Good Value in Belfast! by Dr Paul Hamilton
A sizeable group of delegates gathered in the new Education Centre in the Royal Group of Hospitals, Belfast on 11th April for the Joint Spring Scientific Meeting of the ACB (Northern Ireland Region) and Association of Clinical Biochemists in Ireland. Dr Peter Sharpe opened the day's proceedings, serving in his last few days of office as chair of the regional group, and chaired the morning session.
The first talk of the day came from Mrs Pamela McCreedy who spoke on 'Transforming Your Care (TYC).' TYC was a report that followed a major ministerial review of health and social care services in Northern Ireland. The broad aim of the initiative, which will have major implications for services, is to provide better outcomes for the population despite increasing pressures on the system. Proposed changes were outlined, and the role of integrated care partnerships explained. The expansion of health and care centres in primary care and acute networks for secondary care are of central importance.
Next, Dr Clodagh Loughrey spoke on 'Eating disorders, nutrition and the lab.' Dr Loughrey engaged the audience in an evidence based account of treating patients with eating disorders that was brought to life by the use of carefully selected case histories drawn from her own clinical experience. Patients with eating disorders can often exhibit no major biochemical abnormalities so sometimes it can be difficult to determine their true nutritional status using conventional biochemical testing. Elements of the MARSIPAN ('Management of really sick patients with anorexia nervosa') report were detailed, and the importance of anticipating, recognising and treating re-feeding syndrome was highlighted. The talk concluded with the report of patient with an extremely severe case of anorexia nervosa.
After coffee, Dr Derek McKillop delivered his presentation on realistic and safe laboratory turnaround times. Turnaround times are often quoted as an indicator of laboratory quality, and they are recognised by the Royal College of Pathologists as a Key Performance Indicator. Dr McKillop presented findings from a National Turnaround Time Survey which captured the working practices and opinions of two thirds of the clinical biochemistry consultant workforce in the UK. The use of point of care testing to achieve very fast turnaround times was discussed, as were measures that would be necessary if turnaround time targets are to be achieved and enforced.
Rounding off the morning session was Dr Una Graham who spoke on the topic of endocrine hypertension. Dr Graham outlined the various endocrine diseases in which hypertension can be a feature and provided a succinct overview on how these diseases should be screened for. Next a detailed overview of primary aldosteronism was presented. The rationale for detecting patients affected by this disease was presented, before details of working up a suspected case were discussed. Finally, the investigation and treatment of patients affected with phaeochromocytoma were examined.
Prof. Maurice O'Kane chaired the afternoon session. Dr Mike Hallworth got things going with his view on the value of laboratory medicine. Dr Hallworth, who has very recently retired, explained that up to 5% of healthcare expenditure was spent on laboratories. He gave a very balanced overview of the clinical and economic gains that laboratories bring to healthcare systems. The importance of fit-for-purpose information systems to assist in the handling of vast quantities of data was outlined. This was a particularly thought-provoking session since many of the challenges that laboratory medicine must meet and overcome in the near future were highlighted.
Dr Alan Balfe then gave a detailed overview of haemochromatosis. The latest understanding of how the body handles iron was presented, along with the pathogenesis of iron overload disorders. A clear account of the many genetic causes for haemochromatosis was put in the context of rational testing in real world scenarios. Possible future innovations in this field were also discussed.
The last lecture of the day was provided by Dr Seamus Murphy. A very clear overview of irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) was presented using endoscopic images to reinforce pathological discussion. National guidelines for diagnosis were outlined, and the importance of providing a positive diagnosis of IBS explained. Faecal calprotectin, a protein found in high concentrations in neutrophils, is markedly raised in patients with IBD, and seems to be a useful test in confirming suspicions of IBS where low levels would be expected. The potential role for calprotectin in assessing disease activity was also discussed.
Overall, the day was highly enjoyable and worthwhile. Thanks are due to all speakers and organisers, and to Roche who sponsored the event.
Morning session speakers (L-R) Dr Derek McKillop, Dr Una Graham, Mrs Pamela McCreedy, Dr Clodagh Loughrey.
Invited speakers (front row L-R) Dr Alan Balfe and Dr Mike Hallworth with sessional Chairmen Dr Peter Sharpe and Professor Maurice O’Kane (back row L-R).