Speakers
Alexandra Yates
Karen Perkins
Rue Ball
Parallel session
This fascinating and thought provoking session, will focus on how aspects of laboratory medicine may in the past have added to healthcare inequalities, and how laboratory medicine can address these issues going forward.
The session will examine the impact our currently established reference ranges have on both transgender patients and minority ethnic groups of patients. Summarising the current situation, and presenting recent publications on the establishment of appropriate reference ranges.
By the end of this session, we hope that those that attend will foster a deeper understanding of the structural inequities within healthcare systems and how laboratory medicine can both highlight and contribute to the dispersion of these disparities.
Chair: Alexandra Yates
11.30 Laboratory social science: building diversity equity and inclusion into your laboratory - Karen Perkins
Diversity implies there is variation within a group. If variety is the spice of life, how can we flavour our daily work to better address the representation and intersectionality of human biodiversity? Let us explore diagnostic implications of issues such as race adjustment factors, reference interval applications and sex and gender differences in our local population.
Equity refers to the fair treatment of all people. Access is a component of equity. Let us explore how we, as clinical scientists can provide better access to our diagnostics by interrogating pre-analytical, analytical and post-analytical processes to reach the diverse members of our local community.
Inclusion involves the act of establishing policies, procedures and practices that ensure equitable access to our resources. Listening to patient voices about how, where and when they need access to our services builds a sense of belonging amongst our service users and purposefully cultivates engagement and innovation in the way we deliver laboratory medicine for the future.
We can focus effort in these three areas to remove health inequalities and make it become ‘business as usual’ not a separate issue, requiring special attention in our workspace.
12.00 Results from TransRIHTS: the trans & non-binary reference intervals while on hormone therapy study - Rue Ball
Laboratory test results are compared to reference intervals (RIs) to inform patients’ diagnosis and treatment. RIs for some tests may be affected by the hormone therapy taken by some transgender (trans) and non-binary people. However, to date there has been limited evidence establishing RIs in this population. Using an inappropriate RI increases the risk of delayed diagnosis or unnecessary further investigation. This compounds existing barriers to trans and non-binary peole accessing healthcare. To address this, the TransRIHTS study recruited a cross-sectional sample of 250 healthy trans and non-binary volunteers taking hormone therapy. Volunteers completed a questionnaire about their health and hormone therapy, and provided urine and blood samples. This is the largest study of RIs in healthy trans volunteers published to date. Separate RIs were calculated for people taking testosterone and oestradiol hormone therapy for 27 routine chemistry and immunoassay investigations. These include 13 tests with sex-based RIs: creatinine, liver enzymes, lipids, prolactin and ferritin. This talk will present the calculated RIs, compare them to cisgender RIs, and explore how they are affected by variation in hormone therapy. Recommendations will be made for how RIs should be reported for routine biochemistry tests in trans and non-binary service users.
12.30 Estimated GFR and ethnicity: Past, present and future directions - Rouvick Gama
Estimating the glomerular filtration rate (eGFR) is a vital component in diagnosing, classifying, and managing chronic kidney disease. The eGFR equations developed in the United States (US) originally included an ethnicity coefficient for individuals of Black ethnic backgrounds. However, it has been shown that this overestimates eGFR, which can negatively impact patient care through delayed diagnosis and improper medication management. In 2021, the National Institute for Health and Care Excellence (NICE) removed the ethnicity coefficient. Despite this, ethnic disparities in measuring kidney function persist. This talk will outline the original rationale for the ethnicity coefficient, the evidence supporting its removal, the performance of the currently recommended eGFR equation across different ethnic groups in the UK, and the emergence of newer equations, as well as their potential role in the future.
Alexandra, is a Consultant Clinical scientist in the Clinical biochemistry department at the Countess of Chester hospital, GB, where her interest include analytical interferences, renal medicine, and quality improvement. Other wider interest include equality and diversity within healthcare organizations, Alexandra is passionate in enacting meaningful change leading to equity for all and recognizing the benefits this bring to the healthcare and wider community.
Alexandra was appointed as Director of Scientific affairs for the Association for clinical biochemistry and Laboratory medicine in May 2019 after 5 years on the scientific committee, and a previous role as a national member on the ACB council.
As chair of the Scientific and clinical practice committee, she leads the committee in the vision that; the scientific committee and clinical practice committee should serve all LabMed members across pan-pathology disciplines, enabling and promoting translation research and innovation, and providing scientific and clinical expertise to our strategic partners, benefiting the wider health care community.
Pronouns: She/her
A diverse career to date, which includes post-doctoral research associate at National Heart and Lung Institute, London, team leader at Unilever R&D working on a project focused on what it takes to be a healthy octogenarian – living healthy for longer. I am currently Principal Clinical Scientist at Morecambe Bay Hospitals NHS Trust, since 2020. I have a special interest in capillary sampling and enabling access to blood tests for underserved populations.
Pronouns: She/her
Rue graduated as a Clinical Scientist in 2021. She has worked in routine biochemistry at Synnovis for three years, and during that time she has done audits, research and teaching to improve the care medical laboratories provide to trans & non-binary people. She is co-chief investigator of a forthcoming nationwide study about PSA reference intervals in trans women and non-binary people with a prostate.
Pronouns: She/they
Dr Rouvick Gama is a clinical research fellow and specialist renal registrar with an interest in clinical research. His field of research is assessing and addressing ethnic disparities in kidney disease, with an aim of improving chronic kidney disease (CKD) diagnosis and management and reducing health inequalities. He has previously published an observational study which highlighted the inaccuracy of using the ethnicity co-efficient for people of Black ethnicity in a UK population, contributing to the removal of ethnicity coefficients in the NICE 2021 CKD guidelines.
He is currently undertaking a PhD, funded by Kidney Research UK, which aim to explore the impact of kidney function assessment (eGFR) on people of all ages and from diverse backgrounds. In addition, his work includes using novel point-of-care technologies to improve early identification and management for people with CKD, through the development of new clinical pathways. His works aims to improve the accuracy of kidney function measurement and management of CKD whilst reducing ethnicity-related and health inequalities, thereby addressing a growing public health concern.
Pronouns: He/him