Republic of Ireland Regional ACB Meeting
Friday 16th January 2009.
The Educational and Research Centre, St. Vincent’s University Hospital, Dublin.
The start of 2009 has not been a good one with ’economic downturns’, credit crunches, salary levies and the widespread belief that the only difference between Ireland and Iceland is one letter and 6 months! So an ACB scientific meeting in January was a welcome distraction for us all. This year many colleagues from the UK accepted the invitation to come to Dublin and the early morning starts, long drives and one speaker’s gallant dash from Tokyo were really appreciated.
Dr. Edmund Lamb started the morning session with an excellent and informative overview of Chronic Kidney Guidelines. His main focus was on the key messages for laboratories in the recently published NICE guidance on CKD. These messages focus on staging system modifications, ACR/PCR, eGFR methodology, bone metabolism and osteoporosis. It recommends sub-classifying CKD stage 3 into 3A and 3B, each with different levels of risk. The suffix ’p’ should be applied to denote the presence of proteinuria when staging CKD, ACR should be used in preference to PCR and an eGFR >= 60 ml/min/1.73m2 should be interpreted with caution. Dr. Lamb said attention should now be re-focused on standardisation of creatinine measurement, proteinuria assessment and the expansion and validation of the MDRD equation.
Dr. Denis O’Reilly gave a thought provoking review on thyroid disorders and their management down through the years. The fact that the ability to measure Total T4 and TSH and more recently free thyroid hormones has heralded a new age in terms of patient care with , in his opinion, too much emphasis on the thyroid hormone result. He discussed the controversies with respect to ’normal’ TSH values and the cut-off’s for instituting thyroxine replacement and the concerns vis-a-vis quality of life. The current health care culture is being driven increasingly by targets and the clinicians need to return to clinical acumen and listen to and treat their patients not the number.
Dr. Deirdre Madden reported on recommendations from the Commission on Patient Safety and Quality Assurance , whose aim was to provide recommendations for a framework of patient safety and quality which would lead to governed healthcare facilities in Ireland. The Commission recommended the development of national programmes and standards for clinical and other forms of patient safety audit, development of systems for adverse event reporting, the promotion of the use of evidence-based practice and the dissemination of information derived from these sources to facilitate learning.
At lunch time Deirdre and Dermot Deverell launched the new ACBI Website. This website will be an extremely useful tool for all members as it will contain notices of all upcoming meetings, enable us to book for conferences, have information on published guidelines and reports and keep us all in touch with activities in the profession. We would like to thank Deirdre and Dermot for all the work they have done and congratulate them on a superb website.
Now that we are starting to dual report HbA1c results it was really appreciated that Professor Eric Kilpatrick came to Dublin to give us an excellent talk on standardisation of HbA1c and its relationship with estimated glucose (eAG). HbA1c results should be reported in both IFCC units (mmol/mol) and derived NGSP units (%) (synonymous with DCCT), using the IFCC-NGSP master equation for the time being. Eric shared with us his ’Kilpatrick Kludge’ the easy way to convert the DCCT HbA1c to the IFCC number (minus 2, minus2!) There are concerns with the reporting of an estimated glucose, its relationship with HbA1c especially in patients with haemoglobinopathies, anaemia and renal failure. At present there is currently insufficient experimental evidence to support the introduction of eAG. Further research into the individual utility of eAG and of its use in all groups of individuals with diabetes is required in order to determine what role reporting of eAG has in clinical practice.
Professor Brian MacCraith from the Biomedical Diagnostics Institute gave an interesting presentation on the technologies currently under development for Point of Care Diagnostics. They are utilising cutting- edge technologies such as the automated selection of monoclonal antibodies, low cost enhanced microfluidic platforms and improved transduction technologies. These have been combined with their own signal amplification technology which can yield a 100-fold increase in signal detection thus enabling greater sensitivity of analytes such as cardiac biomarkers. Brian briefly introduced some of the various devices they have or are currently developing, three of particular note are the Platelet Function Microfluidic Platform, the CVD Risk Chip, and the Coagulation Monitor for use in the critical care environment.
Last but not least Mike Hallworth spoke about the need to promote laboratory medicine. As scientists we need to give the public, other healthcare professions and policy makers a better understanding of what laboratories do. This will lead to better use of laboratory tests thereby facilitating improved care and reduced costs. Our service should be patient-centred based on clinical decision-making and measured patient outcomes. Mike was chair of Lab Tests Online UK and said that Labtests Online (LTO) has expanded the lab’s visibility more than 20 million times last year alone. Ireland with the aid of the LTO UK has now its own webpage ( www.labtestsonline.ie ) with access to UK site which has specific information for Irish users. Mike finished his talk with a quote ’The only way to predict the future is to shape the future’ which I think was a very appropriate message to take home with us.
I would like to thank all our speakers for giving up their time and coming to Dublin as we appreciate that they all have hectic schedules. Thanks also to the delegates who braved an extremely stormy weekend to come to St. Vincent’s University Hospital and the Regional Committee for helping organise the meeting.
Geraldine Collier, Chair of ACB RoI Region.