october

16 | Meeting ReportsDilemmas in LaboratoryMedicineEmma StevensonThe Spring ACB Wales & South West andWessex Meeting took place in Cardiff. It wasnot just the pleasant weather or views overthe beautiful Vale of Glamorgan thatbrought together so many ACB Members andnon-Members, but the chance to discuss a hottopic in laboratory medicine: to test or not totest.The focus of the meeting was dilemmas inlaboratory medicine. Accordingly, thepresenters covered some of the morecontroversial matters currently occupying theminds of biochemistry professionals, includingtumour markers and point of care testing.That is the Question . . .The first speaker was Consultant ChemicalPathologist, Dr Soha Zouwail, who gave aninteresting talk on “Benchmarking requestingprofile: A way forward to quality use ofpathology”. Perhaps, not surprisingly, around25% of pathology tests may be inappropriate,related in part to media influence and aconcerning rise in websites offering privateblood tests for conditions like “cancer”.Dr Zouwail explained to us how her laboratoryhad been measuring GP requesting activity,which showed significant variation in the rateof biochemical sets ordered by GPs.By engaging and educating GPs andimplementing a regular primary carenewsletter, she told us that local interventionappeared to be effective at tackling thisvariation. To avoid the danger ofover-diagnosing, we should take theGoldilocks approach to testing: not too little,not too much, but just right. We came awayunderstanding the need to focus on qualitynot cost-saving, through information,education and requestor accountability.Katy Heaney looked at point of care testingand introduced the POCT Manager’s role asthe work of an idealist, in the sense that avisionary is required to answer the mostimportant POCT question: “to implement ornot to implement?” Katy discussed thedecision process of the POCT committee,including practical considerations, clinicalevidence and cost-efficiency, in addition tosome amusing personal experiences of deviceimplementation. She emphasised that POCTcan result in a more positive patientexperience but left us with the big question:Can the NHS afford to give weight to patients’opinions of POCT service, even when there islittle evidence to support cost or clinicalbenefit?The final presentation of the morningsession was a clinician’s viewpoint on the useof procalcitonin in sepsis by Dr Robert Orme.He told us that diagnosis of infection is oftendifficult and procalcitonin has been welcomedas a biomarker for early diagnosis of sepsis, inmonitoring treatment success and inpredicting patient outcome. The test can beused to improve clinical decision-making andreduce the length of antibiotic courses, whichis currently an important issue owing toinappropriate antibiotic usage and the threatof resistance. Dr Orme stressed to us thatprocalcitonin is not a “magic bullet”, butmust be used in conjunction with otherinvestigations and clinical signs. He ended histhorough and interesting talk with adescription of the successful (andcost-effective) introduction of prolcalcitoninanalysis in his local Trust in Gloucestershire.Right Tests Used EffectivelyThe afternoon session commenced withDr Cathie Sturgeon, who discussed tumourmarkers and posed the question, “Are wedoing the right tests and are we using themeffectively?” From the NHS Atlas of Variation,it is clear that there is a huge variation in testrequesting. Variation is particularly evidentwith tumour marker requesting and CathieACB News | Issue 618 | October 2014