The research interests of the Clinical Biochemistry Unit encompass a number of themes and there is extensive collaboration with other clinical and academic disciplines in TCD and its associated teaching hospitals when carrying out this research:
Paediatric Reference Ranges – the “Celtic Ranges Project”
Laboratory investigations in sick children now include panels of 20 or more biochemistry and haematology tests. Modern analysis is very fast and accurate, using very small samples.
This project addresses a substantial area of difficulty because, unlike in adults, being able to tell what is normal and whether the test results represent pathological findings is not always clear-cut in children due to a lack of robust reference intervals to compare the result with.
The CELTIC Ranges Project will not only improve diagnostic accuracy by providing a comprehensive and harmonized set of locally-determined reference intervals for commonly ordered tests but will also reduce diagnostic risks and serve as an invaluable resource for Irish paediatric laboratory medicine.
Biochemical aspects of diabetes, endocrinology and atherosclerosis
Staff in the Clinical Biochemistry unit are interested in the study of lipids and lipoproteins including subclasses in the postprandial state and their role in the pathogenesis of atherosclerosis in diabetes. This work has led to several publications and is carried out in collaboration with the Departments of Endocrinology and Cardiology.
- Lipid markers in diabetic dyslipidaemia (Dr Ann Leonard, PhD). This project assessed the contribution that lipid markers including apo B48 and apolipoprotein E genotypes make to fasting and postprandial lipaemia in diabetic patients before and after restoration of euglycaemia. In collaboration with Dr G Boran and Dr J Gibney.
- EU Collaborative study of insulin resistance (EGIR-RISC study) with Prof J Nolan (Steno Diabetes Centre, Denmark).
- Vhi studies, 2009-2014. We collaborated with the Vhi in the largest study in Ireland into the prevalence of diabetes mellitus. .
We are currently providing a range of cytokine microarray, ELISA-based assays, and lipid biomarkers including LDL and HDL subclasses as a service both for our own collaborateive research projects and for other clinicians with an interest in this area.
- Current work in progress includes a prospective study of cardiovascular health in volunteers in collaboration with Dr Vincent Maher (consultant cardiologist).
Osteoporosis and Metabolic Bone Disease
An integrated programme of clinical and laboratory research in this area is currently a focus, including rare metabolic bone disorders such as hypophosphatasia.
Point of Care Testing
We are interested in the use of advanced highly connected glucometry systems and have also published a number of recent papers on the state of point of care testing nationally
Thyrometabolic disorders including subclinical hypothyroidism
The clinical biochemistry Unit has a longstanding interest in thyrometabolic disorders including studies of subclinical hypothyroidism and an interest in discordant thyroid function test results which has led to publications including a letter to Nature Genetics.
- Ongoing clinical and laboratory studies in subclinical hypothyroidism (MD project), in collaboration with the Departments of Endocrinology, Radiology, and Neurophysiology.
- Publication of national thyroid function testing guidelines for primary care in May 2016.
Biochemical and molecular Genetics of the porphyrias, dyslipidaemias and other metabolic disorders
Biochemical Investigation and clinical management of porphyrias at the National Porphyria Centre at St. James’s Hospital Clinical Biochemistry Department is under the direction of Dr. Vivion Crowley, Consultant Chemical Pathologist and Head of Department, St. James’s Hospital, Dublin.
In addition, specific mutation scanning methods for a range of other metabolic disorders including monogeneic hypercholesterolaemias, haemochromatosis and specific inherited endocrine disorders have been developed in the Molecular Diagnostics Laboratory, St. James’s Hospital, which continues to undertake research and development in this area of laboratory medicine.
Clinical and laboratory informatics
Staff in the clinical Biochemistry unit have developed a major interest over the years in clinical and laboratory informatics and are actively involved in a number of important international research projects.
- Participant, EU projects (EUDIP, EUCID, EUBIROD), 2001-2013. Dr. Boran and colleagues have participated in a series of 3 EU large projects which have been addressing large scale diabetes databases and registries across Europe.
- Informatics Support for Patient-centred Integrated/Shared-Care for Diabetes, 2000-2004. Dr. Boran was Joint Co-chairman (previously with Prof R O’Moore, later with Prof J Nolan) of the Steering Board of this collaborative project between Tallaght and St James’s Hospitals, TCD Department of Computer Science (Prof Jane Grimson) and DIT (Bill Grimson). This project was funded by the Information Society Commission and the Health Boards Executive E-Government Group.
- A repository to support shared care for diabetes, 2004-2006. The Health Research Board awarded funding under its Information Infrastructure call in December 2004. Dr Gerard Boran (Principal Investigator), Dr James Gibney (co-applicant), Prof John Nolan (co-applicant) subsequently developed one of the few integrated diabetes databases in routine clinical use for clinical outpatient management functions as well as for collection of diabetes health indicators.
Trace element biochemistry
The Clinical Biochemistry Department at Tallaght Hospital is equipped with an atomic spectroscopy system and provides a trace element clinical and analytical service to the local population and external hospitals. Over the years, the department has collaborated in a number of studies including possible toxic renal effects due to uranium exposure in drinking water. An ICP-MS system will be commissioned in 2017.
The National Clinical Programme in Pathology and the HSE’s Laboratory
The HSE’s Clinical Strategy and Programmes Directorate established a National Clinical Programme in Pathology with the initial objectives of implementing a National Pathology Network and a Programme for Laboratory Modernisation. Dr. Boran served as national clinical lead of the National Clinical Programme in Pathology from April 2011 to August 2016.
The Programme places clinical requirements and patient safety as top priorities as well as value for money and cost savings. As part of this programme, we developed with stakeholders a set of guiding principles known as the Ten Principles of Laboratory Medicine Modernisation: these summarise the main requirements for service improvement, including patient confidence, user satisfaction, quality, safety, and value for money. The Objectives for the Clinical Programme are:
- To assist the HSE to implement a national pathology network and modernisation programme based on a whole-system approach with cooperative hubs and spokes organised according to clinical need
- To coordinate the pathology modernisation activities of individual laboratories using the 10 principles as the framework and to ensure this is integrated with government plans for future organisation of clinical services
- To rationalise referral patterns for specialist tests by assisting the HSE to develop a national network of specialised laboratory services, and to ensure that in-sourcing and out-sourcing of tests is appropriate
- To develop a National Laboratory Handbook so as to assist in demand management, together with Guidelines and Order Sets for common clinical diagnostic problems which lead to large scale laboratory investigations
Volume 1 of the National Laboratory Handbook was published in May 2016:
The National Point of Care Testing Consultative Group
Dr. Boran is currently chair of National Point of Care Testing Consultative Group (based at RCPI). This group has produced the Irish National Guidelines for safe an effective management and use of point of care testing for the hospital environment (the Green Book) and for community and primary care users (the Blue Book). The Guidelines may be downloaded by clicking on the cover pages below:
The Irish External Quality Assurance Scheme
The Clinical Biochemistry Unit has several representatives on the Steering Committee and Working Groups of the ISO-9001 certified Irish National External Quality Assurance Scheme. Further details can be obtained at www.ieqas.ie