. samples to see how the strains were once standard hormone treatment or The claim comes from a new large-scale related to each other and compared them chemotherapy has failed. genomic study looking at how samples of with strains from other parts of the globe. Results from recent clinical trials have cholera are related to each other. They found that nearly 80% of the shown that giving abiraterone alongside The authors found that nearly 80% secondary infections were linked to the steroids and hormone therapy as a of infections were related to the fi rst fi rst case in that household within the fi rst-line treatment can reduce the case of the disease entering the fi rst fi ve days. chance of the cancer coming back household, rather than to other strains Daryl Domman, lead author and improve survival, when compared of the disease that were circulating in of the study, said: “Preventing this with hormone therapy alone. the same area. spread within the household could Harpal Kumar, Cancer Research There are up to fi ve million cases per enormously reduce cholera outbreaks, UK’s Chief Executive, called the year globally and around 120,000 deaths and highlights the need for decision “disappointing”. every year, according to Unicef. prioritising local control strategies. The committee that made the decision Researchers at the Wellcome Sanger “This could have a huge impact, concluded that it could not accurately Institute in Cambridge looked at not only on the individual households, estimate the drug’s cost eff ectiveness samples taken from cholera patients at but also on the entire region.” based on the data that was submitted. the International Centre for Diarrhoeal go.nature.com/2NoFIhG bit.ly/BS_AugNews06

keep people awake, while reducing which have reduced blue light in screens of people who are working UNDER THE cyan is associated with helping them an attempt to lessen the damage at night and need to stay awake. MICROSCOPE sleep. The impact was felt even if to sleep. This month: Cyan changes were not visible. How easy is it to reduce cyan? What’s next for cyan? It’s not too tricky, apparently. The As in the colour cyan? Wasn’t this the case recently Researchers are now calling for researchers say that they can create That’s the one – the blue-green that with blue light? devices for computer screens and the same colours without using cyan. is one of the primary colours in the Yes. Researchers have already phones that could increase or subtractive colour model. established the link between decrease cyan levels. What about just not looking at colours and sleep – and blue light your device late at night? What’s the latest? was previously identifi ed as Why would you want to That's a good idea. A recent study University of Manchester researchers more likely to delay sleep. increase levels? of 91,000 people said screen use believe that the colour is a hidden "Night mode" settings have While lowering levels can help after 10pm could increase the factor in encouraging or preventing since been created for people sleep, increasing cyan likelihood of developing depression, sleep. They say higher levels of cyan phones and laptops, could be helpful for the bipolar disorder and neuroticism. IMAGES: ISTOCK/SCIENCE PHOTO LIBRARY

P8-11 IBMS Aug18_News_v2gh.indd 11 20/07/2018 11:06 Hydragel von Willebrand Multimers Within-day results! Multimers

Small multimers

Intermediate multimers

Large multimers

P P P P C

Densitometry • Same day results • Simplified method • Reduced hands-on time • No transfer to a membrane • Ready to use gels and reagents • Results via densitograms • Clear and reproducible results

Sebia (UK) Ltd River Court, The Meadows Business Park Station Approach, Blackwater Camberley, Surrey GU17 9AB Tel: 01276 600636 Fax: 01276 38827 Check availability with your Sebia representative email: [email protected] www.sebia.co.uk

BIO.08.18.012.indd 12 18/07/2018 10:17 NEWS THE BIOMEDICAL Technology SCIENTIST 13

TECH

NEWS NIGHTINGALE HEALTH OLYMPUS BLOOD SAMPLE DRIVING RESEARCH FORWARD ANALYSIS Nightingale Health will analyse the With expanded imaging capabilities, now feature fully integrated multi- biomarker profi les of 500,000 blood Olympus has launched version 2.1 channel acquisition and support for samples from UK Biobank. of its imaging platform cellSens. the latest high-end devices. The Nightingale’s biomarker profi ling Enabling researchers to create capabilities of cellSens Entry technology will be used to analyse UK clean and detailed images in have also been expanded, so Biobank blood samples by measuring less time, it delivers faster users can now manage encoded metabolic biomarkers that recent studies deconvolution and improved devices, perform measurements have found are predictive of future risk for feature sets across all levels. and export the results to Excel. heart disease, type 2 diabetes and many cellSens Dimension and Standard olympus-lifescience.com other common chronic diseases. Until recently, technological constraints SYNBIOSIS and prohibitive costs have prevented the MEASUREMENT SOFTWARE UPGRADE analysis of comprehensive metabolic data from large-scale biobank collections. Synbiosis’ eAST software for automatic The new eAST software now has all nightingalehealth.com zone measurement of antimicrobial the 2018 breakpoint values for European susceptibility testing (AST) plates has Committee on Antimicrobial Susceptibility been upgraded to improve antibiotic SIR Testing (EUCAST) and Clinical Laboratory (Susceptible, Intermediate, Resistant) Standards Institute (CLSI) guidelines category determination. included in its expert rules database. It rapidly generates and analyses AST The plate images can be stored in a data, making it ideal for regulated clinical secure SQL database for cross-referencing. and antibiotic development laboratories. synbiosis.com

www.cityassays.org.uk Serum Copper, [email protected] 0121 507 5348 Selenium & Zinc www.cityassays.org.uk Address for samples: Copper, Zinc and Selenium are essential Trace Elements Laboratory trace elements. Deficiency and toxicity can City Hospital, Dudley Road Birmingham B18 7QH manifest as severe clinical symptoms. SWBH Path TV News Regular monitoring in patients on parenteral nutrition and patients requiring long-term nutritional support SWBH Pathology is crucial for improving clinical outcomes. @Cityassays An information leaflet is available from our website. Price: £11 each or £27 for all three Turn round target: 2 working days

P13 IBMS Aug18_Tech News_v2gh.indd 13 20/07/2018 11:07 THE BIOMEDICAL OPINION 14 SCIENTIST Big question

THE BIG QUESTION THIS MONTH WE ASK “Does biomedical science still represent a career for life?”

P14-15 IBMS Aug18_Big Question_v1gh.indd 14 20/07/2018 11:09 OPINION THE BIOMEDICAL Big question SCIENTIST 15

Chris Chase Ian Davies Maria Haynes

Pathology Training Manager Healthcare Science Course Leader Consultant Biomedical Scientist Hull and East Yorkshire Hospitals Staffordshire University Maidstone and Tunbridge Wells NHS Trust NHS Trust n short, yes. But it is an interesting es. Now more than ever there are bsolutely, yes. With more and more question that opens up discussions increasing options for career clinical decisions being made from about roles of biomedical scientists opportunities that are more the information gathered from I across healthcare and beyond. Y diverse. A “career” is no longer A laboratory testing, there will Firstly, I suppose it depends what your about choosing your discipline, working always be a need for biomedical scientists. vision of a biomedical scientist is. through the grades to one day become a That is not to say that the job will not Traditionally, we undertake laboratory- manager. Management is not where change – with the introduction of based diagnostics, and that role will everyone wants to ultimately end up. We automation, robotics and artifi cial certainly continue to be a pivotal and have seen an increase in specialties and intelligence, biomedical science is at the exciting area of practice, as test additional qualifi cations at FRCPath level forefront of advances in technology, and repertoires increase and the possibilities for those who want a career with hands- with a greater diagnostic use of molecular of the genomic era expand. on practical applications, off ering better biology and genomics, job roles will Importantly though, we need not job satisfaction. undoubtedly change, with a greater confi ne ourselves to that role and must emphasis on the science. consider the skills and knowledge that With the traditional boundaries that biomedical scientist education brings are being broken down within healthcare and how we can apply these across the science, such as in advanced practitioner wider healthcare and life sciences sector It is no longer just roles within cellular pathology and – for example product development, equivalence routes, there is now a greater management and public health. about progressing opportunity for career development for Using myself as an example, my to management, biomedical scientists. background is as a biomedical scientist There are many routes now open within an NHS clinical chemistry there has been for biomedical scientists to follow department. A few years ago, I decided – education and training, quality, higher that I wanted to change focus and began an increase management, or advanced scientifi c roles. a journey into academia – although I am These routes to progression are very clear no longer on the “laboratory bench”, I use in specialisms and prescriptive and with a wide range of the knowledge, behaviours and skills of a postgraduate qualifi cations now available, biomedical scientist every day, whether it career progression should be not too be in delivering education, identifying arduous for ambitious scientists, provided research opportunities or counselling the appropriate resources and supportive students. I identify primarily as a mechanisms are available. biomedical scientist and the same would The work biomedical scientists do now be true if my career path had led me into and will do in the future is vital within healthcare management or research and the healthcare environment and development, for example. opportunities within the profession will So yes, it can provide a lifelong career, only increase and yes, biomedical science especially when entered into with an

IMAGE: ISTOCK can be a career for life. It has been for me. open mind and the ability to diversify.

P14-15 IBMS Aug18_Big Question_v1gh.indd 15 20/07/2018 11:09 THE BIOMEDICAL OPINION 16 SCIENTIST One-to-one

FROM HAEMATOLOGY TO STAND-UP COMEDY Dave Spikey may be a famous comic and actor now, but in the late sixties he was starting a biomedical science career.

did an event for a room full about what I did on my holidays during of clinical biochemists; it primary school, and the teacher wrote, was an interesting gig. ‘Another good essay from David, but why What I hadn’t realised and does everything have to have a comedy I should have done is that element?’ I wasn’t even aware I was doing you can’t tell a clinical that – it was just the way I was seeing biochemist just one joke. life,” he says. You’ve got to tell them a Dave was academic – he passed his “Ijoke that’s not very funny, a joke that’s 11-plus, went to grammar school and was funny and a joke that’s hilariously funny sitting his A-levels with plans to become a so they’ve got a low and high control – doctor when his father (then a painter at night and come in and help save lives,” that’s the only way it’s going to work.” and decorator) had an accident and he says. “I loved haematology.” Dave Spikey knows what he’s talking couldn’t work; as the eldest child Dave Dave progressed on to the Higher about. Unusually for a stand-up comic he needed to become breadwinner. National Certifi cate and went on to do the started his career as a biomedical scientist While in hospital, he saw a job advert two-year Special Examination leading to – joining Bolton Royal Infi rmary in 1968 for medical laboratory technicians and Fellowship. He got the senior post at the as a Junior Medical Laboratory Technician encouraged Dave to apply – suggesting it hospital following his viva for the Special and rising up the ranks over a 30-year would stand him in good stead once he exam. “I instigated a thalassaemia and career to become Chief Biomedical could resume his studies. “I went to the haemoglobinopathy screening programme Scientist in haematology at the Royal interview on the Friday from the comfort for our population in Bolton and Bolton Hospital. of my new home, the sixth-form common introduced all the techniques for that.” The year 2000 came and he found room, and found myself on the Monday himself one Monday morning in a rainy, morning in a white coat in a microbiology Career success windswept Bolton carpark, dressed as a lab helping sample phlegm.” He also improved other areas of the giant berry and singing the Katrina and laboratory. “We were a very basic lab. the Waves classic Walking on Sunshine. He Starting out Haematology was really expanding back was fi lming an episode of Channel 4 Dave was one of seven basic-grade juniors in the mid-1970s and we were getting left sitcom Phoenix Nights, which marked his who did the rounds in the hospital in behind. There was an old-fashioned move into full-time comedy. But this microbiology, histopathology, attitude of sending everything to didn’t come overnight: he’d been doing biochemistry and haematology, be tested at Manchester Royal stand-up and writing comedy in his spare while working towards their Infi rmary. We thought: ‘No, we time since 1987. Ordinary National Certifi cate can do it here.’ I introduced on day release. “I found my cytochemistry techniques Early years home in haematology – I – PAS, Sudan Black, etc – I got Comedy has always been a huge part of thought it was the SAS of all that started. Those areas I Dave’s life. “I remember an essay I wrote pathology. I aspired to be on call am immensely proud of, mainly

P16-17 IBMS Aug18_OnetoOne_v1gh.indd 16 20/07/2018 11:09 OPINION THE BIOMEDICAL One-to-one SCIENTIST 17

ALL ABOUT DAVE Won Mastermind with the highest- ever score with the specialist subject, human blood: “I told the producers I’d love to do the red blood cell as my specialist subject. They said: ‘The red blood cell – it’s a bit narrow though, isn’t it?’ I thought: ‘A bit narrow?! It’s bloody microscopic!’” Introduced column chromatography in the lab, which led to screening programmes in Bolton for hypochromic microcytic anaemia. Had an animal sanctuary at home – rescuing dogs, goats, ducks, battery hens – and works with a range of charities, including Animals Asia, Pet Rehome and Paws for Kids. Has won two British Comedy Awards and been nominated for a BAFTA, appeared on Parkinson and the Royal Variety Performance, and is most because I instigated them,” he adds. and act himself. “I was terrifi ed but once I proud of the Performance of the Year The career didn’t come without its saw them laughing, it was like a drug.” award for his first-ever tour show. challenges, and the biggest in his early After a colleague told him he should * Dave Spikey’s 30th Anniversary Tour, days in microbiology was having to kill be a comedian, he started doing talent Juggling On A Motorbike, is at theatres mice and guinea pigs that had been shows, later playing one gig a month around the UK from 27 September 2018. tested on, then dissect them. “I was so as a hobby: “It took me three years or For details, visit davespikey.co.uk inept at it that it’s a whole comedy sketch so to get a bit of motion.” right there – I feel guilty even joking Originally performing in the ubiquitous about it,” he says. “I’ve always been a working men’s clubs, Dave “died horribly him on as one of their acts. “The other massive animal lover and I refused to do in half of them” because his observational massive turning point was meeting Peter it in the end. I was threatened with the comedy wasn’t popular, but a comedy Kay when he won the North West sack, but I didn’t lose my job.” seminar evening in Bolton started Comedian of the Year [Dave had won the featuring comics doing similar award the previous year and as a result Move to comedy conversational humour to Dave. was compering the event]. “Hospitals provide a brilliant little arena “I got more and more work that way, “We got on straight away and wrote for comedy. In certain situations things then I started to go to gigs in London. That Peter Kay Thing together, then we can get quite dark and they just need That’s where it became hard. I would wrote Phoenix Nights.” somebody to diff use them. Sometimes work my days until quarter past fi ve, then Dave’s fi rst career has infl uenced his you get it right and sometimes you get it drive down to London, do a spot in a grotty second. “Over the years I’ve garnered so wrong,” he adds. pub and then drive all the way back up, all many stories. I never just tell one gag This kind of environment provided for nothing.” after another.” And despite his huge fertile ground for Dave and his colleagues success, he misses it: “As soon as I walked to put on pantomimes. He originally Comedy success in the lab I loved being part of that team. wrote and directed them, but when one The fi rst turning point was an open spot You met everybody, you knew everybody; performer took exception to his directing at the Comedy Score in London, which it was a fantastic family, it was a fantastic and walked off stage, Dave had to go on went so well that the management took place to work.”

P16-17 IBMS Aug18_OnetoOne_v1gh.indd 17 20/07/2018 11:09 THE BIOMEDICAL SCIENCESCIENCE 1818 SCIENTISTSCIENTIST PathologyPathology networnetworksks

CONSOLIDATION OF PATHOLOGY NETWORKS

P18-21 IBMS Aug18_Pathology Networks_v3gh.indd 18 20/07/2018 11:09 P18-21 IBMS Aug18_PathologyNetworks_v3gh.indd 19

PHOTOGRAPHY:PHOTOGRAPHY: RICRICHARDHARD GLEGLEEDED A of imp im per ado bec whe hav cou is met ser mor mea at int and dem con bee NHS org tre and looksa atthenextstepsandfuture plans. out theprogresso networks madeonthe29 at NHSImprovement,a HeadH Consolidation ofPathology Services of sizeandscalealsomeanswe operate improve ourpatientoutcomes. Thislack im perative to diagnosediseaseearlier and personalised medicineisbecoming an adoption ofnewtechniquesto support becoming harder tosecure andwhen when fundingfor capitalequipmentis have ademonstrable workforce shortage, country. Thisisallatatimewhen we is adoptedinconsistently across the methods andtechniquestakes longerand Innovation andadoptionofnew services. more expensive equipmenttoprovide our meaning thatwerequire more peopleand at thesizeandscaleofotherservices international we do not services operate and quality. compared to When demonstrates variationintermsofcost confi isineffi guration ofservices been longknownthatthecurrent NHS ischallenging.Inpathology ithas organisations as large and complex as the treatment andchangeinstaff .Change for re t n u ado siz the per atmat ern vic e son ani omi n l

ntr e a pti fi rov hod e n f nin g qu N t ons d a is e a pte es.

ong ati ura ati si on sats

y. ali t de ali xpe ent d und e o ng ch H l g t s a nd tra ze h ve o Thi In d i ona

mon sed ty. t ion of tio all ur o kn S har hat nsi nd and e an o tes ing nov sca to nco new f eng s i Wh n o

l s s a pat k technology,tec changein in patients,change Change inapproach,Cha change constantcon hasbeenchange. healthcare,hea theother the provision ofuniversal year, oneconstantyea hasbeen s theNHSentersits70tht own me d c I ve

p tec e der str dia le we va s a P ati m fo erv s nsi sc he s l f s pat r en hno ing ien han equ r, dic sta lth ria als abl

a hni r c pr nge te ll ale gno o on arg a to re erv th ice ste one NHS p t chn ien at com ovi t o api . I tio ine o m car g nt t e w qui ipm log ge at h que se of and r e a s w ice se n p in ntl

a t r utc sio t ts, n i o cur has tal co e, o iqu the y, y, in re re ot ork is e ean par en h dis nd as ap s i s t ent ime y a e d v ath l the nst n t n o s ch ad cha ome her s i be mor eq e a sta o es s i h e ter pro e ake beb for eas ed cu s cro com s w o n ang opt ro i erm com olo to uip

g f u ant m neffi nd wh

to ot ff nge en n s i rre se ce . m to s. ach s l e e p ss y e o ot pr niv her ion gy ts sup rvi e iei ple Ch men e cient and Thi en whe s o h cha ong e ntn sho ha ing

the arl ovi eop ope c in S per , c a x 70t n it i n ers ces ien ang

c x a f c s b of we por s l

e d han ier nge t rta de er has

an t i n t le ate rat ost h al

r ne s t ack t a een e , e f s s t and ge,

an our and v

. ge g

e

he t w D David Wells, sets nd or o

i

d e

c

n

a p e v

s s t tru Imp pat lar to NHS nat in pat thi Unw Per Hea Lor car imp wit typ cos var effi Hos fro del netne hos AllAl EssEs net est type ofhospital,however,can belinked to cost. Thisvariationisnotlinked tosizeor variation intermsofpay andnon-pay effi ciencytool) show unwarranted Hospital, theonlineproductivity and from providers (nowavailable onModel deliver thesechanges.Thedata collected networks andasked toform plansto hospital trustswere mappedintothese All hospitaltrusts,andlater,allspecialist approach. laboratory Essential Services” networks were modelledonthe“Hub and establish 29pathology networks. These trusts, settingoutaplan.Theplanwasto Improvement wrote toallacutehospital inEngland,NHS pathology services largest everdatacollection undertaken in to changethat. NHS Improvement wasgiven thetask national planandcomparative data. in driving changehasbeenaclear pathology. Oneofthebiggestobstacles this istrueacross healthcare notjustin Unwarranted Variations, demonstratedthat Performance inEnglishNHSAcuteHospitals: Health, entitled Lord CarterofColes for theDepartmentof care. Themostrecent report authored by impacts uponhospitalandcommunity with several single points of failure that i

h a d C InI In September2017,following the cha dri ges for m p abl s i ive e. sts iat t. ent d C e o hol hol hoh ci h s wor wor ionio e pitpi n pit lth act

rov arr o Sep W enc man Thi s t Im The

vin spi ion r t , s ish t e f h d nge eve al 2 n art ogy ogy ant ial al, al rov pi , e s u ks k ks eme al rue l ett pro hes 9

tem ver s v y t tru e g c tal osp s ce nti pla f er ed 29 ral th mom Se in ide . O pon and wer

th o se u ing l ari ool in n vem ac han nt e c e o sts of Var rvi tr tle n a l da ita pa te ber l ne rvi at. si r st rs t Eng s ros ust i e e m atiat ) s rms as han ho Col wro ngl u ta d nli ou ces tho iat l, d we nd rec , ces (no ge ent es of t

how 20 Ope Operational Productivity and ked on lis how s h r s, s spi col s ion t a a w ne ode es ” l e p re re log the ent ges te has com h N e w a d 17, of e and in t eal wa is s tal rat abo lec for pl o

pro tot , d mapma oin i t to eve lle un y n pa p l . T En HS o fo not o bi vai an. re s ion be thc r s g T par tio n emo an fo la all rat th d odo l y a llo duc war ts gge n he k por etw r, gla en a Acu al lab rm ped ter ive n u d c are e D Th li er ati s win w can of ory aca

nd n t n Pro dat nke nst nd, tiv st t a a c ran

, a le l ork te n t omm e p ute plapl e ve fai nde epa s rk in he no non duc obs uth ity ap g t ll Hos a c on be lea rat . d t he NH ted s.s to lan lur dat ns t j c spe “Hu ho rtm pro rta he H tiv oll li tac an r The ed Mod t o s pit ore -pa uni ust the tas e t

to nke S a. as spi ity waw ciaci ect ken d ach als ize les b aba tha y ent hat d b k y se ty se in an tal el s tst lisli d t : ed

nd n . or t in

y d

of o t o

systems donothave theimmediacyto where ITsystemshave failedorback-up high-profile issuesacross thecountry, hospitals. We have seenanumber of aff ordable multiplewhen serving back-up anddisasterrecovery become high levelsofredundancy andimmediate treatments. Interoperable ITsystemswith to thelatestandbestdiagnostictests successful and,vitally, patientsgetaccess are more robust andmore likely tobe effi ciently, meaningthatbusinesscases larger populationisutilisedmore (POCT) equipmentpurchased a toserve technology orpoint-of-care testing methodologies. Thelatestsequencing repertoire oftestsutilisingthebest allowing laboratoriestoprovide awider optimum equipmentcanbepurchased, Thisscalecanalsoensureservices. laboratories capable ofmaintaining whatever reason, there willbeother being unavailablesingle laboratory for centres will ensure, in the event of a workforce, andequipmentacross multiple resilience; consistent protocols, scale across networks canenable service which isnotalways available. Working at be able toaccessspecialtyexpertise, – irrespective ofwhere theylive –should more appropriate turn-around times. Networking candeliver thesefasterand nee needed toadequately supporttheircare. cur currently receive theturn-around time are areas ofdiagnosticspatientsdonot eco economic benefit. We knowthatinsome trusts tounderstandtheclinicalaswelltru One ofthechallengestothischangeisfor The benefiTh ts innovativeinn ways of working. adoptingbestpracticeand the service sys whe hig hos aff bac hig tre to sucs are effi lar (PO tec metme rep all opt ser lab wha sin cen wor res sca whi be – i mor Net ar re ec Wor Working inlarger networks, patients owi rre ci the ord gerg abl atm ilii r vic hno ora tem gleg sts le as ert ren h-p h l nom imu e cesce k-u ku he ova tre pit CT)CT ded wor mo ch se kfo hod e a re tev of i

enc ent spe acr be o of es. e t eve rvi abl oir ng tor als kin s w sfu to la pop la tly IT I is p a eq rofi tiv ent re re ppr f log rce s d th er fu m e kin to olo ic nt tes dia o a bor ly, oss e; ce cti e o Th pul e w not un n es . W ls ies lab e c sys rob l a e w o g i ill uip nd re o n rea y o , a , W ul ben s. s opr ad le efi a con g c gie e me qui t ata cce ado ve of gno is ato f t p der cei nd, hal n l ne ati en nd e heh Int ora hen ca tem a is ustus equ to Pathology networks P r p dis al ot men ays son t at an d nd iat red scasc est s. efi of l ani sue ss pme sis m l two ve pab arg sur way h ry ry on o pti s sta sti lenl ave ero er equ tor hav viv oin o ast a The e t l ate an t. whe s h , t del of o spe s u se bes le ten und o tal the bei ng g t p cs ng s a e e, er is nd le y networ We ges rks ies her perp s a nt t-o er SCIENCESCI rvi urn p d m ipm se e t wo canc ave ly ly til ive lyly, in cia t d utiut pat urc u la cro t p ng net of tha re re bes ancan en the tu ENC rec vai ng he can f-c abl to sup a isiis e w ca tes kno rki to -ar r t the pa iag ore b lty mai rot lisl ent fa the al rn- ien ss c hash ag una ks wor t btb t p a n ng n n e E lab pr ove are a imm y a mul e I th hes as ng. t sts cl tie so ile ill por ed oun be nos the w t oco ex ovi li ev y l ts usi aro ini he rac nta e ac is T s umb nab le. eque theth nd vai d o ks, nts ry ry ens be kel d

te mormom e f per pu t ent tip ive do hat ros cha ls,

tic de d t THE BIOMEDICALBI edi cal nes co tic to und yst Wo sti ini bec lab r b imm ot ast y t pa hei enc le rch be ure

ge e le tis er not unt ime s m – a w e a e serse te acy ng of her nge O as ems in ng s c SC SCIENTIST ack ser o bob tie rki e le i st MEDI er ome t a w g ms r c sho e, of IENTI ti t ase sts ing

me a nd

ve edied we ry, so ase for f ult ide s. nts me

ng and e vic cce to C -up are se is A S 20/07/2018 11:10 ce wi d, uld me ana T L

a

ll

atea ipl s r e fo

at ss 191 . th as d s 9

r e THE BIOMEDICAL SCIENCE 20 SCIENTIST Pathology networks

VARIATION IN USE OF MLA AND BMS STAFF IN ACUTE TEACHING TRUSTS

0.4 0.6

Left. Ratio MLA 0.3 to total lab staff 0.4 for acute teaching trusts 0.2 (high to low) Right. Ratio 0.2 0.1 BMS to total lab staff for acute teaching trusts 0.0 0.0 (high to low)

provide seamless continuity, these bodies and industry experts to ensure all pace in carrying out the work of failures have led to issues for service parts of the system work together to modelling and forming networks. provision, and ultimately suboptimal support this change. This includes work During the year we also mapped patient care. that is on-going in genomics, specialist trusts into the 29 pathology The greatest benefi t is to the workforce. antimicrobial resistance, screening, networks with an ambition for them to Training opportunities and advanced workforce, digital/AI innovations and other work collegiately with other trusts locally, roles are more consistently available innovative disruptive technologies. This is but also to work on a national level to when services cover larger populations. to ensure the system makes one change to ensure patients have access to expert The medical workforce in certain a truly interoperable system that will clinical diagnostic services whilst disciplines within pathology is in short deliver on the national grand challenge to supporting the sustainability of these supply and biomedical and clinical diagnose disease earlier and improve services, recognising the challenges they scientists are well placed to adopt new patient outcomes. face in training, recruitment, retention and innovative roles to not only enable To date, over 80% of trusts are making and adoption of new technologies. networks to progress, but also to deliver a progress towards networking their The announcement in the spring by the high-quality timely diagnostic service to pathology services, others are going Secretary of State for Health and Social Care patients. This is an opportunity to put through the processes to enable them. awarding a total of £68m to organisations into place the advanced roles envisioned To date, only two hospital trusts have progressing projects networking their by the modernisation of scientifi c careers found themselves unable to agree with pathology service demonstrates the programme and ensure all staff work to the proposed model. commitment to delivering this change to their top capability and competence. We continue to work with trusts, the sector. In addition to that, we have been collecting and validating data, making working closely with the Offi ce of Life Progress some changes to the original networks or Science to support the adoption, at pace, of Since the publication of NHS confi rming the proposed confi guration. the Life Science Industrial strategy for the Improvement’s operational productivity We have completed our series of CEO benefi t of our patients and the NHS. report into the consolidation of workshops for most regions, these 29 pathology networks, we have been sessions have been very useful to all Next steps progressing a number of workstreams involved and have helped us move with There is still much to do. Some networks to support providers in delivering the move at pace, as named networks making changes essential for sustainable, high- ambitious plans for the future of quality, clinically-focused pathology pathology in their region, and existing services in England. NHS Improvement It is an opportunity networks embrace the “at scale” drive and has issued a number of toolkits to share to put into place have begun active discussions with other learning, provide best practice advice and networks to see how they can deliver on guidance. The Pathology team at NHS the advanced a larger scale. Disappointingly, some Improvement have been engaging with networks are yet to get off the ground providers, arm’s length bodies, professional roles envisioned and some are not seeking to work at the

P18-21 IBMS Aug18_Pathology Networks_v3gh.indd 20 20/07/2018 11:10 SCIENCE THE BIOMEDICAL Pathology networks SCIENTIST 21

required level of consolidation. These as well as individual trusts, maintain a services are in the minority. The sector, high level of transparency through staff both inside the NHS and industry, reports and system engagement to ensure that, unlike previous pushes, the THE PRINCIPLES successful change. We also work closely commitment to change is palpable. NHS All networks were modelled with the national unions, industry and Improvement will continue to support on the following principles: UKAS to ensure the whole sector is and monitor development of these informed of the changes. Patient referral routes, networks, feeding into the Care Quality population size (1.5m minimum Commission’s Use of Resources to 2.5m maximum), existing Leadership inspections, where trusts are not making partnerships, such as STPs We are under no illusion of the challenge progress in removing unwarranted (Sustainability and Transformation that the creation of 29 networks brings to Partnerships) or existing variation in cost and quality. We are also trusts and staff . The networks will need to networks and geography was also exploring working with commissioners considered for certain networks. cover the needs of several hospitals, who ultimately buy pathology services to providing the services essential for identify best price and quality supporting The way the networks would patient care, reaching out into the those that do network. operate would be for the local community providing direct access network to decide. Networks diagnostic testing as well as introduce currently operating in England are Committing to quality either an alliance of partners new and innovative approaches to NHS Improvement is charged with rolling working together, a public joint pathology, such as digital pathology and out the national Pathology Quality venture where one trust takes on personalised medicine. It is vital that the Assurance Dashboard (PQAD) proposed by the running of services for the other profession gets behind the change, hospitals, or a private joint venture the Barnes review in 2012. This providing the expertise to the local where a new provider runs the dashboard, which will be issued in the services for the networked hospitals. networks, identifying the needs and summer, will hold trust boards to account opportunities to ensure a high-quality for the pathology service they provide to All activity that is not required to good value pathology service. This their patients. Measuring not only support direct acute patient care presents the profession with a unique would be done in one place for the clinically appropriate turn-around times opportunity to develop not only new whole network (either as a single but also: adoption of NICE guidelines; hub or a disturbed hub). advanced clinical roles, but also new number of training posts in the service; senior operational leadership roles for number of tests provided under ISO 15189; Essential service laboratories will be those prepared to take on the challenge. and how many community point of care just that, only services that are essential to support the acute delivery audits performed, amongst other metrics. Future of healthcare will be available. We have worked closely with the Pathology has a huge part to play in professional bodies to ensure these supporting the future of healthcare in metrics are appropriate and relevant. England. Pathology cuts across the Historically, creation of networks has not traditional boundaries of primary and led to a deterioration in quality, we expect for Pathology, Professor Adrian Newland secondary care, it has the data that can networks once transition is complete to and vice-chaired by the President of the drive clinical pathways and testing be ISO 15189 accredited for all tests that Royal College of Pathologists, Professor strategies. We will need to challenge are provided. This may mean Jo Martin. The board is attended by a traditional delivery models, such as consolidation of certain tests into representative from the IBMS and employing POCT to support not only a specialists testing centres with the representatives of the other professional personalised approach to medicine but relevant clinical and scientifi c expertise. organisations of the Pathology Alliance, also a public health imperative. It is NHS England, Health Education encouraging that other devolved nations Pathology Optimisation England, and senior leaders from are following the progress of the 29 Delivery Board existing networks. The Board’s role is to pathology networks carefully and have As well as working with the aspirant hold us to account and provide expert commenced similar programmes. networks, NHS Improvement hosts the advice to ensure creation of clinically Pathology Optimisation Delivery Board, safe and sustainable pathology services For extra diagrams and fi gures, chaired by the National Clinical Advisor for the future. It is important that we, ℹ visit thebiomedicalscientist.net

P18-21 IBMS Aug18_Pathology Networks_v3gh.indd 21 20/07/2018 11:10 THE BIOMEDICALBIOMEDICAL SCIENCESCIENCE 22 SCIENTISTSCIENTIST BloodBlood ggrouproup systems THE DUFFY BLOOD GROUP SYSTEM Head ofof RCI LaboratorLaboratoryy Martin MaleMaleyy givesgives an introintroductionduction to tthehe DuffDuff y yblood blood g rougroupp s ysystem.stem.

a x hen it comes to of Blood Transfusion (ISBT): Fy was of Fymod (Fy ) antigen, which is a weakened learning more about described in 1950 by Cutbush et al, Fyb in form of the Fyb antigen – and which is, an interesting blood 1951 by Ikin et al, and Fy3 in 1971 by Albrey therefore, not detected by all available group system (BGS), et al. Two further antigens (Fy5 and Fy6) anti-Fyb reagents. Duff y is probably exist within the system, but are rarely perfect. Not too many chanced upon. The prevalence of the Duffy BGS antibodies antigens; well- antigens in Caucasian, Black and Chinese Anti-Fya was fi rst described in the serum documented, clinically populations is detailed below. of a multi-transfused haemophiliac Wsignifi cant antibodies, disease association There is also the further complication patient, a certain Mr John Duff y. The last (malaria being the prime example) and, in the current climate of the proliferation of DNA testing, interesting genetic Caucasian populations Black populations Chinese populations mutations (GATA-1) are always a bonus. Fy(a+b+) 49% 1% 9%

Fy(a-b+) 34% 22% 1% Duffy BGS antigens Fy(a+b-) 17% 9% 91% The Duff y BGS has fi ve main antigens Fy(a-b-) <0.1% 68% <0.1% recognised by the International Society

P22-23 IBMS Aug18_Duffy_v2gh.indd 22 20/07/2018 14:24 SCIENCE THE BIOMEDICAL Blood group systems SCIENTIST 23

336 Major (α) 338 Minor (ß)

NH2 Position 42. Glycine Fya CHO Aspartic Acid Fyb CHO Proposed position of Fy3 CHO Position of Fy6

(Diagram courtesy of Malcolm Needs) COOH

counterpart, anti-Fyb can also cause antigen as “foreign”, and they will not, occasional severe HTR, but is usually only therefore, produce anti-Fy3. associated with mild HDFN. Anti-Fy3 was described in 1971 in a Disease association previously transfused pregnant Australian There are numerous examples of Duff y woman. Because the antigen is resistant system antigens being linked to disease to enzyme treatment the urge to name it states – the classical example being its anti-Fyab was also resisted. This was involvement in susceptibility to certain fortunate, as it is now known that the Fy3 strains of malaria. antigen is geographically remote from the There is a selective advantage in being position of the Fya/Fyb polymorphism. Fy(a-b-) in areas where malaria is endemic. Miller et al found Fya and Fyb Anti-Fy3 antigens act as receptors for malarial It has been known for years that people infestation of red blood cells and that within the Black populations, with the Fy(a-b-) red cells are resistant to invasion Fy(a-b-) phenotype have been transfused by Plasmodium knowlesi and P. vivax. with Fy(a+b-), Fy(a+b+) and/or Fy(a-b+) Duff y antigen receptor for chemokines blood, and yet most do not produce anti-Fy3. (DARC) has been found to be associated Many people within the Black with a survival advantage in leukopenic populations are homozygous for a mutation HIV patients. The recessive African- within an erythroid-specifi c, GATA-1, specifi c DARC null allele increases the transcription-factor binding site, upstream risk of HIV-1 infection approximately two letters of his surname were taken to of the coding region of the Duff y gene. three-fold. be used to denote the name of the This mutation prevents expression of DARC has also been implicated in the antigen. Anti-Fya can cause mild to severe the Duff y glycoprotein on red cells, but regulation of the growth of prostate haemolytic transfusion reactions (HTR), not on other cells. cancer tumours, and its interaction with and mild to severe (but only rarely) Duff y glycoprotein was found to be CD82 due to its presence on vascular haemolytic disease of the fetus and expressed in endothelial cells lining endothelial cells acts to inhibit the spread newborn (HDFN). Anti-Fya, in particular, post-capillary venules of soft tissues and of cancer cells. is classically found in combination with splenic sinusoids. other antibodies, and these mixtures can Duff y mRNA was not detected in the Martin Maley is Head of RCI Laboratory make positive conclusive antibody bone marrow of such individuals, but was at NHS Blood and Transplant and a identifi cation diffi cult. This, in turn, can present in their lung, spleen and colon. member of the IBMS Transfusion lead to issues in fi nding compatible blood, This coding sequence is usually Advisory Panel. He would like to credit should transfusion be required. identical to that of FYB, although amongst Geoff Daniels’ book Human Blood Identifi cation of the Fyb antigen people from Papua New Guinea, the Groups, published by Blackwell Science, followed in 1951, when it was shown to be coding sequence is often identical to FYA which infl uences this article. antithetical to the Fya antigen. Although The immune system of such individuals To see the article with full references, a b IMAGES: ISTOCK/ MALCOLM NEEDS found much less commonly than its does not recognise the Fy and/or Fy visit thebiomedicalscientist.net

P22-23 IBMS Aug18_Duffy_v2gh.indd 23 20/07/2018 14:24 THE BIOMEDICAL SCIENCE 24 SCIENTIST The big story CLINICAL CHEMISTRY CLASSICS: TUMOUR MARKERS This series continues with a brief review of pioneering work in the development, analysis and clinical application of important tumour markers, with two examples from the CA serum series – CA125 and CA15-3.

n a previous article in this series, In 1974, Suzanne Knauf and her human ovarian cancer. The 125th most tumour markers were defi ned as colleagues used immunodiff usion and promising clone was termed OC125 and substances released by a tumour immunoelectrophoresis to demonstrate the reacting antigen CA125. A serum into blood or urine, or from the antigens in three subtypes of ovarian radioimmunoassay using OC125 was host in response to the tumour. cancer. Four years later, Bhattacharya developed by Bast and colleagues in 1983 Their measurement in serum or and Barlow detected an ovarian to monitor epithelial ovarian cancer. urine may be used in screening cystadenocarcinoma-associated antigen From 1991, immunometric assays asymptomatic patients for specifi c to serous or mucinous types of became available, often using two Idiagnosis, prognosis, monitoring ovarian cancer, which was measured by epitopes, one recognised by OC125 and the treatment and recurrence detection. radioimmunoassay inhibition and found other by M11, an antibody developed by to be raised in the sera of ovarian cancer Tim O’Brien and colleagues at Arkansas. CA125 – an ovarian cancer patients. In a landmark paper in 1981, This assay, designated CA125II, showed marker and analysis with Robert Bast Jr leading a US combined improved assay precision. Commercial The existence of ovarian tumour-associated research team at Brigham Hospital assays from seven major suppliers were antigens was established by a US team led and Harvard, Boston reported the compared in 1998 and found to be by Michael Levi in 1969 using Ouchterlony development of a highly specifi c clinically reliable for quantitation of double diff usion and gel filtration. murine monoclonal antibody against CA125. Modern automated two site

P24-27 IBMS Aug18_Tumour Markers_v1gh.indd 24 20/07/2018 11:12 SCIENCE THE BIOMEDICAL The big story SCIENTIST 25

P24-27 IBMS Aug18_Tumour Markers_v1gh.indd 25 20/07/2018 11:12 THE BIOMEDICAL SCIENCE 26 SCIENTIST The big story

immunoassays use-high sensitivity ultrasound or a variety of risk algorithms. fl uorimetric and chemiluminescent The largest randomised controlled trial of tracer detection assays. It has been over 200,000 postmenopausal women in proposed that the major forms of CA125 in UK took place in 2001, led by Ian Jacobs serum have molecular weights 200- and Usha Menon at University College 400kDa and the most often quoted serum London with three study groups – CA125 reference range for females is 0-35kU/L and risk algorithm, annual transvaginal (0-35 IU/ml). However, it is signifi cant ultrasound, or no screening. It was that this value is exceeded in many other claimed that the results suggested that malignancies, such as pancreas, liver and there may be a reduction in mortality lung and several “benign” conditions, e.g. with CA125 and risk algorithm. uterine fi broids and endometriosis. However, the main clinical roles of serum CA125 are twofold: to diff erentiate CA125 structure and function benign and malignant pelvic masses in CA125 is a high molecular weight postmenopausal women combined with glycoprotein epitope on a large ultrasound and, secondly and most transmembrane mucin glycoprotein notably, serial measurements to monitor MUC16, but due to its complexity and the response to chemotherapy treatment mucinous nature, there are confl icting following surgical resection and the views on its true molecular structure. The subsequent detection of recurrence. Other MUC16 gene is expressed under normal proposed biomarkers for ovarian cancer CA15-3 a serum tumour marker conditions in epithelial tissues, such as include HE4 – human epididymis protein for breast cancer breast and lung, but overexpressed in 4, which may be combined with CA125 to Studies, notably in the US and Italy epithelial cancers. It has been proposed improve both sensitivity and specifi city, by ME Edynak (1971) and G Fossati (1972) that it may have a lubricating function and mesothelin – a small protein which is respectively, helped to establish the and protect against foreign particles and over expressed in ovarian cancer. existence of tumour-associated antigens infectious agents. It may also act in a in breast cancer. It was further shown more sinister manner to promote cancer Breast cancer that the antigen could be characterised cell proliferation and metastases, and Breast cancer has been known from by sequential solubilisation, protein inhibit anti-cancer immune responses. ancient times but most progress was fractionation and polyacrylamide agar gel made during the 19th and 20th centuries, electrophoresis. Much was gained for our CA125 and ovarian cancer notably following the US National Cancer understanding of the structure of the Ovarian cancer is the sixth most common Act in 1971 with its generous funding for glycoprotein MUC-1 associated with UK female cancer, with a low prevalence, cancer research (see table for the most breast cancer by the studies of the British particularly in premenopausal women. signifi cant achievements). biologist and geneticist Joyce Taylor- Often, vague symptoms lead to a late Despite all this valuable research, it Papadimetriou. MUC-1 is a large diagnosis and a relatively poor prognosis, remains the most common cancer in transmembrane mucin glycoprotein with a 46% fi ve-year survival rate. Risk women worldwide and the second most encoded by the MUC-1 gene and is present factors include age, a close family history common cause of cancer death in females in normal secretory epithelia acting as a of ovarian cancer and inherited mutations in the UK. However, it is more preventive barrier to pathogenic invasion in the BRCA1 and BRCA2 genes. encouraging that with early and but may also play an active role in CA125 is only raised in 50% of stage 1 personalised treatment, 87% of breast oncogenesis and is overexpressed in patients which, with low cancer patients have a fi ve-year breast cancer and shed into the specifi city, severely limits its survival rate. Tumours may circulation. One antigen on MUC-1, role in screening. Nevertheless, occur in the breast ducts or known as CA15-3, can be measured using there have been a number less often aff ect lobular cells, a variety of immunological methods of clinical trials in and around 80% of invasive using the murine monoclonal antibodies, postmenopausal women breast cancers are ductal and 115D8 & DF3, developed by J Hilkens and involving serum CA125 alone, metastases may result in the colleagues (1983) and a group led by D or combined with transvaginal lungs, bones or brain. Kufe (1984), respectively. With further

P24-27 IBMS Aug18_Tumour Markers_v1gh.indd 26 20/07/2018 11:12 SCIENCE THE BIOMEDICAL The big story SCIENTIST 27

SOME SIGNIFICANT EVENTS IN BREAST CANCER HISTORY

DATE Event Persons Country/Workplace

1000 Customised surgical instruments Albucasis Spain

1882 Tumour removal + axillary lymph glands William Banks England

1887 Restorative breast cosmesis Aristide Verneuil France

1894 Radical mastectomy William S Halsted US

1932 Association of oestrogens with breast tumours Antoine Lacassagne France

1938 First mammography performed US

1959 Improved mammography developed in US Robert Egan US

1960s Lumpectomy & radiotherapy Bernard Fisher US

1967 Isolated oestrogen receptor Elwood Jensen US

1971 National Cancer Act USA US

1973 Combination chemotherapy in breast cancer Gianni Bonadonna US

1983 Use of monoclonal D115D8 for CA15-3 John Hilkens Holland

1984 Use of monoclonal DF3 for CA15-3 Donald Kufe US

1986 Discovery of HER2 protein in breast cancer Axel Ulirich Germany

1986 Limited surgery + adjuvant therapy Umberto Veronesi Italy

1987 Breast screening introduced in UK NHS UK

1990 Identifi cation of BRCA1 gene Mary-Claire King US

2001 Chemotherapy & monoclonal antibody in HER2 Pos Dennis Slamon US

developments during the next decade, 90s were optimistic of the clinical value of and propose the use of oestrogen automated two site immunoassays CA15-3; however, it was quickly receptor tissue assays to predict the became available using a variety of recognised that it was another non- response to hormone treatment and capture and detection systems for serum specifi c marker with low sensitivity in the measurement of human epidermal CA15-3. With assays, more robust and preoperative breast cancer and unsuitable growth factor receptor 2 (HER2) to sensitive numerous clinical trials were set for screening asymptomatic patients. identify patients to respond to combined up to assess clinical values. A number of Elevated serum levels were found in a monoclonal antibody therapy, such as tumour markers for breast cancer, number of non-mammary cancers, such that with Herceptin. including CA15-3, were reviewed in 1993 as lung, colon and ovary, and in benign and found that CA15-3 refl ected tumour breast and ovarian conditions. Sensitivity Concluding comments burden and was clinically useful in was found to be 10-15%, 20-25% and 30-35% While much has been achieved in the monitoring therapy. On a technical note, for stages 1, 2 and 3, respectively. It had diagnosis and treatment of ovarian and the standard reference range for females been previously shown that increasing breast cancer, the role of both tumour is <30 U/ml, and some patients exposed to levels may be useful in detecting markers reviewed appears limited to mouse antigens within the environment, advanced disease, and combination with monitoring treatment. The focus of treatment or imaging procedures may serum carcino-embryonic antigen (CEA) attention in breast cancer patients at have mouse antibodies which interfere allows early diagnosis of metastases in present is on the results of the (TAILORx) in the assay of CA15-3. 60-80% of patients with advanced disease. trial, using a combination of HER2 results Expert group the American Society of and a 21-tumour gene expression Clinical trials of serum CA15-3 Clinical Oncology released a 2007 update microarray to determine the benefi ts or A vast number of clinical trials of variable that reports present data is insuffi cient to otherwise of adjuvant chemotherapy. size and quality have been performed recommend serum CA15-3 for screening, The research performed by Robert Bast, during the last 30 years relevant to diagnosis and staging and for monitoring Joyce Taylor Papadimitriou, Mary-Claire tumour markers in breast cancer and it is recurrence after primary breast cancer King, Donald Kufe and John Hilkens was only possible in a short review to present therapy, but permits monitoring of fundamental in achieving signifi cant a general consensus of results; in metastatic disease during active therapy progress during the last four decades. addition, various expert oncology groups when combined with diagnostic imaging, in Europe and the US have made history and physical examination. Later Stephen Clarke is a retired IBMS Fellow. recommendations with regular updates. reports and recommendations tend to To see the references, view the article The early trials of the late 80s and early limit CA15-3 to this clinical application online at thebiomedicalscientist.net

P24-27 IBMS Aug18_Tumour Markers_v1gh.indd 27 20/07/2018 11:12 THE BIOMEDICAL SCIENCE 28 SCIENTIST Lab equipment

“The test tube has this metaphorical meaning that has gone far beyond its physical form”

P28-32 IBMS Aug18_Test Tubes_v1gh.indd 28 20/07/2018 11:14 SCIENCE THE BIOMEDICAL Lab equipment SCIENTIST 29 THE TEST TUBE: A SYMBOLIC STORY

While the test he test tube is possibly the speaking, varies from 10 to 20mm wide, 50 most unobtrusive piece of to 200mm in diameter, and 100 to 150mm tube is hardly the equipment in the lab: its long. We could talk about test tube racks most imposing workaday function and sheer and brushes, but they’re not about to set ubiquity render it more or less the imagination on fi re, are they? item of glassware invisible. Scratch beneath the Yet despite this lack of any real defi ning on a scientist’s surface, though, and you’ll character or compelling backstory, if one fi nd… well, not a whole lot. piece of lab equipment has come to workbench, its TIt has little in the way of an arresting symbolise chemistry, and in some ways symbolic power origin story – indeed, the inception of the the whole of modern science, it is the test test tube is as opaque and colourless as tube. How on earth did that happened? is second to none. many of the solutions it holds. The materials that go into manufacturing test Historic origin tubes are generally unexceptional (mostly Of all the many basic shapes and plastic or glass, though Pyrex is mildly sizes of equipment that populate the diverting), and otherwise there is little to average chemistry lab, the test tube diff erentiate one test tube from another, appears to be a relatively new addition: apart from the size, which, roughly no mention of it, or anything like it,

P28-32 IBMS Aug18_Test Tubes_v1gh.indd 29 20/07/2018 11:14 THE BIOMEDICAL SCIENCE 30 SCIENTIST Lab equipment

appears before the 19th century. wrote in 1814 – though this was more normally reach for when they needed to One version has it that the test tube likely the genesis of the tall form beaker store or mix small amounts of liquids. In an sprang from the imagination of the that carries Berzelius’ name to this day. article for Chemistry World, the science writer Swede Jöns Jacob Berzelius (1779-1848). Another version contends that the test Philip Ball also points out that Faraday’s Considered one of the fathers of modern tube was the brainchild of Michael Faraday letters were littered with descriptions and chemistry, Berzelius has more than (1791-1867). He is, of course, famous for his drawings of test tubes: “He sketches one, enough achievements to his name, not pioneering work in chemistry and for example, in a letter to the German- least discovering silicon, selenium and electromagnetism, and for inventing an Swiss chemist Christian Friedrich thorium, devising the chemical notation early version of what was to become the Schönbein in 1854.” system, and establishing the Bunsen burner, plus the Faraday Perhaps Faraday picked up on Berzelius’ diff erences between organic and cage, which blocks electromagnetic idea, scaled it down so that it would fulfi ll inorganic compounds. In light fi elds. He fi rst mentions the idea a specifi c practical purpose, and in that of that, conceiving the of the test tube in his 1827 way made it his own? We’ll likely never test tube could have book Chemical know, but whatever the truth it’s fairly been something Manipulation, certain that Faraday, Berzelius or anybody he tossed off in an suggesting that else who might have “invented” the test idle moment one small glass tubes tube could not possibly have imagined the rainy afternoon. would be useful for extent to which this simple container has According to the testing reactions. since populated labs all over the world. evidence he They would be a described purpose-built Heat resistance something very replacement for the Arguably, the key moment for the test similar to what we wine glasses that tube was not actually its inception but know as the test Faraday and other rather when the German chemist and tube in an article he chemists would glass expert Otto Schott (the founder

P28-32 IBMS Aug18_Test Tubes_v1gh.indd 30 20/07/2018 11:14 SCIENCE THE BIOMEDICAL Lab equipment SCIENTIST 31

of the global glass manufacturing borosilicate glass is undoubtedly Pyrex, corporation Schott AG) created which was developed by Eugene Sullivan borosilicate glass for the fi rst time in 1893. in the US in 1908 after he had Borosilicate glass is made with boric It’s one of the encountered borosilicate glass as a oxide, silica sand and soda ash, and has the student in Germany. In one form or vital property of a low thermal expansion fundamental, another, Pyrex soon found its way into coeffi cient – in other words, it can iconic bits countless labs and kitchens, where its withstand very high temperatures without fracture-proof powers have prevented stressing its shape, area or volume. This of equipment many a scorching casserole dish from meant that test tubes could be applied shattering upon impact with cold water. directly to a heat source, such as a Bunsen that nobody Even today, most of the glassware to be burner, which would raise the temperature found within the reach of a chemist of the liquid or solid inside but leave the escapes using – including test tubes, fl asks, jugs, tube itself intact and unchanged. bottles and beakers – will have While the actual heat resistance will been manufactured from vary depending on the properties of the borosilicate glass under one brand specifi c type of borosilicate glass, it can name or another. typically withstand temperatures of up to several hundred degrees celsius. It’s also Symbolic power resistant to chemicals and has excellent Never mind the history or physical optical clarity, so it quickly became the properties of the test tube, what truly ideal material for the test tube and other matters is that it has come to signify pieces of glassware. something much bigger. As Andrea Schott called his glass Duran, but the Sella, Professor of Chemistry at

IMAGES: GETTY/ISTOCK/ALAMY most well-known trade name for University College London, says: “The

P28-32 IBMS Aug18_Test Tubes_v1gh.indd 31 20/07/2018 11:14 THE BIOMEDICAL SCIENCE 32 SCIENTIST Lab equipment

test tube has this metaphorical meaning tube really lent itself to that sort of work. that has gone far beyond its physical From that point on, we fi nd that the term form. It is the incubator of ideas, the ‘test tube’ slips into common parlance”. thing to which you turn to carry out experiments. It is extraordinary how that Future role resonance has built up, and I think that Today, the idea of the test tube as a symbol comes from the fact that most people for science is possibly best encapsulated by encounter test tubes in school. It’s one the term “test-tube baby”. Since the birth of the fundamental, iconic bits of in 1978 of Louis Brown, the world’s fi rst equipment that nobody escapes using.” baby conceived using in vitro fertilisation This is a telling point. Children (IVF), this has become the universal term encounter the test tube early on in their for any and all children who have been school careers, usually long before they born as a result of IVF. Anybody with a have the chance to lose interest in IN POPULAR CULTURE passing knowledge of the process will science, and at some point will have The test tube is possibly the only piece of know that the IVF is more likely to happen picked up a test tube, perhaps poured lab equipment with a punk band named in a petri dish than an actual test tube, but after it – Peter and the Test Tube Babies. something inside it, held it over the fl ame “pertri-dish baby” has neither the They formed in 1978, the same year the of a Bunsen burner, and observed what original test-tube baby Louise Brown was alliterative ring or the simple symbolic happened. And even if they never handle born, and are still playing today. power of “test-tube baby” – while the another piece of lab equipment, they will Gothic literature is littered with test tubes average citizen might struggle to point out always have that experience of using a and their sinister contents secreted in dark, a petri dish in a glassware line-up, they’d labs – think Frankenstein and Dr Jekyll and test tube. For Andrea this “summarises have no such trouble with the test tube. Mr Hyde. But the best example is probably the idea of ‘doing science’. And it is part of HP Lovecraft, whose stories ooze horror. For the same reason, most chemical and what has made the test tube a universal Take 1922’s Herbert West–Reanimator, corrosive substance warnings depict a symbol for science”. where the narrator fi nds himself “pouring liquid dripping on to a hand from a test He also argues that the test tube something from one test tube to another… tube and not from another piece of lab when from the pitch-black room we had left established its strong presence in the lab equipment. Confronted with such a there burst the most appalling and towards the end of the 19th century, daemoniac succession of cries that either of warning, nobody needs to dwell a moment when chemical analysis became a big us had ever heard”. This story was the longer on deciphering its meaning. business: “This is one of the reasons why basis for gory 1985 movie Re-animator, But despite its prominent position in so many chemists were trained up in which featured more fl asks, beakers and the public imagination, could the age of test tubes than you could shake an serried ranks, and the point when the the test tube be coming to an end? oversized syringe at. layout of the lab itself became codifi ed, Any Hollywood movie with a vaguely Advances in all fi elds of science mean that with rows of benches, the raised sections scientifi c theme is bound to have a test traditional equipment is increasingly where the reagents go, the fume hoods in tube pop up. For example, the Planet of the taking a backseat to more advanced the middle, and the test tube becomes Apes reboot, Jurassic Park and its endless technology. “My work doesn’t often call sequels, and the Marvel fi lms all use test part of that scene.” for test tubes,” says Andrea Sella, “and in tubes as a sort of shorthand for science Now add the chemists’ fevered work gone wrong and occasionally as the some ways there isn’t that much call for to that scene, and the full image containers of a serum that can test tubes. The spot tests that were comes into focus. “We have save the protagonists’ lives. universal during the 19th and 20th all sorts of qualitative Video games have also centuries have largely disappeared. adopted the test tube and testing going on,” says Spectroscopy has taken over so much, other lab equipment as Andrea, “to identify props to their stories and though there are areas where the test whether sugar or fl our is game play. For example, tube persists, such as chromatography.” contaminated with salt the Resident Evil games Whether this new technology can wield or even arsenic, and we are littered with lab the same power in the popular imagination detritus from the Umbrella have simple precipitation remains to be seen, so while we wait for Corporation’s ongoing tests where the chemists experiments to create zombies. that, the self-eff acing test tube will just add a reagent and do an have to continue its duties as the symbol for immediate observation. The test science that nobody could mistake.

P28-32 IBMS Aug18_Test Tubes_v1gh.indd 32 20/07/2018 11:15 Rapid and accurate detection of antibiotic resistance

NG Biotech have developed a lateral-flow immunochromatography assay kit for rapid, accurate and cost-effective indentifications of Carbapenemase-producing organisms (CPOs) directly from culture colonies.

Carbapenemase-producing CARBA Enterobacteriaceae Rapid NNG-Test CARBAA 5 NG-Test Carba 5 - detects the following variants Results in 15 minutes of carbapenemase-producing Enterobacteriaceae: 15 C From bacterial culture K Type NDM: -1 -4 -5 -6 -7 -9 O Min V Type KPC: -2 -3 I Minimal hands on time N Type IMP: -1 -8 -11 Type VIM: -1 -2 -4 -19 S OXA-48-like: OXA-48 -162 -181 -204 -232 -244 -517 -519 -535 Non-carbapenemases (cross-reactivity): OXA-163 and Accurate OXA-405 (OXA-48-like extended spectrum oxacillinases with very weak carbapenemase activity). Excellent correlation with PCR CTX -M Numerous studies NG-Test CTX-M-M Extended-spectrum `-lactamase available -producing Enterobacteriaceae

C

T NG-Test CTX-M detects variants of Group I User Friendly `-lactamase-producing Enterobacteriaceae: CTX-M-1 -3 -15 -32 -37 -55 -71 - 82 -101 -182 Easy to use S No instrument required Stable at room temperature MCR MCR Genes, resistant to for 24 months Colistin antibiotic NG-TestN MCR-1 NG-Test MCR Genes detects the presence of the plasmid-borne mcr-1, mcr-2 and mcr-3 genes, Cost Effective C causing resistance to colistin antibiotic. Colistin T Lower cost per test is considered a last-resort antibiotic active than PCR against multi-resistant carbapenemase-producing S Enterobacteriaceae and carbapenem-resistant Acinetobacter baumanii.

Freephone: 0800 160 1947 Follow us on: E-mail: [email protected] Web: www.bio-medicallabs.com LABORATORY SUPPLIES

BIO.08.18.033.indd 33 18/07/2018 10:18 THE BIOMEDICAL SCIENCE 34 SCIENTIST Journal synopsis

British Journal of Biomedical Science Issue 3 2018: a synopsis Issue 3 of our journal is now completed. By the time you read this, the hard copy O ne or more may already have landed on your doormats, ℹ of these articles may be the subject and those of you who have been to the of a journal- based learning exercise website will already have accessed and for those seeking read some of the papers. Editor Andrew Blann to improve their continuing professional outlines the content in the latest issue. development profi le.

P34-35 IBMS Aug18_Journal Synopsis_v1gh.indd 34 20/07/2018 11:15 SCIENCE THE BIOMEDICAL Journal synopsis SCIENTIST 35

Although undoubtedly important, Yakoob J et al. Association of Attallah A et al. Clinical value of a hyperglycaemia, overweight and obesity Helicobacter pylori and protozoal diagnostic score for colon cancer based do not account for all cases of type 2 parasites in patients with chronic on serum CEA, CA19-9, cytokeratin-1 diabetes. Our colleagues from India show, diarrhoea. Br J Biomed Sci 2018 75; (3) and mucin-1. Br J Biomed Sci 2018 75; (3) in 200 diabetics and 200 controls, that 105-109. Although H pylori is a common 122-127. It seems that too often we certain genotypes in KCNJ11 and SDF-1β topic of practice in the UK, intestinal (short-sightedly) focus on only one or are linked to this disease, adding further parasites are rare. Yakoob et al refresh two individual markers of a disease or weight to the importance of molecular our knowledge of the latter in patients its process. This study from Egypt shows genetics in this important condition. with diarrhoea who unsurprisingly were that a combination of four serum more likely to carry parasites such as markers provides a powerful tool for the Blastocystis and Entamoeba species. Notably, detection and screening of this common Xu Y et al. Serum relaxin-2 as a novel certain parasitic infections were linked malignancy, and so may one day become biomarker for prostate cancer. Br J to infection with H pylori. a routine assessment. Biomed Sci 2018 75; (3) 145-148. Although PSA is the gold-standard marker for this disease, it is far from Zhong Q et al. Rapid detection and Lee J et al. The gamma-glutamyl perfect. In this brief report, Xu and subtyping of human papillomavirus in transferase to platelet ratio and the colleagues report data on this alternative condyloma acuminatum using loop- FIB-4 score are noninvasive markers to prostate-specifi c product, which performs mediated isothermal amplifi cation determine the severity of liver fi brosis as well as PSA, and which also predicts with hydroxynaphthol blue dye. Br J in chronic hepatitis B infection. Br J survival. Time will tell if it will replace Biomed Sci 2018 75; (3) 110-115. As Biomed Sci 2018 75; (3) 128-132. In a PSA as the marker of choice and so enter human papilloma virus (HPV) is a similar manner to Attalah et al in colon routine practice. leading cause of cervical cancer and cancer, Lee and colleagues constructed an other anogenital growths, simple and empirical score from several routine blood precise diagnosis is important. Our markers. In the absence of other Orchard GE. Haematoxylin – the story colleagues from China report an advance determinants of hepatofi brosis, this score of the blues. Br J Biomed Sci 2018 75; (3) in methods for the detection of HPV may provide practitioners with a useful 149-152. Arguably the most well-known subtypes that off ers a quick and accurate tool to guide clincal practice. of all dyes used in biomedical science, method for the clinical diagnosis of Orchard paints a brief biography of certain subtypes, and so is superior to the this essential reagent, bringing existing method. He QZ et al. A method for improving together history, botany, chemistry the accuracy of non-invasive prenatal and, of course, histopathology. screening by cell-free foetal DNA size Heitmar R et al. Relationship of selection. Br J Biomed Sci 2018 75; (3) systemic markers of haemostasis 133-138. The safest method for detecting Bhatnager R et al. The role of with retinal blood responses in chromosomal abnormalities such as the rs267606943 polymorphism in the cardiovascular disease and diabetes. translocation linked to Down’s syndrome prolidase gene and plasma prolidase in Br J Biomed Sci 2018 75; (3) 116-121. As is to analyse cell-free DNA from the polycystic ovary syndrome. Br J Biomed loss of haemostasis is the common end mother, some of which will contain foetal Sci 2018 75; (3) 153-155. Alongside many point in many mortal diseases, factors DNA. He and colleagues present data on sex hormones, prolidase (an enzyme leading to inappropriate haemorrhage an improvement to this method, with involved in collagen metabolism) may and thrombosis are crucial, as are superior positive predictive value. have a place in this common reproductive methods for predicting this pathology. disease. Our colleagues from India tested Heitmar and colleagues assessed clot the hypothesis that plasma levels are formation and dissolution in this Rizvi S et al. Genetic polymorphism in controlled by a single nucleotide high-risk group, linking these markers KCNJ11 (E23K, rs5219) and SDF-1β (G801A, polymorphism, but as data from 200 cases of haemostasis (and hyperglycaemia) rs1801157) genes are associated with the and 200 controls found no such link, with abnormal function of the circulation risk of type 2 diabetes mellitus. Br J other factors must be responsible for the

IMAGE: SCIENCE PHOTO LIBRARY of the eye. Biomed Sci 2018 75; (3) 139-144. increased prolidase.

P34-35 IBMS Aug18_Journal Synopsis_v1gh.indd 35 20/07/2018 11:16 THE BIOMEDICAL ADVICE 36 SCIENTIST How to

HOW TO… INTERACT WITH POTENTIAL EMPLOYERS Knowing what to prepare before meeting potential employers can give you a headstart in the competitive biomedical scientist job market. The team from recruitment specialists Matchtech give their guidance.

or many, meeting potential research or trade publications, such as The employers is the most nerve- Biomedical Scientist, might provide insight wracking part of the job on future trends, which could aff ect the hunting process. If you’ve been organisation you are interviewing for. invited to interview for a role, From this, you can develop questions This will allow you to familiarise however, it is important to based on your research to demonstrate yourself with their equipment and fi nd remember that it is a positive your desire to work for that organisation out what tests they do. sign that your CV or application and your knowledge of the industry. Fhas impressed. To combat any pre- It is a good idea to learn about the Prepare questions interview nerves, you should be as laboratory and the organisation through Often an interviewer will give you the prepared as possible. First impressions are an informal visit. You can do this through chance to ask a few questions towards the vital when it comes to face-to-face your recruitment agency or by calling the end of an interview and it’s important interviews and there are some simple laboratory manager directly. you do. Start with questions like “why has ways to ensure you’re fully prepped. From the position become available?” and “what wearing the right clothes, to knowing the are the main objectives of the role?” history of the organisation, here are some Having around fi ve questions prepared sure-fi re ways to ensure you stand out EXAMPLE QUESTIONS TO will stand you in good stead. and make a good impression. ASK AT YOUR INTERVIEW: Preparing responses In your opinion, what makes this Do your research An interview for a biomedical scientist organisation a great place to work? Knowing something about the laboratory position is likely to involve a combination Can you tell me what the or organisation and the services it of competency-based and technical culture is like here? provides will be sure to impress. Start questions regarding your laboratory with their website to get a better What opportunities are there for experience, usually around use of career progression? understanding of their products and equipment and tests. You may also be services. It is also a good idea to read What are the next steps in the asked questions around safety, data hiring process? outside sources to gather industry protection and quality management, so knowledge. For example, looking at make sure to prepare your answers.

P36-37 IBMS Aug18_How To_v1gh.indd 36 20/07/2018 11:17 ADVICE THE BIOMEDICAL How to SCIENTIST 37

a blouse also works well. Attending an interview dressed too casually will raise concerns with the hiring manager who may question how seriously you are taking the interview. On the day Greet the interviewer(s) with a smile and a handshake. Throughout the interview, make eye contact, stay engaged and try mimicking their style – if they’re formal, be formal, if they’re informal, be informal. Avoid negative body language, such as crossing your arms; be open and engaged in the way you hold yourself.

Matchtech has over 10 years’ experience helping biomedical scientists fi nd jobs in NHS and private laboratories all over the UK. If you’re considering a new challenge and would like to have a confi dential conversation, please contact Matchtech’s medical team of specialist recruiters on 01489 898247. | [email protected].

Competency-based questions are a The most important document to bring popular way for employers to assess a when interviewing for a role is your potential employee’s future performance. continuing professional development The best way Questions could be based on how you folder. This will give you something to have dealt with a diffi cult situation or refer to during the interview and will to prepare is to they may ask you to describe a time when provide examples of how you have re-read the job you have worked well in a team. The best improved during your career. way to prepare is to re-read the job It is also a good idea to bring ID with specifi cation to specifi cation to understand what core you and two examples of proof of address, competencies they are looking for. If team such as a utility bill or bank statement. understand the work is a desired attribute, prepare an Should you be successful, bringing ID may example of when you have demonstrated help the organisation to set the ball core competencies your ability to work in a team. This is a rolling on any necessary DBS checks. popular topic in interviews and is likely to come up in an interview for a small Dress to impress laboratory, as the right person will have While your day-to-day work will likely see an impact on the team dynamics. you in casual clothes and a lab coat, for the interview dress smartly, unless told Pack the night before otherwise. A smart shirt and tie Pack your bag/briefcase/handbag the combination, paired with suit trousers evening before to avoid unnecessary and clean (black or brown) shoes is a stress. Ensure you have a pen, notepad winner for men. For women, avoid being and extra copies of your CV, plus anything too glitzy. Smart, low-key dresses will that may have been specifi cally requested. never tire, but a trouser suit or skirt with

P36-37 IBMS Aug18_How To_v1gh.indd 37 20/07/2018 11:18 THE BIOMEDICAL ADVICE 38 SCIENTIST Celebrate the sector

housands of IBMS members took part in Biomedical Science Day, holding events, taking “lab-selfi es” and getting on social media to raise the BIOMEDICAL profi le of the profession. The day took place on 19 TJuly – the birthday of IBMS founder Albert Norman – and was the second- ever Biomedical Science Day. SCIENCE DAY: Members were encouraged to promote the vital role they play in healthcare and to showcase their work to patients and the public. Spanning all biomedical disciplines, the IBMS called on AT THE HEART laboratory staff to celebrate their work to help explain what they do and the impact their work has on patients’ healthcare. The theme for the day was “At the OF HEALTHCARE heart of healthcare”, which was used to show how biomedical scientists’ work July was a month of celebrations and produces the data on which doctors, consultants and surgeons base their professional promotion, with the diagnoses to plan treatment. second ever Biomedical Science Day Spreading the word and the 70th birthday of the NHS. There were numerous ways that people got involved on the day, from lab tours and eye-catching hospital displays to members visiting schools and spreading

P38-39 IBMS August18_NHS-Bio Science Day_v3gh.indd 38 20/07/2018 11:18 ADVICE THE BIOMEDICAL Celebrate the sector SCIENTIST 39

Alison Geddis, IBMS President, said: “We’ve been overwhelmed NHS142 hospitals and trusts and by the response to Biomedical Science the word with talks and demonstrations. The IBMS produced a wide range of Day this year. The accredited universities14 resources, which could be downloaded across the UK took part profession has really from its website. These included posters, leafl ets, letter templates and The IBMS sent out come together. digital imagery and free Biomedical Science Day event packs, which could Hundreds of be ordered online. laboratory The IBMS collated an online collection

of activities that members had created , 6000posters, doors were and which could be used to promote biomedical science to students of all ages. opened It also ran a series of competitions across the on the day, encouraging biomedical science staff across the country to , country to NHS 10leafl ets and000 wristbands, showcase their work. It asked members to email in photos from the staff , the public and day, with categories including best patients – helping workplace photo, best biomedical science-themed cake (which was , to raise awareness judged by biomedical scientist and 5fuzzy000 bugs and Great British Bake Off star Yan Tsou) best of the important role event and best video, among others. of biomedical science The full list of winners has been published on the IBMS website. , in healthcare. ” 30stickers000

HAPPY BIRTHDAY, NHS Biomedical Science Day came lit up blue for the evening Fellows, Jo discussed the exactly two weeks after a of 5 July. vital role of biomedical landmark occasion – the 70th IBMS member Jo Horne scientists with the then- birthday of the NHS. There celebrated the landmark Health Secretary. She said: were celebrations across the birthday at 10 Downing Street. “Jeremy gave a short speech country, including a ceremony Jo, who is a Chief – in his fi rst sentence he at Westminster Abbey and a Scientifi c Offi cer (CSO) WISE described the importance of choral concert at York Minster. Fellow, was invited to the the workforce to the NHS To help mark the occasion, drinks reception, which was and included scientists in the buildings, historic monuments also attended by Theresa list of people mentioned. and other high-profi le sites May and Jeremy Hunt. That’s the power of a across the country were Along with other CSO WISE two-minute conversation.”

P38-39 IBMS August18_NHS-Bio Science Day_v3gh.indd 39 20/07/2018 14:10 THE BIOMEDICAL MY IBMS 40 SCIENTIST News MY IBMS NEWS

STEM VOLUNTEERING BIG BANG AWARD FOR LISA IBMS member Lisa Coulthwaite won a leadership award at the national Big Bang Fair. The fair is the largest science, technology, engineering and maths Industry Partnership. (STEM) event for young people in the UK. This year, Lisa had the This annual event at the NEC in role of careers captain Birmingham hosts stage shows, volunteer team leader, interactive workshops, exhibits and and worked with national competitions, with over 70,000 volunteers and staff from Engineering UK. ONLINE LEARNING people attending. Lisa said: “Volunteering is a fantastic NEW CPD RESOURCE Lisa, a lecturer from Manchester way to develop your skills and build Metropolitan University, led a team of experiences, while making a diff erence IBMS members are encouraged to try the new eHealthPD app. volunteers to engage attendees in fun and having fun too. The eCPD provision is being careers-focused activities. “The Big Bang Fair is an amazing offered by The Royal College It was the third year that Lisa had experience with lots of diff erent of Pathologists. volunteered at the Big Bang Fair, taking volunteering opportunities for anyone Its eCPD portfolio consists on a diff erent role each year. interested in engaging young people in of over 300 courses – a large number of which may be relevant For her fi rst year, she ran an interactive STEM. I am very proud to receive this and of interest to IBMS members. biomedical science activity with NHS volunteering award and will defi nitely For more details and to download Careers. The following year, she was a be supporting the Big Bang Fair again the app to your Apple or Android career ambassador for the Science next year.” device, visit ehealthpd.com/ecpd

IBMS PUBLICATION New feature for The Biomedical Scientist

Do you know about the latest The magazine’s editors These could also include principles and methods used are looking for authors to “back-to-basics” refresher in your laboratory? contribute in order to help articles, or reviews of scientifi c Are you up to speed on support individuals preparing principles, or techniques now the newest techniques that for Institute qualifi cations, as being used in the expanding are being used in the fi eld well as sharing and spreading fi eld of molecular pathology of genomic medicine? knowledge that is of interest to and genomic medicine. The Biomedical Scientist is the profession. The articles will be included looking for scientists to share Examples of areas to in each issue and will be up to their knowledge in a new series cover include pure science, 1,000 words. of “How to...” articles that will technology, health and safety, For more information about feature a clinical, scientifi c or quality issues or general how to be featured, email technical issue. trouble-shooting topics. [email protected]

P40-41 IBMS Aug18_IBMS News_v2gh.indd 40 20/07/2018 11:23 MY IBMS THE BIOMEDICAL Awards SCIENTIST 41 PRESIDENT’S PRIZES Continuing the coverage of winners from around the country

AWARDS CEREMONY Northern Ireland PRESIDENT’S PRIZE WINNERS labs commended SUNDERLAND AWARD SUCCESS IN GLASGOW Ulster University held its second annual Impact The recipient of the IBMS Excellence Awards ceremony, recognising organisations for President’s prize at Glasgow their commitment to pioneering research and Caledonian University was graduate employability. William Johnston. From over 200 applications, laboratories from Northern Health & Social Care Trust and the South Eastern Health & Social Care Trust were shortlisted for awards. At the ceremony in Titanic Belfast, Northern Trust Harry Carr was awarded the laboratories were the fi rst regional laboratory to be highly IBMS President’s Prize at his commended in the “Placement Employer nominated by UU graduation ceremony from the student” category. University of Sunderland. The South Eastern Trust laboratories were highly Debra Padgett, IBMS Council commended for the second year running in the “Placement Member – North East Region, William was awarded a Employer in the Public Sector” category. presented the award after he First-Class Honours degree in Declan McKenna from achieved a First-Class Applied Applied Biomedical Science. He Ulster University said: Biomedical Science Honours undertook his clinical “This is highly-deserved degree. His fi nal year project placement in the Cell Science recognition for the was on improving patient Laboratories at Dumfries and outstanding placement outcomes following Galloway Royal Infi rmary. opportunities they provide organ transplantation. William has been accepted to for our biomedical Harry said: “It was a study for a PhD at the Glasgow science students. wonderful surprise to receive Dental Hospital. He is pictured “This work experience is the award, it’s nice to be being presented with his invaluable in enhancing recognised for the work I’ve prize by Allan Wilson, IBMS their knowledge, skills done over the past year.” Council Member. development and future employability prospects.”

DEVELOPING TECHNOLOGY Contribute to the Topol review

IBMS members are being Biomedical scientists are and future NHS staff. genomics will be of particular encouraged to take part in the encouraged to share their Evidence from biomedical interest, as this fi eld is Topol review. evidence and experience to scientists who work in expected to revolutionise This explores how to prepare inform the report about which aspects of cancer care, from the healthcare workforce technologies are currently prediction, screening, diagnosis through education and training being used and which provide and treatment. to deliver the digital future. the best potential to be used in The review is led by It aims to enable NHS staff to future healthcare. geneticist Dr Eric Topol and utilise developing technologies The evidence received will it is being facilitated by – such as genomics, digital help form an understanding of Health Education England. medicine and artifi cial these changes on the required Evidence can be submitted intelligence – in order to skills, education, curricula, online at hee.nhs.uk/our-work/

IMAGES: ISTOCK improve NHS services. training and learning of current topol-review

P40-41 IBMS Aug18_IBMS News_v2gh.indd 41 20/07/2018 11:20 !3ƫ

ƫ(,.+0! 0%*ƫ ƫ$/ƫ 0$!ƫ/)!ƫ.!(%(!ƫ,!."+.)* !ƫ/ƫ

ƫ(,.+0! 0%*ƫƫ10ƫ3%0$ƫ 0$!ƫ)!/1.%*#ƫ.*#!ƫ!40!* ! ƫ0+ƫ ĂĉĀĀƫϪ#ĥ#ċƫ$%/ƫ)!*/ƫ"!3!.ƫ %(10%+*/ƫ * ƫ.!,!0ƫ0!/0/ċƫ

$!ƫƫ'%0/ƫ* ƫƫ.!#!*0ƫƫ+00(!/ƫ.!ƫƫ . + ! ƫ"+.ƫ!/5ƫ!..+.ƫ".!!ƫ(+ %*#ƫ * ƫ0. !%(%05ƫ3$!*ƫ1/! ƫ3%0$ƫ+1.ƫƫ !)%*%ƫ%*/0.1)!*0ċ

+.ƫ0.+1(!ƫ".!!ƫ/),(!ƫ !40. 0%+*ƫ0$!ƫƫ'%0ƫ%/ƫ"1((5ƫ +),0%(!ƫ3%0$ƫ+1.ƫ,.!ġ"%((! ƫ (.!,Ĵƫƫ!40. 0%+*ƫ01!/ċ

+),(!0%*#ƫƫ+1.ƫƫ.*#!ƫ+"ƫ ď* ƫ"+.ƫ(+.0+.%!/ /+(10%+*/ƫ"+.ƫƫ"! (ƫ .!-1%.%*#ƫƫ,+%*0ƫ+"ƫ .!ƫƫ (,.+0! 0%*ƫ3!ƫ(/+ƫ$2!ƫ .,% ƫ0!/0ƫ3!ƫ$2!ƫ(/0ƫ 0$!ƫ.#!*0! ƫƫ
(!#.%ƫ ".+)ƫ1.+/,%0(ċ //5ƫ3$!.!ƫƫ)!/1.!)!*0ƫƫ +"ƫ"! (ƫƫ (,.+0! 0%*ƫƫ *ƫ !ƫ +)%*! ƫƫ3%0$ƫƫƫ(.#!ƫ .*#!ƫ+"ƫ10+%))1*!ƫƫ+.ƫ %*"! 0%+1/ƫƫ %/!/!ƫ//5/ď

BIO.08.18.042.indd 42 18/07/2018 10:19 MY IBMS THE BIOMEDICAL Continuing professional development SCIENTIST 43

JOURNAL-BASED LEARNING EXERCISES Each article’s contents should be read, researched and understood, and you should then come to a decision on each question. The pass mark is 17 out of 20 questions answered correctly. JBL exercises may be completed at any time until the published deadline date. Please select your choice of correct answers and complete the exercises online at: www.ibms.org/cpd/jbl

DEADLINE WEDNESDAY 7 NOVEMBER 2018

Patient blood management and the importance of the Transfusion Practitioner role to Immunohistochemistry on old archival paraffi n blocks: is there an expiry date? embed this into practice. Bielby L, Moss RL. Transfus Med 2018; 28 (2): 98–106. Grillo F, Bruzzone M, Pigozzi S et al. J Clin Pathol 2017; 70 (11): 988–93 (http://jcp.bmj. Assessment No 080218 com/content/70/11/988). Assessment No 080718

Patient blood management (PBM) is a widely established international initiative, Formalin-fi xed, paraffi n wax-embedded (FFPE) tissue blocks are the standard 01 with a multidisciplinary approach to increase transfusion. 01 archived system in the pathology laboratory. The majority of transfusion practitioners (TPs) were registered nurses or biomedical Humidity can decrease section antigenicity as early as two months 02 scientists, but others have a midwifery, operating department practitioner or 02 after sectioning. scientifi c research background. Implementing PBM programmes has shown no signifi cant improvement in either This study shows that antigenicity in stored paraffi n blocks is preserved at 03 patient outcomes or cost reductions. 03 least for several years. In terms of patients, the National Health Service 2010 white paper promoted the For some neoplasms, recurrences may present decades later when new 04 message “no decision without me”. 04 treatments are available. Treatment choices may be dependent on biomarkers which may be evaluated on old archived FFPE tissue. Iatrogenic anaemia is a condition of unknown aetiology. Gastro-entero-pancreatic neoplasms have their grade based on the 05 05 proliferation index identifi ed by Ki-67 immunostaining.

There is increasing evidence that pre-operative anaemia is associated with a higher Four membrane-bound antibodies were used in the study of antigenicity. 06 risk of complications, prolonged hospital stay, transfusion requirement and mortality. 06 It is important that a TP has the ability to communicate and work effectively with a All antibodies used in the study had either heat or enzyme pretreatment. 07 multidisciplinary team. 07 The multidisciplinary team would include healthcare professionals who are clinical, All immunohistochemistry (IHC) reactions were performed within a week 08 nursing, laboratory and pharmacy staff, as well as the TP, and may also include the 08 of sectioning. patient’s GP. The UK National Comparative Audit (NCA) has demonstrated that up to 30% of Only one of the cases from the 1970s had staining intensity graded equal to 09 blood is used inappropriately. 09 the positive controls. PBM programmes have shifted the tolerance to lower haemoglobin (Hb) levels, All LCA staining from 1980 onwards showed equivalent immunoreactivity on 10 where symptoms are treated, rather than the Hb level. 10 the test sections and the controls. Point-of-care (POC) testing is increasingly reported as a tool used in PBM, especially Homologous staining results were seen for cytokeratin markers for all cases. 11 viscoelastometry, for coagulation testing. 11 Mapping the patient fl ow from the time of the decision for surgery to their Ki-67, CD31, CD34 and LCA showed variable, age-related immuno signal decay. 12 admission to the operating suite would in no way help determine where and what 12 opportunities are available to assess patients for anaemia. The introduction of a single-unit transfusion policy has reduced blood costs and Ki-67 staining was not improved by deeper sections of the paraffi n block. 13 unnecessary transfusions, and has also reduced the risk of reactions, particularly 13 transfusion-associated circulatory overload (TACO). Although the use of red cells generally has decreased over the last several years, the Longer heat pretreatment protocols had no effect on the intensity of 14 same cannot be said for the use of group O, D-negative red cell units. 14 Ki-67 staining. The TP plays only a passive role in auditing appropriate transfusion practice Cytoplasmic antigenicity is maintained in FFPE material for 60 years or more. 15 to guidelines. 15 Single-unit transfusion applies to all patients, irrespective of whether they are stable, Slight antigen decay begins after 25–30 years for antigens localised on the 16 normovolaemic adult inpatients, who do not have evidence of clinically signifi cant 16 cell membrane. bleeding or are bleeding in theatre. PBM has a long history, with much of the early work undertaken in America and Water content, both endogenous and exogenous, is a proven factor in 17 Canada to reduce blood loss in surgery. 17 antigen decay. The use of an electronic prescribing system has demonstrated a reduction in the Oestrogen and progesterone receptor demonstration is unaffected by 18 use of blood. 18 immunosignal loss in older archival blocks. 19 TPs have been publishing their work for years, but it has largely been ignored. 19 Café-au-lait staining patterns were not seen with Ki-67 immunoreactivity. When PBM was launched in the UK, the role of the TP was identifi ed as part of the The minimum tissue block legal retention period in Italy is 30 years. 20 structure required to drive it forward. 20 REFLECTIVE LEARNING Outline the management of anaemia and haematinic defi ciencies in pregnancy What improvements to the study could you identify? 01 and post-partum. 01 Outline the cornerstones of patient blood management in surgery. What methods of validation are/should be used in your laboratory on aged 02 02 blocks? What would this mean in practice?

P43 IBMS Aug18_My IBMS-JBL_v1gh.indd 43 20/07/2018 11:20 THE BIOMEDICAL MY IBMS 44 SCIENTIST Continuing professional development

A wide range of training courses, CPD and local events and activities is listed below. Members are advised to contact organisers for further information. A full list EVENTS AND is available on the IBMS website. TRAINING COURSES

DATE TITLE VENUE CONTACT August

1 Aug – 17 Sep UK NEQAS Cellular Pathology Technique tissue morphology Gateshead I [email protected] and recognition workshop 21 – 23 Aug Standardized susceptibility testing – residential workshop 2018 Cardiff I [email protected]

September 4 – 6 Sep Three-day update for cervical cytology Bristol I [email protected]

11 Sep Mycology teaching workshop London I [email protected]

12 Sep Mycology teaching workshop London I [email protected]

12 – 13 Sep Beginners immunohistochemistry course Sheffi eld I l.baxter@sheffi eld.ac.uk

12 – 13 Sep UK NEQAS Cellular Pathology Technique Mohs/BMT/renal Gateshead I [email protected] workshop 13 Sep Mycology teaching workshop London I [email protected]

19 – 20 Sep UK NEQAS cellular pathology technique muscle/neuropathology Liverpool I [email protected] and electron microscopy Introduction workshop 21 – 22 Sep Advanced course in EBUS/mediastinal EUS and rapid on-site Watford I [email protected] evaluation for chest physicians and cytopathology teams 28 Sep Update course in gynaecological cytology – MDT cases and Birmingham I [email protected] squamous lesions October 4 Oct ISO Accreditation for POCT October 2018 Leicester I [email protected]

8 – 12 Oct Introduction to the principles and practices of working safely Porton Down I [email protected] at ACDP containment Level 3 9 Oct HPLC troubleshooting Reading, Scotland, Manchester I [email protected]

9 Oct Intermediate immunohistochemistry Sheffi eld I l.baxter@sheffi eld.ac.uk

10 Oct BSAC antimicrobial susceptibility testing user day Birmingham I [email protected]

10 Oct HPLC method development Reading, York, Scotland, London, Manchester I [email protected] 13 Oct Biomed online learning courses London I [email protected]

17 Oct One-day update in cervical cytology audit Bristol I [email protected]

17 Oct UK NEQAS Cellular Pathology Technique tissue morphology Gateshead I [email protected] and recognition workshop 18 Oct UK NEQAS Cellular Pathology Technique Tissue Preparation Gateshead I [email protected] Techniques Workshop 22 Oct Update course in gynaecological cytology – HPV update and Birmingham I [email protected] glandular lesions

P44-46 IBMS Aug18_My IBMS HTH-CPD_v4gh.indd 44 20/07/2018 11:20 MY IBMS THE BIOMEDICAL Examinations SCIENTIST 45

HERE TO HELP TIPS FOR EXAM SUCCESS

Chris Ward, IBMS Head of Examinations, provides advice for those undertaking IBMS examinations and those supporting candidates this September.

t may be several years since you last sat an exam and day-to-day you probably use IT rather than writing with a pen. This means that you will probably not be used to writing for long periods of time. It is, therefore, a good idea to practise writing and one way of doing this would be to Imake use of the past exam papers that are available in the qualifi cation resources you do answer the other questions on there may be more information that then section of the IBMS website. This will also the paper. alters the perspective on the case. help you understand the type of questions asked in the exam. The examiners will Read the instructions Plan your answers not be able to award you marks if they Recently there have been several At the start of the exam, read all the can’t read your handwriting, so write incidences where candidates have been questions that are on the paper and then legibly and in pen. asked to answer one question from each select the order in which you are going to of three sections but have instead attempt the questions. This is much Pre-seen questions answered two questions from one section better than simply answering the fi rst For the Higher Specialist Diploma and one other question from another question that you like the look of. You (HSD), where there are pre-seen section. Candidates who did his may fi nd that there is one you like even questions, use the time from the release immediately lost a third of the marks more later on in the paper. of these questions to the exam to prepare available for the paper. Answer the question that is set – not the your answers to these questions, but Normally, you will be able to answer the question you would hope would be set. remember that you cannot take your questions in any order, but for the HSD Candidates occasionally present an prepared answers into the exam room. case study paper within each case it is answer that shows a good degree of When it comes to the exam, remember important to answer the questions in the knowledge and understanding, but misses that these questions are worth the same order they appear. This is because there the point that the question is asking. You amount of marks as the other questions may be occasions where you will be given can’t be awarded marks for an answer that on the paper, so whilst you are likely to a limited amount of information and be is nothing to do with the question. write more on the pre-seen questions expected to give an answer based purely Look at the number of marks that are than you will on the others, make sure on those details. Later on in the study available for the question. There is no

P44-46 IBMS Aug18_My IBMS HTH-CPD_v4gh.indd 45 20/07/2018 11:20 THE BIOMEDICAL MY IBMS 46 SCIENTIST Examinations

Before you start point in writing a whole page for a nomenclature and if you use question that only has fi ve marks abbreviations always defi ne them when writing your attached to it. Equally, if you only write you fi rst use them in your answer. response, it is good two sentences for a question that is worth 20 marks, you are not going to achieve The day of the exam practice to write a full marks for your answer. When it comes to the day of the exam You should look for key words and allow yourself plenty of time to get to the brief plan of your phrases in the question, such as outline, exam venue. It is better to be there early describe, compare and list, as these tell than late, and we all know what public proposed answer you the type of answer the examiners are transport can be like. expecting to see. If it specifi cally asks for Once you are in the exam room, try to an annotated diagram, bullet points or a remain calm and do not panic. Remember table, make sure you do that. there will be no “trick” questions. Focus Before you start writing your response on what is being asked and keep track of for the essay questions, it is good practice time in the exam so that you answer all to write a brief plan of your proposed the questions that you need to. answer. You will fi nd it much easier to After the exam has fi nished do your write an answer that says what you want best to forget about it. You can’t change it to say if you have made a plan fi rst. what you have written and the result will In your answer avoid text-speak, jargon be what it will be. and acronyms, instead use appropriate Finally, good luck with your exams.

The NEW SLS Catalogue is OUT NOW!

As the UK’s largest independent supplier of laboratory equipment, chemicals and consumables, we offer our customers a tailored and flexible approach to sourcing their scientific requirements.

This edition has a new feature called ‘At a Glance’ information. This provides the user with 3 key product features enabling them to • Over 18,000 products all in one place NEW! quickly compare specifications and • 20% completely decide if the product is suitable for • Compact size – taking up less space and easier to handle their needs. • Fresh look with additional features for ease of use

To request your NEW 2018 –19 SLS catalogue To request your NEW 2018–19 SLS catalogue Phone us on 0115 982 1111 Phone us on 0115 982 1111 email us [email protected] visit our website www.scientificlabs.co.uk or visit our website www.scientificlabs.co.uk

P44-46 IBMS Aug18_My IBMS HTH-CPD_v4gh.indd 46 20/07/2018 11:21  Ð(Ò Ò Ò*GÒÐ  with the Small, Benchtop Promega Maxwell® RSC Systems

• Parallel processing of up to 16 (RSC) or 48 (RSC48) samples in approximately 30 minutes

• Purify DNA or RNA from a variety of primary samples including blood, buffy coat, plasma, ccfDNA, FFPE, saliva and tissue

• 8VHGHGLFDWHGSUHÀOOHGFDUWULGJHV

For more information please visit: https://www.promega.co.uk/products/instruments/maxwell-instruments/ Follow us on @promegauk Or contact [email protected] to arrange a demonstration 0800 559900 www.promega.com

BIO.08.18.047_.indd 47 18/07/2018 11:05

Non Gynaecological Cytology Training Opportunities 2018/19

Cervical Screening

Histopathology

Non-Gynae Cytology Workshops Diploma in Cervical Cytology A Course for the Expert Role in Specimen Ideal for non-medical staff new to diagnostic This is a three day course ideal for anyone Dissection cytology wishing to gain experience in sample intending to sit the pre-registration Diploma in This course is suitable for BMSs who intend to collection and preparation techniques Cervical Cytology Suitable for SurePath ™ and train as histological tissue specimen dissectors, ThinPrep® morphology 17th – 19th October 2018 in particular those undertaking the RCPath/ 5th – 7th September 2018 IBMS Diploma. It covers all the mandatory Courses in Expert Practice Diagnostic elements and a selection of specialist modules Cytology Three Day Update Course in Cervical Cytology including: for Consultant Biomedical Scientists These courses cover serous fl uids, urine and Gastronintestinal and Hepatobiliary; It includes elements of Gynae Histopathology, respiratory cytology and ideal for anyone Gynaecological; Breast; Skin; Osteoarticular and HPV testing and MDT cases amongst other topics wishing to further their experience or workings Soft Tissues, Genito-uropathology; Exam and towards the IBMS DEP 14th – 16th November 2018 Portfolio sessions; Endocrine, Head and Neck 20th, 21st, 22nd, 23rd November 2018 Your Role as a Cervical Screening Provider This is a perfect opportunity to gain practical Lead/Hospital Based Programme knowledge to support your everyday practice Exam Practice for the Diploma of Extended Co-ordinator and provide evidence to your employer that Practice in Non-Gynaecological Cytology This course developed in association with you have received appropriate training. Ideal for anyone taking the IBMS Diploma the NHSCSP AMG to guide both experienced The next course will commence in of Extended Practice in Non-gynaecological CSPLs and those new to the role and covers November 2018 with the Introductory Cytology many different topic areas that the CSPL may encounter Modules, specialist module sessions will 16th – 17th May 2019 be held throughout 2019. Early June 2019

For further information contact our Admin Team: [email protected] Tel: 0113 2466330 www.nepsec.org.uk

Biomed Online Now booking short courses for October for CPD, PG Certs, PG Dips and MSc.

020 8331 9978 biomedonline.co.uk

BIO.08.18.048.indd 48 18/07/2018 11:08 RECRUITMENT THE BIOMEDICAL For recruitment advertising contact our Sales Team +44 (0)20 7880 7665 SCIENTIST 49

Raigmore Hospital, Inverness Belfast Health and Clinical Services Division Cellular Pathology Department Social Care Trust Healthcare Scientific Professional Manager – caring supporting improving together Band 8a £42,058 - £50,470 – Full-time, Permanent Ref: IM9.18.31a Belfast Health and Social Care Trust and Queens This is an opportunity to join a progressive UKAS Accredited department situated in one of the most beautiful areas of Scotland. We provide a comprehensive Cellular Pathology service to clinicians University of Belfast have established a Cell Based Therapy throughout the NHS Highland and Western Isles areas though some specialist work is referred Clinical Trials Unit in Victoria Pharmaceuticals. We are to Glasgow. seeking to recruit a Cell Therapy Production Manager to lead The department is divided into 2 technical sections: Histology – which contains routine this cutting edge development within Northern Ireland Histology and the Special Diagnostics sections (the latter incorporates Immunocytochemistry, healthcare. Initial therapy areas will be in acute respiratory Immunofluoresence and renal biopsies) and Cytology (which comprise non-gynaecological cytology and the andrology service) distress syndrome, renal medicine and ophthalmology. The department works a 5 day week, and currently does not undertake out of hours work. Applicants must be HCPC registered, have professional knowledge and technical expertise Cell Therapy Production Manager – of laboratory sciences attained either through relevant Masters Degree, IBMS Specialist Diploma in Cellular Pathology, or equivalent. You should have at least ten years post-registration practical Victoria Pharmaceuticals experience. You must possess excellent communication skills both oral and written and be Ref No: 51120218 fully computer literate. You should have extensive experience at a managerial level at band 7 (senior BMS) as a minimum. Closing date: Tuesday 14th August 2018 Informal enquiries to: Mr Andrew Soden; tel: 01463 704265; email: [email protected]. Application Forms and Job Descriptions can be downloaded via our website To be advised of future vacancies you can also find us on https://jobs.scot.nhs.uk/_Details.aspx?vacNo=477841 or available from, and to be returned Facebook & Twitter. See the links below to the Employment Services Section, Assynt House, Beechwood Business Park, Inverness IV2 3BW or by emailing your name and address to [email protected]. https://twitter.com/BelfastTrust Short-listed applicants will normally be contacted by email, unless otherwise stated. https://www.facebook.com/Belfast Please check your emails regularly, including your junk/spam folder. Trust#!/BelfastTrust Please quote reference: IM9.18.31a. We are an equal opportunities employer Closing date for completed applications: Friday 31 August 2018. NHS Highland is committed to being an equal opportunities employer and welcomes applications irrespective of race, gender, age, disability or sexual orientation.

www.nhshighland.scot.nhs.uk For more information and to apply online go to HSCRecruit.com

Education Manager (Qualifi cations)

An exciting opportunity has arisen to work as an Education Manager (Qualifi cations) within the Education Team at the London headquarters of the IBMS. The successful candidate will work closely with the Deputy Head of Education, Head of Examinations and Education Manager (Processes) to ensure the smooth running of the busy and wide-ranging work of the Education Department. It is a varied role and would suit somebody who is a registered biomedical or clinical scientist looking to step across into the development and provision of the IBMS’s routes to registration and our portfolio of qualifi cations. We are looking for someone who is passionate and knowledgeable about the profession, able to focus on the challenges facing our members and those studying for qualifi cations with us, is able to work autonomously and as part of a team and willing to travel nationwide. For an informal chat please email [email protected] for the attention of Jocelyn Pryce, Deputy Head of Education, to arrange a suitable date and time. Please apply by sending a statement detailing how you fi t the criteria (no more than 2 sides of A4) along with a current c.v. to [email protected]. Salary: up to £36,423 (35-hour week). The closing date for applications will be 24th August 2018.

BIO Recr Aug18.indd 49 18/07/2018 16:52 THE BIOMEDICAL MY LAB 50 SCIENTIST Norbert Sene

MY LAB LABORATORY ON THE ROCK IBMS Gibraltar Branch Secretary Norbert Sene gives a guided tour of the Pathology Department at Saint Bernard’s Hospital in Gibraltar.

ibraltar is a British Overseas Territory positioned on the northern shore of the Strait of Gibraltar that links the Mediterranean Sea with the Atlantic Ocean, at the boundary between the continents of Europe and GAfrica. The Gibraltar Health Authority’s Department of Pathology is located at Saint Bernard’s Hospital. The department is multidisciplinary, covering transfusion science, haematology, biochemistry, microbiology, mycology, virology, histology, cytology, and Joe Pickering lead the biochemistry conducts post-mortems. Biomedical and immunohistochemistry services. section, using the latest analysers and scientists Tanya Watson, Carmen Our laboratory information system covering a wide range of clinical tests, from Delicado, Charlotte Gillborne-Jones, Samy links all sections, which feature a wide LFTs to hormones, HbA1c and allergy Pearce and Jennie Dodd run our range of sophisticated analysers and screening. Biomedical scientists Karyn microbiology section, which is geared other equipment, which, together Rowbottom and Mohit Mahbubani towards the isolation, identifi cation and with the latest techniques, provide a undertake a wide range of haematological antibiotic sensitivity testing of micro- comprehensive repertoire of tests. In tests, from FBC to leukaemia diagnosis and, organisms, from bacteria to viruses. Tests 2017, the department performed almost together with Consultant Haematologist range from traditional bacterial culture one and a half million analyses, from both Dr Pepe Duran, manage an INR clinic for on agar plates to detection by PCR. primary and secondary care samples. more than 500 patients. Consultant Microbiologist Dr Nick Cortes Pathology Services Manager Dr Alex The department manages its own provides support to the section. Menez heads his team of biomedical blood bank, supplied mostly from local The department also incorporates the scientists, biomedical assistants, donations; the units are leuko-depleted, Laboratory of the Public Analyst, with production assistants and clerical staff . grouped and checked for transfusion- Public Analysts Natalie Hernandez and Quality Manager Audrey Olivares-Smith transmitted viruses for cross-matching. Xenia Duarte performing the statutory ensures standards are maintained and Senior biomedical scientists Lawrence function of microbiological and chemical works closely with Blood Bank Manager Stagnetto and Mike Allison lead the examination and analysis of food and Ernest Gomez to comply with blood histology and cytology section that drink. It is also responsible for providing a donation directives. includes biomedical scientist Andrew wide range of scientifi c analysis, including The department participates in UK Cavilla and Cytoscreener Steven Garcia. environmental parameters, analysis of NEQUAS schemes and all qualifi ed The section processes a wide range of drugs of abuse and toxicology, as well as biomedical scientists are registered with the specimens, including skin lesions and providing expert witness to the law courts. Health and Care Professions Council (UK). In cervical, gastric, and breast biopsies: The department is proud of its excellent addition, Gibraltar has its own IBMS branch all part of screening programmes. The teamwork, and those that have retired, and enjoys an active CPD program. team works closely with Consultant like myself, continue to be a part of the Senior biomedical scientists Wayne Acris Pathologist Dr Naim Qandi, who also Gibraltar pathology family.

P50 IBMS Aug18_My Lab_v2gh.indd 50 20/07/2018 11:21 QIAstat-Dx The next generation of syndromic insights

QIAstat-Dx® (DiagCORE®) is powered by proven QIAGEN® sample and assay technologies. You can now confidently provide clinical insights to patients with the highest level of versatility.

Learn more at QIAstat-Dx.com.

The QIAstat-Dx (DiagCORE) is intended for in vitro diagnostic use in Europe.

Trademarks: QIAGEN®, Sample to Insight®, QIAstat-Dx® (QIAGEN Group). DiagCORE® (STAT-Dx Life S.L.) Registered names, trademarks, etc. used in this document, even when not specifically marked as such, are not to be considered unprotected by law. 07/18 © QIAGEN 2018, all rights reserved.

Sample to Insight

BIO.08.18.051.indd 51 18/07/2018 11:09 Roche Diagnostics gives you I KNOW WE ARE The Power of Knowing that you’re using accurate information to SAVING LIVES make the right decisions today, so your patients can experience a healthier tomorrow. THE POWER OF KNOWING

BIO.08.18.052.indd 52 18/07/2018 11:10