Endodiabology June 2010 issue 2
ENDODIABOLOGY
Endodiabology.blogspot.com
NORTHEAST
NEWSLETTER
FOR SPRs AND BOSSES TRAPPED
IN THE NORTHERN DEANERY
JUNE 2010
Editors: Shaz Wahid (shahid.wahid@sthct.nhs.uk) and
Petros Perros (petros.perros@ncl.ac.uk) and Arut Vijayaraman (riarut@aol.com )
Associate Editors: Shafie Kamarrudin, Ravi Erukulapati
SpR PLACEMENTS (NTN year of training from 1st October 2008)
• Newcastle- Ravi Erukalapati(5), Sudeep Manohar (3), Nimanth De Alwis (1), Arif Ullah (3), Srikanth Mada(3) Naveen Siddaramaiha (2), Sarah Steven (2)
• North Tyneside/Wansbeck- Anjali Santhakumar (3), Vacant
• South Tyneside- Rohanna Wright (2),
• Gateshead- Preeti Rao (3)
• Sunderland- Naveen Aggarwal (1), Chandima Idampitiya (5)
• North Tees/Hartlepool- Shafie Kamarrudin (4), Hamza Ali Khan (1)
• Middlesbrough- Freda Razvi (5), Atif Munir (1), Sajid Ethol Kalathil (1), Catherine Napier (1)
• Bishop Auckland Vacant
• Durham- Jeevan Mettayil (4)
• NGH/QEH- Vacant
• Research with numbers (supervisor)- Eelin Lim(5-Prof Taylor); Stuart Little (2-Dr Shaw) & Asgar Madathil (4-Dr Weaver)
MEETINGS / LECTURES / ANNOUNCEMENTS
• 8th June 2010 Northern Endocrine & Diabetes Spring CME, Freeman Hospital. Contact mshafie_kamaruddin@yahoo.co.uk
• 8 June 2010 Association for study of obesity (ASO) conference: Cardiff: Contact: Catherine.stone@aso.org.uk
• 19th – 22nd June 2010 ENDO 2010, San Diego, USA. Contact endostaff@endo-societ.org or www.endo-society.org/scimeetings .
• 25th – 29th June 2010 American Diabetes Association 70th Annual Scientific Sessions, Orlando, Florida, USA. Contact meetings@diabetes.org .
• 7 July 2010 SpR management training session : Managing service change: Management team from SothTyneside: Lumley castle 6- 8 pm. Contact: anjalisan@yahoo.com & jmjeevan@yahoo.com
• 10- 15 July International Congress of Neuroendocrinology: Rouen, France: Contact hubert.vaudry@univ-rouen.fr
• 14th July 2010 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247 Lorraine.waugh@tfh.nuth.northy.nhs.uk.
• 14- 17 July Mayo clinic Endocrine course: Rochester, Minnesota, USA Contact: hinchley.rebecca@mayo.edu
• 6 September 2010: UKI NETS (UK Ireland Neuroendocrine Tumour Society) conference Belfast: Contact joy.ardill@qub.ac.uk
• 11- 16 September 2010: International Thyroid Congress: Paris, France Website: www.itc2010.com
• 15th September 2010 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247 Lorraine.waugh@tfh.nuth.northy.nhs.uk.
• 20th – 24th September 2010 46th EASD Annual meeting, Stockholm, Sweden. Contact www.easd.org
• 7 October 2010 British Thyroid Association annual meeting: Royal college of pathologists; London: Contact s.h.s.pearce@ncl.ac.uk
• 18 October 2010 National training scheme for the use of radioiodine in benign thyroid disease : Birmingham, UK ; Contact helen.flood@uhb.nhs.uk
• 26- 30 October 2010 : American Thyroid Association meeting : Palmsprings, USA : Website: www.thyroid.org
• 8th-10th November 2010 Society for Endocrinology Clinical Update, venue TBC. Contact www.endocrinology.org
• 9th November 2010 RCP Updates in Medicine, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247 Lorraine.waugh@tfh.nuth.northy.nhs.uk.
• 17th November 2010 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247 Lorraine.waugh@tfh.nuth.northy.nhs.uk.
• 18th-19th November 2010 ABCD autumn meeting, London. Contact www.diabetologists.org.uk followed by SpRs meeting 19th-21st November 2010.
• 24th November 2010 Northern Endocrine Region Research and Audit Group annual meeting, Lumley Castle, Durham 2pm-8pm. Contact shahid.wahid@sthct.nhs.uk
TRAINING ISSUES
DIABETES & ENDOCRINOLOGY PIMD WEBSITE Our specialty website is available on http://mypimd.ncl.ac.uk/PIMDDev . Click onto the specialty training tab then follow to Diabetes & Endocrinology. This site is essential reading, especially for ARCP preparation.
SPR management training session: “Managing Service Change”-Management Team from South Tyneside. Lumley Castle 6-8pm 7th July 2010. Contact anjalisan@yahoo.com & jmjeevan@yahoo.com
for more information.
Registering with PMETB It is essential that all new SpRs/StRs (even LATs) register with the PMETB through the newly created Joint Royal Colleges of Physicians Training Board (formally the JCHMT) on www.jrcptb.org.uk. Not doing so means your training is not counted.
Log Book/Portfolio Documentation It is a trainee’s responsibility to make sure their portfolio/log book is prospectively completed and the necessary signatures obtained. Any experience that is not signed off by your educational supervisor at the time cannot be counted towards training. The e-portfolio for DM&ENDO is available now for StRs.
Assessment tools Please see www.jrcptb.org.uk; it is the trainee’s responsibility to give all the appropriate forms to their Educational or Clinical Supervisor. It is the trainee’s responsibility to make sure that the appropriate assessment summaries are available in their portfolio for ARCP purposes, e.g. MSF Summary Form.
Documenting CCU and ITU experience It is essential that trainees document their CCU and ITU experience. This is best done by keeping a summary log of the cases seen on CCU and ITU and linking it with reflection or assessment. This should then be signed off by your Educational Supervisor to be of any use at the Acute Medicine PYAs.
Audit Assessment tool This is now available in draft form on the JRCPTB website. Its use is highly recommended.
General Internal Medicine Curriculum is now updated and available on www.jrcptb.org.uk. All trainees appointed ST3 from August 2009 will be offered entry to train for this CCT. Trainees before this date can easily apply to train in this CCT (i.e. dual accredit), again detailed in the website. The transference process to the G(I)M curriculum has gone smoothly for our specialty.
MRCP Diabetes & Endocrinology This exam has to be completed and passed by all trainees appointed after August 2007 before their PYA. We recommend sitting it ASAP and well before your PYA.
INFORMATION for QA Could each individual trainer send the following to Simon Pearce: educational qualifications, any training positions held and any educational courses attended.
MORE INFORMATION for QA Could each unit’s Training Lead please send to Simon Pearce a completed training unit information report and an updated SpR/StR job description as per Nicky Leech’s e-mail.
Trainers & Trainees meeting The next T&T is on 24th June 2010. Details to be confirmed nearer the time, but please note in your diary.
Another Trainee Rep on STC With Jeevan’s Consultant appointment a vacancy will exist from July 2010. Could interested SpRs please contact Nicky Leech.
More Associate Editors for ENDODIABOLOGY I am sure you will agree that since its inception in October 2002 ENDODIABOLOGY has been a great success. With the current associate editors moving onto pastures new soon could interested SpRs please contact Shaz Wahid.
TRAINERS EVENT 13th October 2010 This morning session is specifically for the faculty of trainers in Diabetes&Endocrinology in the Region. It promises to be an interesting morning with sessions on NHS Education England, Trainees in difficulty and on the job work based assessments. Details to follow from Simon Pearce.
Training Committee Chair- Simon Pearce, s.h.s.pearce@ncl.ac.uk; Regional Speciality Advisor- Shaz Wahid, shahid.wahid@sthct.nhs.uk; Programme Director- Nicky Leech nicola.leech@nuth.northy.nhs.uk; Consultant member (SAC rep)- Richard Quinton, Richard.Quinton@nuth.nhs.uk; Consultant member-Jean MacLeod, Jean.Macleod@nth.nhs.uk; Consultant member-Arutchelvam Vijayaraman Vijayaraman.Arutchelvam@stees.nhs.uk ; Consultant member-Simon Eaton, simon.eaton@northumbria-healthcare.nhs.uk; SpR representative- Anjali Santhakumar anjalisan@yahoo.com ; SpR representative- Jeevan Mettayil jmjeevan@yahoo.com
NEWS FROM THE NORTHEAST
• Congratulations to Jeevan Mettayil and Khaled Dukhan on their new appointments as Consultants at South Tyneside.
• Congratulations to Kathryn Stewart on the birth of her baby Daughter.
• Preethi Rao will be undertaking an interdeanery transfer to Sheffield where her husband has a post. We will miss her!
• Congratulations to Ravi Erukalapati on his Acute Physician Consultant post at Sunderland.
• Welcome to Dr Rajarshi Mukhopadyay who joined County Durham & Darlington NHSFT formally from April 2010 as consultant in Diabetes and endocrinology. Raj obtained his CCST from West Midlands. In addition he obtained his MD in General Medicine and a DM in endocrinology from Calcutta, India. His base hospital is Darlington.
• ABCDs visit to the North East on 6th May was a success. A good day with plenty of networking. Hopefully, they will be in town in the future.
•
LETTERS
The Dreaded portfolio review station-Shaz Wahid
It was good to meet colleagues and interview a good field at the recent StR interviews. We have offered numbers to excellent candidates of whom all are from the region. The only downer when I began the day was being allocated the portfolio review station. I have avoided this station for 3-yrs, perceiving it to be boring. The only positive was being paired with Jean MacLeod, allowing a good natter and catch up. Although, Jean did warn Nicky that Shaz and I on the same station will really make time management of the station a real challenge due to our gifts of being able to talk the hind leg of a horse! Imagine my surprise when I found the station to be really good and thinking to myself what have I been missing. It is just like an old style interview. You really do get a chance to get under the psyche of candidates and challenge them. What was even more surprising was that our time management of the station was meticulous, probably something to do with the stop whatch and Jean using a gag when I meandered too much. To conclude, I would recommend the portfolio review station as the best station to undertake.
British Thyroid Association Annual meeting-Simon Pearce
The BTA annual meeting has a new date and venue. October 7th 2010, at Royal College of Pathologists, London. There is a focus on thyroid nodules in the morning and thyroid disease in pregnancy during the afternoon with overseas speakers including Susan Mandel (Philadelphia), Victor Pop (NL) and Domenico Salvatore (Naples). Promises to be an excellent one day meeting, I think £50 for SpRs & nurses, £70 for consultants.
Book Review-“Gods of Management” by Shaz Wahid
I would highly recommend this book by Charles Handy, published by Arrow in paperback edition, for its fun value and not only its more serious message. There are four Gods. Zeus is the leader, represented by a spider’s web. He is feared, respected and occasionally loved. Such leaders are powerful, charismatic, impulsive and benevolent all at the same time. We all need Zeus leaders, but an organisation where the Zeus leader predominates can only lead to a club culture often described as an “old-boys” culture. It runs entirely on Trust.
Apollo is the God of order and rules. Apollonian management brings control to an organisation by breaking down work into separate, specific job description. The symbol of Apollo is a temple. The top is linked by management, e.g. the head of each department, with the pillars representing functions and roles in the organisation. All of this is controlled by rules and regulations. An organisation where Apollo predominates can be described as role orientated. Apollonian leaders can be described as administrators.
Athena is the arch problem solver of craftsmen and sea captains. Her symbol is a net, where power lies at the interconnecting nodes not at the centre as in Zeus or at the top as in Apollo. The Athenian leader deals in solutions. An organisation where Athena predominates is described as task orientated.
Dionysus is the God of individualism. In the Dionysian organisation the organisation is the servant of the individual. The symbol of Dionysus is a cluster of stars surrounded by a circle. Drs and solicitors are the archetypal individuals that exist in a Dionysian organisation. The culture is all about the person.
However, many of you can see where there can be clashes between Dionysian individuals (Drs) and Apollonian organisations (The management). We live in hard times that will only become more challenging. Many have asked why Management Shaz? It could be any of “I am easily bored” “I am good at service change” amongst plenty of valid reasons. But, ultimately it is my desire to act as bridge in my organisation to help the 4 cultures of “club”, “role”, task” and “person” each with their own God to work together for the benefit of our patients. I wish to develop a kinder Apollonian organisation with the symbol of a village. In a softer Apollonian organisation we realise that not every task is professional, there are still mundane repetitive tasks that need covered. Employs that do these tasks are human and although under more management control than the professionals they are still treated as individuals. Even the most Apollonian task should have a Dionysian tinge. The village is the best symbol as it represents a small personal place where everyone has a name, character and personality. I sincerely hope you read this book.
RECENT PUBLICATIONS FROM THE NORTHEAST
1. Gan EH, Quinton R. Physiological significance of the rhythmic secretion of hypothalamic and pituitary hormones. Progress in Brain Research. 2010; 181: 111-125.
2. Maccoll GS, Quinton R, Bülow HE. Biology of KAL1 and its orthologs: implications for X-Linked Kallmann syndrome and the search for novel candidate genes. Front Horm Res. 2010; 39:62-77.
3.Gianetti E, Tusset C, Noel SD, Au MG, Dwyer AA, Hughes VA, Abreu AP, Carroll J, Trarbach E, Silveira LF, Costa EM, de Mendonça BB, de Castro M, Lofrano A, Hall JE, Bolu E, Ozata M, Quinton R, Amory JK, Stewart SE, Arlt W, Cole TR, Crowley WF, Kaiser UB, Latronico AC, Seminara SB. TAC3/TACR3 Mutations Reveal Preferential Activation of Gonadotropin-Releasing Hormone Release by Neurokinin B in Neonatal Life Followed by Reversal in Adulthood. J Clin Endocrinol Metab. 2010 Mar 23. [Epub ahead of print]
4. Wright RJ, Kanagasundaram NS, Quinton R. Darbepoetin alfa and chronic kidney disease. N Engl J Med. 2010; 362: 653.
5. Razvi S, Weaver JU, Vanderpump MP, Pearce SH. The incidence of ischemic heart disease and mortality in people with subclinical hypothyroidism: reanalysis of the Whickham Survey cohort. J Clin Endocrinol Metab. 2010 Apr;95(4):1734-40.
6. Razvi S, Weaver JU, Pearce SH. Subclinical thyroid disorders: significance and clinical impact. J Clin Pathol. 2010 May;63(5):379-86.
7. Dias RP, Chan LF, Metherell LA, Pearce SHS, Clark AJL. Isolated Addison’s Disease is unlikely to be caused by mutations in MC2R, MRAP or StAR, three genes responsible for familial glucocorticoid deficiency. Eur J Endocrinol 2010; 162:357-9.
8. Turner JJ, Christie PT, Pearce SH, Turnpenny PD, Thakker RV. Diagnostic challenges due to phenocopies: lessons from Multiple Endocrine Neoplasia type1 (MEN1). Hum Mutat 2010; 31:E1089-101.
9. Pearce SH, Cheetham TD. Diagnosis and management of vitamin D deficiency. BMJ 2010; 340: 142-147.
10. Boelaert K, Newby PR, Simmonds MJ, Holder RL, Carr-Smith JD, Heward JM, Manji N, Allahabadia A, Armitage M, Chatterjee KV, Lazarus JH, Pearce SH, Vaidya B, Gough SC, Franklyn JA. Prevalence and relative risk of other autoimmune diseases in subjects with autoimmune thyroid disease. Am J Med 2010; 123:183.e1-9.
11. Newby PR, Pickles OJ, Mazumdar S, Brand OJ, Carr-Smith JD, Pearce SH, Franklyn JA, WTCCC, Evans DM, Simmonds MJ, Gough SCL. Follow up of potential novel Graves’ disease susceptibility loci, identified in the UK WTCCC genome-wide non-synonymous SNP study. Eur J Hum Genet 2010; in press
12. Frontiers in Hormone Research, Vol 39. Kallmann Syndrome & Hypogonadotropic Hypogonadism. Editor: R Quinton, Karger AG, Zurich
ISBN 978-8055-8617-7.
RECENT PUBLICATIONS IN DIABETES & ENDOCRINOLOGY THAT HIT THE NEWS OR THAT MAY HAVE A SIGNIFICANT IMPACT ON MANAGEMENT
Loss of vision? Clear as crystal! Ranjeet J Pandit et al. Lancet 2010;375:610.An excellent case report of an unusual presentation of primary hyperparathyroidism.
Familial adenomatous polyposis and hypertension. Hopkins TG et al. Lancet 2010;375:1752. The association of FAP with Primary Hyperaldosteronism represented in a case report.
Investigating suspected bone infection in the diabetic foot. James Teh et al. BMJ 2010;340:415-421. A useful summary.
Porphyrias. Puy H et al. Lancet 2010;375:924-937. An excellent review article.
Effects of intensive blood-pressure control in type 2 diabetes mellitus. ACCORD Study Group N Engl J Med. 2010;362(17):1575-85. The authors investigated whether therapy targeting normal systolic blood pressure (i.e., <120 mm Hg) reduces major cardiovascular events in patients with type 2 DM at high risk for cardiovascular events by randomizing 4733 participants with type 2 DM to intensive therapy, targeting SBP < 120 mm Hg, or standard therapy, targeting SBP < 140 mm Hg. The primary composite outcome was nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes. The mean follow-up was 4.7 years. After 1 year, the mean SBP was 119.3 mm Hg in the intensive-therapy group and 133.5 mm Hg in the standard-therapy group. The annual rate of the primary outcome was 1.87% in the intensive-therapy group and 2.09% in the standard-therapy group with a hazard ratio with intensive therapy of 0.88; 95% confidence interval [CI], 0.73-1.06; p=0.20. The annual rates of death from any cause were 1.28% and 1.19% in the two groups, respectively (HR, 1.07;0.85-1.35; p=0.55). The annual rates of stroke, a prespecified secondary outcome, were 0.32% and 0.53% in the two groups, respectively (HR,0.59; 95% 0.39-0.89; p=0.01). Serious adverse events attributed to antihypertensive treatment occurred in 3.3% of people in the intensive-therapy group and 1.3% people in the standard-therapy group (p<0.001). This trial suggests In patients with type 2 DM at high risk for cardiovascular events, targeting a systolic blood pressure of less than 120 mm Hg, as compared with less than 140 mm Hg, did not reduce the rate of a composite outcome of fatal and nonfatal major cardiovascular events. The same group have also shown the ineffect of combination lipid therapy in type 2 DM, i.e. combining fibrate with statin therapy. This trial has certainly thrown the cat among the pigeons. Does it change my practice. Not really, I have always bucked the trend recently in that: I have stopped being a fan of combination lipid therapy and accept TRIGS < 5mmol/l; I target a BP < 140/80 mmHg in patients only aiming for a SBP < 130 mmHg in patient with renal disease. The accompanying editorial by Peter Nilsson is a balanced read.
NEXT NEWSLETTER Due out beginning of October 2010 so keep the gossip coming.
Endodiabology.blogspot.com
NORTHEAST
NEWSLETTER
FOR SPRs AND BOSSES TRAPPED
IN THE NORTHERN DEANERY
JUNE 2010
Editors: Shaz Wahid (shahid.wahid@sthct.nhs.uk) and
Petros Perros (petros.perros@ncl.ac.uk) and Arut Vijayaraman (riarut@aol.com )
Associate Editors: Shafie Kamarrudin, Ravi Erukulapati
SpR PLACEMENTS (NTN year of training from 1st October 2008)
• Newcastle- Ravi Erukalapati(5), Sudeep Manohar (3), Nimanth De Alwis (1), Arif Ullah (3), Srikanth Mada(3) Naveen Siddaramaiha (2), Sarah Steven (2)
• North Tyneside/Wansbeck- Anjali Santhakumar (3), Vacant
• South Tyneside- Rohanna Wright (2),
• Gateshead- Preeti Rao (3)
• Sunderland- Naveen Aggarwal (1), Chandima Idampitiya (5)
• North Tees/Hartlepool- Shafie Kamarrudin (4), Hamza Ali Khan (1)
• Middlesbrough- Freda Razvi (5), Atif Munir (1), Sajid Ethol Kalathil (1), Catherine Napier (1)
• Bishop Auckland Vacant
• Durham- Jeevan Mettayil (4)
• NGH/QEH- Vacant
• Research with numbers (supervisor)- Eelin Lim(5-Prof Taylor); Stuart Little (2-Dr Shaw) & Asgar Madathil (4-Dr Weaver)
MEETINGS / LECTURES / ANNOUNCEMENTS
• 8th June 2010 Northern Endocrine & Diabetes Spring CME, Freeman Hospital. Contact mshafie_kamaruddin@yahoo.co.uk
• 8 June 2010 Association for study of obesity (ASO) conference: Cardiff: Contact: Catherine.stone@aso.org.uk
• 19th – 22nd June 2010 ENDO 2010, San Diego, USA. Contact endostaff@endo-societ.org or www.endo-society.org/scimeetings .
• 25th – 29th June 2010 American Diabetes Association 70th Annual Scientific Sessions, Orlando, Florida, USA. Contact meetings@diabetes.org .
• 7 July 2010 SpR management training session : Managing service change: Management team from SothTyneside: Lumley castle 6- 8 pm. Contact: anjalisan@yahoo.com & jmjeevan@yahoo.com
• 10- 15 July International Congress of Neuroendocrinology: Rouen, France: Contact hubert.vaudry@univ-rouen.fr
• 14th July 2010 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247 Lorraine.waugh@tfh.nuth.northy.nhs.uk.
• 14- 17 July Mayo clinic Endocrine course: Rochester, Minnesota, USA Contact: hinchley.rebecca@mayo.edu
• 6 September 2010: UKI NETS (UK Ireland Neuroendocrine Tumour Society) conference Belfast: Contact joy.ardill@qub.ac.uk
• 11- 16 September 2010: International Thyroid Congress: Paris, France Website: www.itc2010.com
• 15th September 2010 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247 Lorraine.waugh@tfh.nuth.northy.nhs.uk.
• 20th – 24th September 2010 46th EASD Annual meeting, Stockholm, Sweden. Contact www.easd.org
• 7 October 2010 British Thyroid Association annual meeting: Royal college of pathologists; London: Contact s.h.s.pearce@ncl.ac.uk
• 18 October 2010 National training scheme for the use of radioiodine in benign thyroid disease : Birmingham, UK ; Contact helen.flood@uhb.nhs.uk
• 26- 30 October 2010 : American Thyroid Association meeting : Palmsprings, USA : Website: www.thyroid.org
• 8th-10th November 2010 Society for Endocrinology Clinical Update, venue TBC. Contact www.endocrinology.org
• 9th November 2010 RCP Updates in Medicine, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247 Lorraine.waugh@tfh.nuth.northy.nhs.uk.
• 17th November 2010 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247 Lorraine.waugh@tfh.nuth.northy.nhs.uk.
• 18th-19th November 2010 ABCD autumn meeting, London. Contact www.diabetologists.org.uk followed by SpRs meeting 19th-21st November 2010.
• 24th November 2010 Northern Endocrine Region Research and Audit Group annual meeting, Lumley Castle, Durham 2pm-8pm. Contact shahid.wahid@sthct.nhs.uk
TRAINING ISSUES
DIABETES & ENDOCRINOLOGY PIMD WEBSITE Our specialty website is available on http://mypimd.ncl.ac.uk/PIMDDev . Click onto the specialty training tab then follow to Diabetes & Endocrinology. This site is essential reading, especially for ARCP preparation.
SPR management training session: “Managing Service Change”-Management Team from South Tyneside. Lumley Castle 6-8pm 7th July 2010. Contact anjalisan@yahoo.com & jmjeevan@yahoo.com
for more information.
Registering with PMETB It is essential that all new SpRs/StRs (even LATs) register with the PMETB through the newly created Joint Royal Colleges of Physicians Training Board (formally the JCHMT) on www.jrcptb.org.uk. Not doing so means your training is not counted.
Log Book/Portfolio Documentation It is a trainee’s responsibility to make sure their portfolio/log book is prospectively completed and the necessary signatures obtained. Any experience that is not signed off by your educational supervisor at the time cannot be counted towards training. The e-portfolio for DM&ENDO is available now for StRs.
Assessment tools Please see www.jrcptb.org.uk; it is the trainee’s responsibility to give all the appropriate forms to their Educational or Clinical Supervisor. It is the trainee’s responsibility to make sure that the appropriate assessment summaries are available in their portfolio for ARCP purposes, e.g. MSF Summary Form.
Documenting CCU and ITU experience It is essential that trainees document their CCU and ITU experience. This is best done by keeping a summary log of the cases seen on CCU and ITU and linking it with reflection or assessment. This should then be signed off by your Educational Supervisor to be of any use at the Acute Medicine PYAs.
Audit Assessment tool This is now available in draft form on the JRCPTB website. Its use is highly recommended.
General Internal Medicine Curriculum is now updated and available on www.jrcptb.org.uk. All trainees appointed ST3 from August 2009 will be offered entry to train for this CCT. Trainees before this date can easily apply to train in this CCT (i.e. dual accredit), again detailed in the website. The transference process to the G(I)M curriculum has gone smoothly for our specialty.
MRCP Diabetes & Endocrinology This exam has to be completed and passed by all trainees appointed after August 2007 before their PYA. We recommend sitting it ASAP and well before your PYA.
INFORMATION for QA Could each individual trainer send the following to Simon Pearce: educational qualifications, any training positions held and any educational courses attended.
MORE INFORMATION for QA Could each unit’s Training Lead please send to Simon Pearce a completed training unit information report and an updated SpR/StR job description as per Nicky Leech’s e-mail.
Trainers & Trainees meeting The next T&T is on 24th June 2010. Details to be confirmed nearer the time, but please note in your diary.
Another Trainee Rep on STC With Jeevan’s Consultant appointment a vacancy will exist from July 2010. Could interested SpRs please contact Nicky Leech.
More Associate Editors for ENDODIABOLOGY I am sure you will agree that since its inception in October 2002 ENDODIABOLOGY has been a great success. With the current associate editors moving onto pastures new soon could interested SpRs please contact Shaz Wahid.
TRAINERS EVENT 13th October 2010 This morning session is specifically for the faculty of trainers in Diabetes&Endocrinology in the Region. It promises to be an interesting morning with sessions on NHS Education England, Trainees in difficulty and on the job work based assessments. Details to follow from Simon Pearce.
Training Committee Chair- Simon Pearce, s.h.s.pearce@ncl.ac.uk; Regional Speciality Advisor- Shaz Wahid, shahid.wahid@sthct.nhs.uk; Programme Director- Nicky Leech nicola.leech@nuth.northy.nhs.uk; Consultant member (SAC rep)- Richard Quinton, Richard.Quinton@nuth.nhs.uk; Consultant member-Jean MacLeod, Jean.Macleod@nth.nhs.uk; Consultant member-Arutchelvam Vijayaraman Vijayaraman.Arutchelvam@stees.nhs.uk ; Consultant member-Simon Eaton, simon.eaton@northumbria-healthcare.nhs.uk; SpR representative- Anjali Santhakumar anjalisan@yahoo.com ; SpR representative- Jeevan Mettayil jmjeevan@yahoo.com
NEWS FROM THE NORTHEAST
• Congratulations to Jeevan Mettayil and Khaled Dukhan on their new appointments as Consultants at South Tyneside.
• Congratulations to Kathryn Stewart on the birth of her baby Daughter.
• Preethi Rao will be undertaking an interdeanery transfer to Sheffield where her husband has a post. We will miss her!
• Congratulations to Ravi Erukalapati on his Acute Physician Consultant post at Sunderland.
• Welcome to Dr Rajarshi Mukhopadyay who joined County Durham & Darlington NHSFT formally from April 2010 as consultant in Diabetes and endocrinology. Raj obtained his CCST from West Midlands. In addition he obtained his MD in General Medicine and a DM in endocrinology from Calcutta, India. His base hospital is Darlington.
• ABCDs visit to the North East on 6th May was a success. A good day with plenty of networking. Hopefully, they will be in town in the future.
•
LETTERS
The Dreaded portfolio review station-Shaz Wahid
It was good to meet colleagues and interview a good field at the recent StR interviews. We have offered numbers to excellent candidates of whom all are from the region. The only downer when I began the day was being allocated the portfolio review station. I have avoided this station for 3-yrs, perceiving it to be boring. The only positive was being paired with Jean MacLeod, allowing a good natter and catch up. Although, Jean did warn Nicky that Shaz and I on the same station will really make time management of the station a real challenge due to our gifts of being able to talk the hind leg of a horse! Imagine my surprise when I found the station to be really good and thinking to myself what have I been missing. It is just like an old style interview. You really do get a chance to get under the psyche of candidates and challenge them. What was even more surprising was that our time management of the station was meticulous, probably something to do with the stop whatch and Jean using a gag when I meandered too much. To conclude, I would recommend the portfolio review station as the best station to undertake.
British Thyroid Association Annual meeting-Simon Pearce
The BTA annual meeting has a new date and venue. October 7th 2010, at Royal College of Pathologists, London. There is a focus on thyroid nodules in the morning and thyroid disease in pregnancy during the afternoon with overseas speakers including Susan Mandel (Philadelphia), Victor Pop (NL) and Domenico Salvatore (Naples). Promises to be an excellent one day meeting, I think £50 for SpRs & nurses, £70 for consultants.
Book Review-“Gods of Management” by Shaz Wahid
I would highly recommend this book by Charles Handy, published by Arrow in paperback edition, for its fun value and not only its more serious message. There are four Gods. Zeus is the leader, represented by a spider’s web. He is feared, respected and occasionally loved. Such leaders are powerful, charismatic, impulsive and benevolent all at the same time. We all need Zeus leaders, but an organisation where the Zeus leader predominates can only lead to a club culture often described as an “old-boys” culture. It runs entirely on Trust.
Apollo is the God of order and rules. Apollonian management brings control to an organisation by breaking down work into separate, specific job description. The symbol of Apollo is a temple. The top is linked by management, e.g. the head of each department, with the pillars representing functions and roles in the organisation. All of this is controlled by rules and regulations. An organisation where Apollo predominates can be described as role orientated. Apollonian leaders can be described as administrators.
Athena is the arch problem solver of craftsmen and sea captains. Her symbol is a net, where power lies at the interconnecting nodes not at the centre as in Zeus or at the top as in Apollo. The Athenian leader deals in solutions. An organisation where Athena predominates is described as task orientated.
Dionysus is the God of individualism. In the Dionysian organisation the organisation is the servant of the individual. The symbol of Dionysus is a cluster of stars surrounded by a circle. Drs and solicitors are the archetypal individuals that exist in a Dionysian organisation. The culture is all about the person.
However, many of you can see where there can be clashes between Dionysian individuals (Drs) and Apollonian organisations (The management). We live in hard times that will only become more challenging. Many have asked why Management Shaz? It could be any of “I am easily bored” “I am good at service change” amongst plenty of valid reasons. But, ultimately it is my desire to act as bridge in my organisation to help the 4 cultures of “club”, “role”, task” and “person” each with their own God to work together for the benefit of our patients. I wish to develop a kinder Apollonian organisation with the symbol of a village. In a softer Apollonian organisation we realise that not every task is professional, there are still mundane repetitive tasks that need covered. Employs that do these tasks are human and although under more management control than the professionals they are still treated as individuals. Even the most Apollonian task should have a Dionysian tinge. The village is the best symbol as it represents a small personal place where everyone has a name, character and personality. I sincerely hope you read this book.
RECENT PUBLICATIONS FROM THE NORTHEAST
1. Gan EH, Quinton R. Physiological significance of the rhythmic secretion of hypothalamic and pituitary hormones. Progress in Brain Research. 2010; 181: 111-125.
2. Maccoll GS, Quinton R, Bülow HE. Biology of KAL1 and its orthologs: implications for X-Linked Kallmann syndrome and the search for novel candidate genes. Front Horm Res. 2010; 39:62-77.
3.Gianetti E, Tusset C, Noel SD, Au MG, Dwyer AA, Hughes VA, Abreu AP, Carroll J, Trarbach E, Silveira LF, Costa EM, de Mendonça BB, de Castro M, Lofrano A, Hall JE, Bolu E, Ozata M, Quinton R, Amory JK, Stewart SE, Arlt W, Cole TR, Crowley WF, Kaiser UB, Latronico AC, Seminara SB. TAC3/TACR3 Mutations Reveal Preferential Activation of Gonadotropin-Releasing Hormone Release by Neurokinin B in Neonatal Life Followed by Reversal in Adulthood. J Clin Endocrinol Metab. 2010 Mar 23. [Epub ahead of print]
4. Wright RJ, Kanagasundaram NS, Quinton R. Darbepoetin alfa and chronic kidney disease. N Engl J Med. 2010; 362: 653.
5. Razvi S, Weaver JU, Vanderpump MP, Pearce SH. The incidence of ischemic heart disease and mortality in people with subclinical hypothyroidism: reanalysis of the Whickham Survey cohort. J Clin Endocrinol Metab. 2010 Apr;95(4):1734-40.
6. Razvi S, Weaver JU, Pearce SH. Subclinical thyroid disorders: significance and clinical impact. J Clin Pathol. 2010 May;63(5):379-86.
7. Dias RP, Chan LF, Metherell LA, Pearce SHS, Clark AJL. Isolated Addison’s Disease is unlikely to be caused by mutations in MC2R, MRAP or StAR, three genes responsible for familial glucocorticoid deficiency. Eur J Endocrinol 2010; 162:357-9.
8. Turner JJ, Christie PT, Pearce SH, Turnpenny PD, Thakker RV. Diagnostic challenges due to phenocopies: lessons from Multiple Endocrine Neoplasia type1 (MEN1). Hum Mutat 2010; 31:E1089-101.
9. Pearce SH, Cheetham TD. Diagnosis and management of vitamin D deficiency. BMJ 2010; 340: 142-147.
10. Boelaert K, Newby PR, Simmonds MJ, Holder RL, Carr-Smith JD, Heward JM, Manji N, Allahabadia A, Armitage M, Chatterjee KV, Lazarus JH, Pearce SH, Vaidya B, Gough SC, Franklyn JA. Prevalence and relative risk of other autoimmune diseases in subjects with autoimmune thyroid disease. Am J Med 2010; 123:183.e1-9.
11. Newby PR, Pickles OJ, Mazumdar S, Brand OJ, Carr-Smith JD, Pearce SH, Franklyn JA, WTCCC, Evans DM, Simmonds MJ, Gough SCL. Follow up of potential novel Graves’ disease susceptibility loci, identified in the UK WTCCC genome-wide non-synonymous SNP study. Eur J Hum Genet 2010; in press
12. Frontiers in Hormone Research, Vol 39. Kallmann Syndrome & Hypogonadotropic Hypogonadism. Editor: R Quinton, Karger AG, Zurich
ISBN 978-8055-8617-7.
RECENT PUBLICATIONS IN DIABETES & ENDOCRINOLOGY THAT HIT THE NEWS OR THAT MAY HAVE A SIGNIFICANT IMPACT ON MANAGEMENT
Loss of vision? Clear as crystal! Ranjeet J Pandit et al. Lancet 2010;375:610.An excellent case report of an unusual presentation of primary hyperparathyroidism.
Familial adenomatous polyposis and hypertension. Hopkins TG et al. Lancet 2010;375:1752. The association of FAP with Primary Hyperaldosteronism represented in a case report.
Investigating suspected bone infection in the diabetic foot. James Teh et al. BMJ 2010;340:415-421. A useful summary.
Porphyrias. Puy H et al. Lancet 2010;375:924-937. An excellent review article.
Effects of intensive blood-pressure control in type 2 diabetes mellitus. ACCORD Study Group N Engl J Med. 2010;362(17):1575-85. The authors investigated whether therapy targeting normal systolic blood pressure (i.e., <120 mm Hg) reduces major cardiovascular events in patients with type 2 DM at high risk for cardiovascular events by randomizing 4733 participants with type 2 DM to intensive therapy, targeting SBP < 120 mm Hg, or standard therapy, targeting SBP < 140 mm Hg. The primary composite outcome was nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes. The mean follow-up was 4.7 years. After 1 year, the mean SBP was 119.3 mm Hg in the intensive-therapy group and 133.5 mm Hg in the standard-therapy group. The annual rate of the primary outcome was 1.87% in the intensive-therapy group and 2.09% in the standard-therapy group with a hazard ratio with intensive therapy of 0.88; 95% confidence interval [CI], 0.73-1.06; p=0.20. The annual rates of death from any cause were 1.28% and 1.19% in the two groups, respectively (HR, 1.07;0.85-1.35; p=0.55). The annual rates of stroke, a prespecified secondary outcome, were 0.32% and 0.53% in the two groups, respectively (HR,0.59; 95% 0.39-0.89; p=0.01). Serious adverse events attributed to antihypertensive treatment occurred in 3.3% of people in the intensive-therapy group and 1.3% people in the standard-therapy group (p<0.001). This trial suggests In patients with type 2 DM at high risk for cardiovascular events, targeting a systolic blood pressure of less than 120 mm Hg, as compared with less than 140 mm Hg, did not reduce the rate of a composite outcome of fatal and nonfatal major cardiovascular events. The same group have also shown the ineffect of combination lipid therapy in type 2 DM, i.e. combining fibrate with statin therapy. This trial has certainly thrown the cat among the pigeons. Does it change my practice. Not really, I have always bucked the trend recently in that: I have stopped being a fan of combination lipid therapy and accept TRIGS < 5mmol/l; I target a BP < 140/80 mmHg in patients only aiming for a SBP < 130 mmHg in patient with renal disease. The accompanying editorial by Peter Nilsson is a balanced read.
NEXT NEWSLETTER Due out beginning of October 2010 so keep the gossip coming.
posted by Arutchelvam at 10:24 PM
