Transcript Infection Sciences

Gavin Ryan and Rowenna Roberts | Healthcare Scientist Trainees
West Midlands Regional Genetics Laboratory
Birmingham Women's NHS Foundation Trust
5th November 2014
Undergraduate degree
in Genetics
PhD at the University of
Birmingham – research
on thyroid cancer
STP in Genetics at West
Midlands Regional Genetics
Laboratory – MSc at
Nottingham University
Undergraduate degree
in Genetics
Genetic technologist
at the West Midlands
Regional Genetics Lab
for 6 months
STP in Genetics at West
Midlands Regional
Genetics Laboratory –
MSc at Nottingham
University
3 month Internship at the
West Midlands Regional
Genetics Lab
• PhD – academic research
→ Postdoctoral research → own research group
• Graduate training programmes – CRUK, Wellcome
trust
• Industry – drug discovery/development
• Clinical trials
• Medical writing
• Science communication
• Teaching
• NHS
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What is a healthcare scientist?
What opportunities are available?
What is the STP and where did it come from?
Different divisions and themes available
My experience so far
Overview of the genetics service
How is it assessed?
Recruitment process
Benefits and opportunities
Allied Health
Professionals
Health
Informatics
Midwifery
Wider Healthcare
Team
 Over 50,000 HCS employed in the NHS
Doctors
Management
Ambulance
Nursing
 Comprise
5% of Healthcare
workforce in the UK
BUT
 80% of diagnoses can be attributed to work carried out by HCS
- 1 billion pathology Healthcare
lab tests
Dental
- 12 million physiological
tests
Scientists
 Play a vital role in the diagnosis, treatment and prevention of a huge
number of medical conditions
 Develop and apply new technologies to improve care
 Lord Darzi's NHS Next Stage Review
(2008)
- highlights important role of HCS within
the NHS in developing a sustainable
workforce for the future
 Led to DoH publishing Modernising
Scientific Careers: The UK Way Forward
(2010)
- the strategy for the development of
the HCS workforce and their education
and training
Proposals:
• Introduce a new simplified career pathway
• Develop new training programmes incorporating
academic and work-based training
• Develop appropriate qualifications and awards
Aims:
• Standardise training across specialisms and Trusts
• Improve education, training and career structures
• Build flexible workforce with greater integration
between scientific specialities
• Ensure workforce is equipped to meet the
challenges of future delivery of care
• Improve the quality of care for people
Ultimate aim is to improve patient outcomes
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Launched in 2012
UK wide organisation working across
all sectors of healthcare
Commissioned by DoH
Set up routes to registration following
completion of MSC training
- approval by HPC to grant certificates
Body responsible for
registration and regulation
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Developed in 2011
Maintain consistency and
standardisation
Ongoing QA of training courses
and overseeing assessment
Support trainees
Support departments and staff
Oversight, coordination
and delivery of training
Assistant
Practitioner
(PTP)
Scientist
(STP)
Consultant
(HSST)
• Entry from college level
• Work towards vocational qualification or
foundation degree
• Band 4
• Direct entry from college
• Work towards BSc degree
• Main focus on technical laboratory skills
• 3 years
• Direct entry from degree level or through PTP
• Work towards masters degree and registration
• 3 years
• Entry through STP
• Doctoral level
Scientist
• direct entry from degree level or through PTP
• work towards masters degree and registration
 Employed as NHS trainee on fixed-term 3 year post
 Train at band 6
 Entry criteria: honours degree (1st or 2:1) in a pure or applied science
area relevant to the specialism. 2:2 also considered if applicant has MSc
or PhD
 MSc in Clinical Science
 Certification of work-based training leading to registration
Organisations involved in training:
1. Host employer (NHS Trust) delivers work-based training
2. Higher Education Institute delivers Masters programme
3. NSHCS for oversight, support and coordination
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Define and choose investigative and clinical options
Provide clinical interpretation of a range of results and procedures
Write and authorise reports
Liaise and provide medical advice to medical professionals
Work directly with patients
Develop and validate new diagnostic/prognostic tests
Assist in supervision of technical staff
 Skills required:
Interest in science and technology
Good communication
Meticulous attention to detail
Ability to work under pressure
Good interpersonal skills
Organisational skills
Leadership & management skills
 3 divisions
 ~50 themes
• Mostly work in hospital laboratories
• Work with blood or tissue specimens
• Use scientific techniques to diagnose and
monitor illness
 3 divisions
 ~50 themes
• Neurosensory sciences
• GI physiology
• Cardiac, Vascular, Respiratory and Sleep
Sciences
• Work in specialised hospital clinics,
departments and wards
• Patient contact.
• Measure what is happening in the body
 3 divisions
 ~50 themes
• Medical physics
• Clinical engineering
• Working with equipment and systems
• Use sophisticated techniques to detect
what is happening in the body
Newcastle University
- Medical Physics and CVRS
University of Liverpool
- Medical Physics
University of Manchester
- Neurosensory Sciences and Blood Sciences
University of Nottingham
- Infection Sciences and Genetics
Aston University
- Neurosensory Sciences
Queen Mary’s, University of London
- Infection Sciences
Kings College London
- Medical Physics and Clinical Engineering
< Biochemistry, UHCW
< Immunology, UoB Medical School
Reproductive Science, BWH >
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Investigation of major organ function e.g. liver, kidneys, pancreas...
Diagnose and manage disease through the analysis of blood, urine and other
bodily fluids e.g. diabetes, thyroid disease, anaemia
Screening and diagnosis of some common cancers e.g. bowel cancer
Foetal anomaly screening – for Down syndrome (hCG, AFP markers) to determine
if patient should undergo invasive amniocentesis test
Newborn screening programme e.g. cystic fibrosis (elevated IRT)
Pregnancy tests
Drug tests
Highly automated
Increasingly work performed outside the laboratory to support the investigation of
patients at the point of care, including in clinics and operating theatres
Embryology
Biochemical
Screening
Ultrasound
Scans
IVF/ICSI
Sickle cell and
Thal Screen
Pregnant
Patient
Amnio/CVS
QF-PCR
Free Fetal
DNA
Pre-implantation
Genetic Diagnosis
Blood group +
Rhesus
Screening
Karyotype
• Testing for allergy and type 1
hypersensitivity reactions
• Levels of immune cells during
infection
• Immunodeficient patients – HIV,
immunosuppressive drugs
following transplant etc.
• Testing of patients with
haematological malignancies i.e.
Chronic Lymphocytic Leukaemia,
Acute Leukaemia, Lymphoma
• Investigating autoimmunity in
patients – thyroiditis, rheumatoid
arthritis
 Andrology → semen analysis
 Embryology → assisted conception techniques
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Assist collection of eggs from patients
Preparation of gametes for fertilisation
Performing fertilisation - IUI, IVF, ICSI
Culture and grading of embryos
Embryo transfer
Patient contact
 Highly technical
 Laboratory-based with lots of patient contact
INTRAUTERINE INSEMINATION
IN VITRO FERTILISATION (IVF)
 Separation of motile sperm and
preparation for transfer at
ovulation
 All semen parameters within
normal range
 With or without fertility drugs
 Oocytes incubated with
prepared sperm in plates
 Recommended for unexplained
infertility
 ~16% for women aged under 35
 Unsuccessful IUI
 Independently penetrate the
zona pellucida
 Fertility drugs to regulate cycle
 ~32% for women aged under 35
INTRACYTOPLASMIC SPERM
INJECTION (ICSI)
 Reduced semen parameters azoospermia, oligospermia or
surgical sperm retrieval
 Directly inject immobilised
sperm into the oocyte
 ~35% for women aged under 35
Embryology
Biochemical
Screening
Ultrasound
Scans
IVF/ICSI
Sickle cell and
Thal Screen
Pregnant
Patient
Amnio/CVS
QF-PCR
Free Fetal
DNA
Pre-implantation
Genetic Diagnosis
Blood group +
Rhesus
Screening
Karyotype
Can be inherited
or occur de novo
Conditions can
range from mild to
severe/fatal
Can
affect a person
at any
age
Genetic
disorders
Can affect any
organ within
the body
Can be due to alterations in
one gene or a combination
of many alterations in many
genes
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Provide genetic testing service to aid patient care:
 Diagnose genetic disorders
 Assess likelihood of passing on to children
 Carrier testing
 Presymptomatic testing
 Prenatal testing
 Diagnose and assess leukaemia and other
cancers
 Work with range of specimen types:
>10Mb Cytogenetics
5Mb
Microarray
6Kb
Molecular
1bp
REASONS FOR CYTOGENETIC TESTING
 Developmental delay, failure to thrive, dysmorphism, symptoms consistent with a
syndrome, infertility, heart defects…
 Leukaemia, lymphoma including follow-up samples from treated individuals
SAMPLES
 Mainly blood samples
 Amniotic fluid samples, CVS samples, tissues
METHOD
 Culture lymphocytes
 Collect cells in metaphase
 G-band to differentiate regions of chromosomes
 Align chromosomes and look for differences
Down syndrome
 Trisomy 21
 Incidence 1 in 800-1,000
 Mild to severe mental disability
 Characteristic facial features
  incidence of heart disease
REASONS FOR MOLECULAR TESTING
 Duchenne muscular dystrophy, Cystic fibrosis, Huntingtons disease, Fragile X
mental retardation, Prader-willi/Angelman……
 Familial breast and breast/ovarian cancer, colon cancer……
SAMPLES
 Extract DNA & RNA from blood, bone marrow, saliva, amniotic fluid, CVS, skin,
tissue biopsies
METHODS
 Polymerase chain reaction (PCR)
 Sequencing
 Fragment analysis and dosage
 Microsatellite analysis
Cystic Fibrosis (CF)
 Most common genetically inherited autosomal recessive disease in Caucasian
populations
 Incidence of 1 in 2500 births; approximately 1 in 25 are carriers
 Multisystem disorder affecting the intestine, pancreas, respiratory tract,
reproductive tract and sweat glands
 Over 1800 different mutations in the CFTR gene have been found to cause CF
 We test for the 39 of the most common mutations covering about ~85% of
cases
mutation
no mutation
G542X/
F508del
Down syndrome
Chr 21
Chr 13
Chr18
QF-PCR microsatellite marker analysis
for common trisomies
Fluorescence in situ hybridisation
Embryology
Biochemical
Screening
Ultrasound
Scans
IVF/ICSI
Sickle cell and
Thal Screen
Pregnant
Patient
Amnio/CVS
QF-PCR
Free Fetal
DNA
Pre-implantation
Genetic Diagnosis
Blood group +
Rhesus
Screening
Karyotype
• Final 2 years composed of 6 modules:
– Research Methods and Statistics
– Disorders of sexual differentiation and infertility
– Genetics of learning disorders
– Population screening (prenatal)
– Genetics of neuromuscular disorders
– Cancer
…….and a research project – 60 credits
Infection Sciences:
− Infectious Disease in the Community
and Hospital Setting
− Antimicrobial Therapy
− High-Risk Groups
− Mycology and Parasitology
− Public Health Worldwide
Clinical Biochemistry:
− Clinical Disorders of the Major
Organs and Cancer
− Endocrinology and Diabetes
− Nutrition
− Drug Investigation
− Pregnancy, Neonatology and
Paediatric Clinical Biochemistry
Clinical Immunology:
− Immunology and Infection
− Immunodeficiency and
Immunotherapy
− Hypersensitivity and Allergy
− Haematological Malignancies and
Transplantation
− Autoimmunity
Vascular Science:
− Ultrasound Science, Haemodynamics
and Instrumentation
− Extracranial Arterial (Imaging)
− Peripheral Venous (Imaging)
− Peripheral Arterial (Screening and
Microvasculature Diagnostics)
University
Work base
Introductory Modules
Induction
E - learning
Rotational
Specialist teaching
Specialist
(elective)
Assessment programme
Continuous assessment
DOPs
CBDs
Competencies
OCEs
MSF
Examinations
Final examination
Awarding MSc
OSFA
Research
modules
Review and confirmation of all
Asssessments
MSc in Clinical Science
REGISTRATION
Interview
• National
• 8432
applications
• Numeric/logic
testing
• 4 weeks March - April
• Scientific and leadership
skills
• Allocation
• Local checks
• 886 interviewed
Short listing
5166 candidates
Genetics → 51 applicants interviewed for 17 national places
Appointment
287 posts
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Distance learning
Organise your own time
Highly variable and always busy
Conferences and courses
Attending clinics
Working for the NHS
Direct impact on patients, patient contact
Chance to experience different disciplines
and areas of healthcare
Research project (60 credits)
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Original piece of research
Application of knowledge and scientific investigation
Write up as dissertation
Registration via Health Professionals Council (HPC)
Standardised training approach - apply for jobs nationally
Eligible to apply for Higher Specialist Scientific Training (HSST)
NHS Careers Advice
www.nhscareers.nhs.uk
NHS Jobs
www.jobs.nhs.uk
National School of Healthcare Science
www.nshcs.org.uk
Academy for Healthcare Science
www.academyforhealthcarescience.co.uk
BWH Genetics Service
www.bwhct.nhs.uk/wmrgl