Endodiabology October 2011 Issue 3
ENDODIABOLOGY
Endodiabology.blogspot.com
NORTHEAST
NEWSLETTER
FOR SPRs AND BOSSES TRAPPED
IN THE NORTHERN DEANERY
October 2011
Editors: Shaz Wahid (shahid.wahid@stft.nhs.uk) and
Petros Perros (petros.perros@ncl.ac.uk) and Arut Vijayaraman (riarut@aol.com )
Associate Editor: Srikanth Mada
StR PLACEMENTS (NTN year of training from 1st October 2010)
• Newcastle- Alison Heggie (2), Sudeep Manohar (5), Nimanthe De Alwis (3), Rohana Wright (3), Anjali SanthaKumar (3), Naveen Siddaramaiha (5), , Vacant, Vacant
• North Tyneside/Wansbeck- Asgar Madathil (4) from Jan 2012, Arif Ullah and Sajid Ethol Kalathil (3) job share with NGH community diabetes post
• South Tyneside- Catherine Napier (3)
• Gateshead- Kathryn Stewart (3)
• Sunderland- Sviatlana Zhyzhneuskaya (1), Shunmugam Nellaiappan (1) from Jan 2012
• North Tees/Hartlepool- Naveen Aggarwal (3), Atif Munir (4)
• Middlesbrough- Jacog Buckovan (2), Shunmugam Nellaiappan (1) till Jan 2012, Agnieska Sawiecicka (2), Stuart Little (3) from Jan 2012
• Bishop Auckland/Darlington/Durham- Humza Ali Khan (3)
• NGH- Arif Ullah/ Sajid Ethol Kalathil (3) job share
• Research with numbers (supervisor)- Stuart Little (3-Dr Shaw), Asgar Madathil (4-Dr Weaver), Sarah Steven (3-Prof Taylor), Anna Mitchell (1-Prof Pearce), Earn Gan (1-Prof Pearce)
MEETINGS / LECTURES / ANNOUNCEMENTS
• 11th October 2011 SfE Regional Clinical Cases Meeting. Venue TBC. Contact www.endocrinology.org/meetings/index
• 12th October 2011 Northern Endocrine & Diabetes Autumn CME, Durham. Contact Sarah Steven(sarah.steven@doctors.org.uk ) or Srikanth Mada (srikanth.mada@nhs.net )
• 7th – 9th November 2011 SfE Clinical Update 2011. Sheffield. Contact www.endocrinology.org/meetings
• 10th-12th November 2012 ABCD autumn meeting, London. Contact www.diabetologists.org.uk followed by SpRs meeting.
• 16th November 2011 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Sue Archibald 0191 223 1247 sue.archibald@nuth.nhs.uk .
• 23rd November 2011 Northern Endocrine Region Research and Audit Group meeting, Lumley Castle, Chester-le-street. Contact Shahid.wahid@stft.nhs.uk
• 24th-25th November 2011 Middlesbrough insulin pump course. Contact Nicky.Skippon@stees.nhs.uk
• 30th November 2011 RCP Updates in Medicine, Freeman Hospital. Contact Sue Archibald 0191 223 1247 sue.archibald@nuth.nhs.uk .
• 30th November-1st December 2012 60th British Thyroid Association Annual meeting, London, www.british-thyroid-association.org .
• 12th December 2011 SfE Clinical Cases. Exeter. Contact www.endocrinology.org/meetings
• 18th January 2012 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Sue Archibald 0191 223 1247 sue.archibald@nuth.nhs.uk .
• 24th January 2012 Northern Endocrine & Diabetes Winter CME, Freeman Hospital. Contact Sarah Steven(sarah.steven@doctors.org.uk ) or Srikanth Mada (srikanth.mada@nhs.net ) or Rohana Wright rohanawright@doctors.org.uk
• 29th February 2012 SfE Clinical Cases. London. Contact www.endocrinology.org/meetings
• 7th-9th March 2012 Diabetes UK APC. Glasgow. Contact www.diabetes.org.uk/conference
• 14th March 2012 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Sue Archibald 0191 223 1247 sue.archibald@nuth.nhs.uk .
• 19th-22nd March 2012 BES 2012. Harrogate. Contact www.endocrinology.org/meetings
• 18th April 2012 Acute Medicine Conference, Freeman Hospital. Contact Sue Archibald 0191 223 1247 sue.archibald@nuth.nhs.uk .
• 8th May 2012 Northern Endocrine & Diabetes Summer CME, Sunderland. Contact Sarah Steven(sarah.steven@doctors.org.uk ) or Srikanth Mada (srikanth.mada@nhs.net ) or Rohana Wright rohanawright@doctors.org.uk
• 16th May 2012 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Sue Archibald 0191 223 1247 sue.archibald@nuth.nhs.uk .
• 4th July 2012 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Sue Archibald 0191 223 1247 sue.archibald@nuth.nhs.uk .
• 19th September 2012 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Sue Archibald 0191 223 1247 sue.archibald@nuth.nhs.uk .
• 11th October 2012 Northern Endocrine & Diabetes Autumn CME, JCUH. Contact Sarah Steven(sarah.steven@doctors.org.uk ) or Srikanth Mada (srikanth.mada@nhs.net) or Rohana Wright rohanawright@doctors.org.uk
• 27th November 2012 RCP Updates in Medicine, Freeman Hospital. Contact Sue Archibald 0191 223 1247 sue.archibald@nuth.nhs.uk .
• 28th November 2012 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Sue Archibald 0191 223 1247 sue.archibald@nuth.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.
Registering with PMETB It is essential that all new StRs (even LATs) register with the PMETB through the Joint Royal Colleges of Physicians Training Board on www.jrcptb.org.uk. Not doing so means your training is not counted.
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.
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 G(I)M PYAs.
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.
The Kelly-Young MRCP Diabetes & Endocrinology Prize This prize is awarded annually at NERRAG to the youngest in terms of training year StR passing the MRCP Diabetes & endocrinology exam. Richard Quinton secures the funding of £800 and it is named after 2 distinguished former Endocrinologists in the region, Bill Kelly and Eric Young.
Critical incident/complaint If you are involved in a critical incident or if reporting an incident concerning training issues please inform your supervisor and the TPD. Ensure they are reflected upon in your portfolio
Portfolio Completion It is essential for trainees to engage with their portfolio on a regular basis and record learning. It is also essential to record the numbers of patients seen as news or reviews for clinics, on-call, ambulatory care. It is essential to record the number of specialty clinics undertaken. Undertaking this activity means that your Educational Supervisor should be able to engage with the portfolio so as to provide you that assessment for ARCP purposes. Please see Jacob’s article.
MERRIT The regional training for StRs is in place and has been delivered on 3 occasions. Contact Stuart and Srikanth for future dates. I really enjoyed preparing for and delivering the South Tyneside session. I was disappointed by the poor attendance given that I (Shaz) cancelled a clinic and then overbooked the preceding clinic by 100% to deliver the session. Hopefully attendance will improve.
Management Training A regional management programme is in place for StRs. Contact Nimantha De Alwis nimdeal@googlemail.com for more information.
Call For Mentors Please read the information in the letters section from Baldev Singh sent to the Editorial Team from Gillian Hawthorne.
Training Committee Chair- Nicky Leech nicola.leech@nuth.northy.nhs.uk; Regional Speciality Advisor- Shaz Wahid, shahid.wahid@sthct.nhs.uk; Programme Director- Arutchelvam Vijayaraman Vijayaraman.Arutchelvam@stees.nhs.uk; Consultant member- Richard Quinton, Richard.Quinton@nuth.nhs.uk; Consultant member-Jean MacLeod, Jean.Macleod@nth.nhs.uk; Consultant member-Dr Peter Carey; Consultant member-Simon Eaton, simon.eaton@northumbria-healthcare.nhs.uk; Consultant member-Salman Razvi salman.razvi@ghnt.nhs.uk ; Consultant member-Paul Peter paul.peter@cddah.nhs.uk ; SpR representative-Srikanth Mada srikanth.mada@nhs.net ; SpR representative-Stuart Little stuartlittle@doctors.org.uk
NEWS FROM THE NORTHEAST
• Congratulations to Arut on his formal appointment as TPD. Please read his article below.
• Congratulations to Sarah Stevens on her Research Fellowship award.
• Welcome to Gus Brookes, who has joined Jim Shaw as a research fellow from Bristol.
• Philip Home is retiring from his NHS post in Newcastle with effect from 31 December 2011. He continues in part time employment from Newcastle University thereafter. A personal thank you to him for his support over the years.
• Congratulations to Terry Aspray on his award of a grant from Arthritis Research UK to study the effects of vitamin D supplementation on bone health in men and women aged over 70: "Optimising Vitamin D Status in Older People: A Randomised Controlled Trial of Vitamin D Supplementation" Grant Code 19544 ; Lead Applicant Name Dr Terence Aspray; Total Amount Requested £ 660,398.
• Congratulations to Srikanth Mada on his appointment as Consultant Endocrinologist for County Durham & Darlington NHS FT.
LETTERS
10 top tips for the e-portfolio-Jacob Bukowczan
1.Don’t get hung up on where to put what.
2. Try and write in your natural style.
3. It’s all about quality not quantity.
4. Visit your e-portfolio regularly: making entries in a timely way and reviewing
the “whole picture” regularly.
5. Don’t put if off until tomorrow, there is never enough time to do it.
6. Review the range of your competencies on a regular basis.
7. Reflection is everything – do it at least once a month.
8. Use your on-calls wisely – ask consultant for an ACAT form after each post take ward round and keep record of all the patients you reviewed that day/night.
9. Use your library – scan and upload all your certificates, presentations, feedback forms early.
10. Link assessments/experiences to the curriculum as soon as possible.
The British Thyroid Association Meeting 30th November & 1st December 2011-Prof Simon Pearce
The BTA meeting in London includes a new half day SpR clinical teaching session on the Wednesday afternoon followed by the full-day clinical and scientific session the day after. Once again, we have a great programme of international speakers for both thyroid cancer and thyroid eye disease, as well as the usual suspects from Newcastle... Registration will be snip- most likely forty or 50 quid for SpRs: see the BTA website for a registration form shortly.
SpRs with interesting 'grey cases' in hyperthyroidism are welcome to submit a short synopsis to myself or Bijay Vaidya.
Call for Mentors: The National Diabetes Consultant Mentorship Programme (NDCMP)-Baldev Singh
May I update you regarding the NDCMP which is to run under the full regulation of the Association of British Clinical Dialectologists with Eli Lilly as the funding body?
Taking up a new consultant post in diabetes and endocrinology is both exciting and challenging. Acquiring experience, expertise and wisdom to develop in this role takes time and such development is not always best met by the standard processes of CME and CPD. Mentorship programmes are valued for their ability to offer independent, trusted and expert support, advice and guidance in relationship to professional development. Mentorship programmes already exist but they vary in their structure and quality, they are not always offered locally and there are none available that are specific to the speciality. Universally, senior SpRs express a high desire for effective Mentorship.
Arrangements are now formalised and the NDCMP will be fully established in early 2012. It will be well structured, well governed and sustained in to the long term. The programme will be systematically offered to all newly appointed consultants in Diabetes and Endocrinology. Mentees will be able to access ABCD accredited Mentors from within their own region and avail themselves of the benefits of a mentoring relationship lasting between 12 to 24 months.
Crucially to NDCMP will be our expert Mentors. They will be drawn from amongst established colleagues who have respect and reputation within the speciality. They will have:
• a minimum of 5 years service experience in substantive posts
• expertise in key other areas such as teaching and training, leadership and management, and service development and perhaps have undertaken extension roles such as (but not limited to) Clinical Director, College Tutor, Clinical Tutor, Undergraduate Lead, Specialist Training, Research, relevant District / Regional / National Committees.
Could those colleagues who feel they fit the bill and who are enthusiastic to be NDCMP Mentors please make themselves known to me (baldev.singh@nhs.net). A brief self nomination form will subsequently be dispatched. Please note that a Mentor group meeting is planned for the 18th (Friday late afternoon) and 19th of November 2011 at a central location (provisionally Coombe Abbey, Warwickshire, www.coombeabbey.com).
A message from our new TPD Arut
From October 1st, I will be taking over as the TPD, (I heard that this is the most desired and thankful job in the whole world, hence I applied!) I join you all in thanking Nicky Leech for managing the programme so well in the last few years. Despite all the challenges ahead, I am quite thrilled to take up this position and keen to work with everybody to uphold the high standards.
The main challenge is to continue to recruit high quality candidates into the specialty-training programme. Looking at the application ratios, our specialty is one of those with a lower ratio. Our region being for away from London does not help. However having highly reputed trainers and high standard research programmes available in the region, I expect will continue to make it attractive. We need to work further on popularising our specialty. I will be very grateful for your suggestions.
The other issue is, high number of outcome 2 in the ARCP, particularly in GIM. It is disheartening to note that some excellent trainees got this adverse outcome, simply because of issues with the e portfolio. This was distressing both for the trainers and the concerned trainees. We will work on continuously finding ways to engage with the e portfolio, by learning from each other’s good practice. I welcome trainees and trainers to share their practices. For example, our trainees at JCUH regularly bring cases for discussion and a NHS topic every fortnight to the educational supervisor and will do an assessment at the end. I noticed the trainees have done a large number of assessments by this way. We also encourage do get the SpR to lead the ward round frequently and do an ACAT at the end. Reviewing the validity of ALS is essential. I suggest that we have a target that no one fails in the forthcoming ARCP except for major training reasons.
We have the next round of interviews in October and we hope to recruit enough candidates, which will fill most gaps in the training programme. I thank all of you in advance for your help, support and guidance in the forthcoming years. Please keep in regular touch with your suggestions.
Regional Insulin Safety and Knowledge Programme-Jan Finn
This project is an initiative to review insulin safety and knowledge in the region. It is going to have a board which will meet 1-2hours bi-monthly (1st meeting 18th Oct 4-6pm venue tbc) so it would be beneficial for each service to have representation at this - someone who leads on diabetes/insulin safety.
There will also be 3 work streams
1/ Hospital insulin charts –An attempt to standardise common features on the hospital insulin charts across the region.
2/ National Insulin Passport-following NPSA guidance.
3/ Professional training - this work stream is going to develop a regional training programme for hospital based health care professionals. Ultimately it will work towards this training programme becoming a mandatory aspect of all health care workers training requirements.
Please send comments to jan.finn@nhs.net
RECENT PUBLICATIONS FROM THE NORTHEAST
1. Mellor A and Woods D. Serum Neutrophil Gelatinase Associated Lipocalin in Ballistic Injuries: A comparison between blast injuries and gunshot wounds. Journal of Critical Care, 2011.
2. Tornberg J, Sykiotis G, Keefe K, Plummer L, Hoang X, Hall JE, Quinton R, Seminara SB, Hughes VA, van Vliet G, van Uum S, Crowley WF, Jr., Habuchi H, Kimata K, Pitteloud N, Bülow H. 2011 Proceedings of the National Academy of Sciences of the United States of America. 108: 11524-11529.
3. Wahab F, Quinton R, Seminara SB. The kisspeptin signaling pathway and its role in human isolated GnRH deficiency. Molecular & Cellular Endocrinology. 2011; June 17 [epub ahead of print].
4. Chan YM, Broder-Fingert S, Paraschos S, Lapatto R, Au M, Hughes V, Bianco SD, Min L, Plummer L, Cerrato F, De Guillebon A, Wu IH, Wahab F, Dwyer A, Kirsch S, Quinton R, Cheetham T, Ozata M, Ten S, Chanoine JP, Pitteloud N, Crowley WF Jr, Martin KA, Schiffmann R, Van der Kamp HJ, Nader S, Hall JE, Kaiser UB, Seminara SB. GnRH-Deficient Phenotypes in Humans and Mice with Heterozygous Variants in KISS1/Kiss1. J Clin Endocrinol Metab. 2011 Aug 31. [Epub ahead of print].
5. A Munir, SL Toh, V Arutchelvam. Insulinoma in a patient with Type 2 Diabetes-Case report, published in Practical Diabetes , Volume 28 Issue 5 (June 2011).
6. Gan EH, Mitchell AL, Macarthur K, Pearce SH 2011 The role of a nonsynonymous CD226 (DNAX-accessory molecule-1) variant (Gly 307Ser) in isolated Addison's disease and autoimmune polyendocrinopathy type 2 pathogenesis. Clin Endocrinol (Oxf), 75(2):165-8.
7. Yarnall AJ, Hayes L, Hawthorne GC, Candlish CA, Aspray TJ. Diabetes in care homes: current care standards and residents' experience. Diabet Med. 2011 Jul 25. doi: 10.1111/j.1464-5491.2011.03393.x. [Epub ahead of print] 2.
8. Aspray TJ, Francis RM. Calcium and vitamin D supplementation and cardiovascular disease: quo vadis? Maturitas. 2011 Aug;69(4):285-6.
9. Sinclair AJ, Aspray TJ et al ; Task and Finish Group of Diabetes UK. Good clinical practice guidelines for care home residents with diabetes: an executive summary. Diabet Med. 2011 Jul;28(7):772-7. doi: 10.1111//.1464-5491.2011.03320.x.
10. Martin-Ruiz C, Jagger C, Kingston A, Collerton J, Catt M, Davies K, Dunn M, Hilkens C, Keavney B, Pearce SH, Elzen WP, Talbot D, Wiley L, Bond J, Mathers JC, Eccles MP, Robinson L, James O, Kirkwood TB, von Zglinicki T. Assessment of a large panel of candidate biomarkers of ageing in the Newcastle 85+ study. Mech Ageing Dev. 2011 Aug 16. [Epub ahead of print]
11. Vanderpump MP, Lazarus JH, Smyth PP, Laurberg P, Holder RL, Boelaert K, Franklyn JA; British Thyroid Association UK Iodine Survey Group (including Razvi S, Pearce SH). Iodine status of UK schoolgirls: a cross-sectional survey. Lancet. 2011 Jun 11;377(9782):2007-12.
12. Newby PR, Pickles OJ, Mazumdar S, Brand OJ, Carr-Smith JD, Pearce SH, Franklyn JA; Wellcome Trust Case-Control Consortium (WTCCC), Evans DM, Simmonds MJ, Gough SC. Follow-up of potential novel Graves' disease susceptibility loci, identified in the UK WTCCC genome-wide nonsynonymous SNP study. Eur J Hum Genet. 2010 Sep;18(9):1021-6.
RECENT PUBLICATIONS IN DIABETES & ENDOCRINOLOGY THAT HIT THE NEWS OR THAT MAY HAVE A SIGNIFICANT IMPACT ON MANAGEMENT
Management of hypertension: summary of NICE guidance. T Krause et al. BMJ 2011;343:d4891. An excellent summary of the guidelines with implications for our patients and services. Get ambulatory monitoring entrenched!
Investigating mixed hyperlipidaemia. A Viljoen and AS Wierzbicki. BMJ 2011;343:d5146. A useful clinical practice paper.
Electronic Health Records and Quality of Diabetes Care. RD Cebul et al. NEJM 2011;365:825-833. An excellent article that can be extrapolated to the UK and provides ammunition for those of us wishing to develop an interactice web-based system for both clinical interactions and register use.
Autoimmune encephalitis. SR Irani et al. BMJ 2011;342:d1918. An excellent editorial detailing 2 condition sthat we should be far more vigilant for than we are.
Multiple endocrine abnormalities. CMPG van Durne et al. Lancet 2011;378:540. An excellent case report of a rare cause for pituitary hypophisitis.
Weighing the benefits of high-dose Simvastatin against the risk of myopathy. A Egan & E Colman. NEJM 2011365:285-287. A perspective well worth a read and a reminder that we should no longer be going to Simvastatin 80mg.
Intensive glucose lowering treatment in type 2 diabetes. D Preiss & KK Ray. BMJ 2011;343:d4343. A thought provoking editorial and rather controversial?
Salt reduction lowers cardiovascular risk: meta-analysis of out come trials. FJ He & GA MacGregor. Lancet 2011;378:380-382. An excellent editorial reviewing the effectiveness of salt reduction. Make sure you have salt-reduction leaflets for your hypertensive patients in clinic.
Glycaemic control in type 1 diabetes during real time continuous glucose monitoring compared with self monitoring of blood glucose: meta-analysis of randomised controlled trial using individual patient data. JC Pickup et al. BMJ 2011;343:d3805. An excellent article that should change your practice if not already.
Diabetic ketoacidosis at the onset of type 1 diabetes. BMJ 2011;343:d3278. It is still common! The article acts a s a reminder and should provoke some thoughts on how you should reduce it in your locality.
Glucocorticoid-Induced Bone Disease. RS Weinstein. NEJM 2011;365:62-70. An excellent overview on clinical practice that is well worth a read.
The Lancet volume 378 2011 number 9786 9-15th July. This edition of the Lancet is essential reading. It includes 4 wonderful primary research papers on diet & Physical activity vs. usual care on diagnosis of Type 2 DM by Rob Andrews (some of you may remember Rob) and co, incidence of heart failure in type 1 DM by Lind et al, HbA1c use for pre-diabetes by Heianza et al and MRFIT on screen detected Type 2 DM by Griffin et al. The 4 accompanying Editorials add to the essential read.
National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2.7 million participants. G Danaei et al. Lancet 2011;378:41-40. A mammoth and impressive study adding to the world perspective of diabetes.
Anti-CD3 antibodies for Type 1 diabetes: beyond expectations. JF Bach. Lancet 2011;378:459-460. See linked paper Lancet 2011;378:487-497.
Arresting type 1 diabetes after diagnosis: GAD is not enough. C Mathieu & P Gillard. Lancet 2011;378:291-292. see linked paper Lancet 2011;378:319-327.
New hope for immune intervention therapy in type 1 diabetes. BO Roep. Lancet 2011;378:376-378. See linked paper Lancet 2011;378:412-419.
The above 3 editorials with their linked primary research papers are a must read for an update on immunotherapy in type 1 diabetes.
Bardoxolone Methyl and Kidney Function in CKD with Type 2 Diabetes. PE Pergola et al. NEJM 2011;365:327-336. An antioxidant inflammation modulator useful in CKD. However a very mixed group of CKD patients.
Sharp: a stab in the right direction in chronic kidney disease. KK Stevens, AG Jardine. Lancet 2011;377:2153-2154. See linked paper Lancet 2011;377:2181-2192. An excellent editorial that critically reviews the linked paper and statin therapy in CKD.
Iodine status of UK schoolgirls: a cross-sectional survey. MP Vanderpump et al. Lancet 2011;377:2007-2012. An excellent study with a thought provoking conclusion. This should be a call to action.
Diagnosis, classification, and treatment of diabetes. A Farmer & R Fox. BMJ 2011;342:d3319. An excellent practical editorial.
Time trends in mortality in patients with type 1 diabetes: nationwide population based cohort study. V Harjutsalo et al. BMJ 2011;343:d5364. An interesting study demonstrating improving mortality in early onset type 1 diabetes but increasing mortality in type 1 late onset type 1 diabetes. Read on……………………………………………………………………………………….
NEXT NEWSLETTER Due out beginning of February 2012 so keep the gossip coming.
Endodiabology.blogspot.com
NORTHEAST
NEWSLETTER
FOR SPRs AND BOSSES TRAPPED
IN THE NORTHERN DEANERY
October 2011
Editors: Shaz Wahid (shahid.wahid@stft.nhs.uk) and
Petros Perros (petros.perros@ncl.ac.uk) and Arut Vijayaraman (riarut@aol.com )
Associate Editor: Srikanth Mada
StR PLACEMENTS (NTN year of training from 1st October 2010)
• Newcastle- Alison Heggie (2), Sudeep Manohar (5), Nimanthe De Alwis (3), Rohana Wright (3), Anjali SanthaKumar (3), Naveen Siddaramaiha (5), , Vacant, Vacant
• North Tyneside/Wansbeck- Asgar Madathil (4) from Jan 2012, Arif Ullah and Sajid Ethol Kalathil (3) job share with NGH community diabetes post
• South Tyneside- Catherine Napier (3)
• Gateshead- Kathryn Stewart (3)
• Sunderland- Sviatlana Zhyzhneuskaya (1), Shunmugam Nellaiappan (1) from Jan 2012
• North Tees/Hartlepool- Naveen Aggarwal (3), Atif Munir (4)
• Middlesbrough- Jacog Buckovan (2), Shunmugam Nellaiappan (1) till Jan 2012, Agnieska Sawiecicka (2), Stuart Little (3) from Jan 2012
• Bishop Auckland/Darlington/Durham- Humza Ali Khan (3)
• NGH- Arif Ullah/ Sajid Ethol Kalathil (3) job share
• Research with numbers (supervisor)- Stuart Little (3-Dr Shaw), Asgar Madathil (4-Dr Weaver), Sarah Steven (3-Prof Taylor), Anna Mitchell (1-Prof Pearce), Earn Gan (1-Prof Pearce)
MEETINGS / LECTURES / ANNOUNCEMENTS
• 11th October 2011 SfE Regional Clinical Cases Meeting. Venue TBC. Contact www.endocrinology.org/meetings/index
• 12th October 2011 Northern Endocrine & Diabetes Autumn CME, Durham. Contact Sarah Steven(sarah.steven@doctors.org.uk ) or Srikanth Mada (srikanth.mada@nhs.net )
• 7th – 9th November 2011 SfE Clinical Update 2011. Sheffield. Contact www.endocrinology.org/meetings
• 10th-12th November 2012 ABCD autumn meeting, London. Contact www.diabetologists.org.uk followed by SpRs meeting.
• 16th November 2011 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Sue Archibald 0191 223 1247 sue.archibald@nuth.nhs.uk .
• 23rd November 2011 Northern Endocrine Region Research and Audit Group meeting, Lumley Castle, Chester-le-street. Contact Shahid.wahid@stft.nhs.uk
• 24th-25th November 2011 Middlesbrough insulin pump course. Contact Nicky.Skippon@stees.nhs.uk
• 30th November 2011 RCP Updates in Medicine, Freeman Hospital. Contact Sue Archibald 0191 223 1247 sue.archibald@nuth.nhs.uk .
• 30th November-1st December 2012 60th British Thyroid Association Annual meeting, London, www.british-thyroid-association.org .
• 12th December 2011 SfE Clinical Cases. Exeter. Contact www.endocrinology.org/meetings
• 18th January 2012 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Sue Archibald 0191 223 1247 sue.archibald@nuth.nhs.uk .
• 24th January 2012 Northern Endocrine & Diabetes Winter CME, Freeman Hospital. Contact Sarah Steven(sarah.steven@doctors.org.uk ) or Srikanth Mada (srikanth.mada@nhs.net ) or Rohana Wright rohanawright@doctors.org.uk
• 29th February 2012 SfE Clinical Cases. London. Contact www.endocrinology.org/meetings
• 7th-9th March 2012 Diabetes UK APC. Glasgow. Contact www.diabetes.org.uk/conference
• 14th March 2012 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Sue Archibald 0191 223 1247 sue.archibald@nuth.nhs.uk .
• 19th-22nd March 2012 BES 2012. Harrogate. Contact www.endocrinology.org/meetings
• 18th April 2012 Acute Medicine Conference, Freeman Hospital. Contact Sue Archibald 0191 223 1247 sue.archibald@nuth.nhs.uk .
• 8th May 2012 Northern Endocrine & Diabetes Summer CME, Sunderland. Contact Sarah Steven(sarah.steven@doctors.org.uk ) or Srikanth Mada (srikanth.mada@nhs.net ) or Rohana Wright rohanawright@doctors.org.uk
• 16th May 2012 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Sue Archibald 0191 223 1247 sue.archibald@nuth.nhs.uk .
• 4th July 2012 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Sue Archibald 0191 223 1247 sue.archibald@nuth.nhs.uk .
• 19th September 2012 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Sue Archibald 0191 223 1247 sue.archibald@nuth.nhs.uk .
• 11th October 2012 Northern Endocrine & Diabetes Autumn CME, JCUH. Contact Sarah Steven(sarah.steven@doctors.org.uk ) or Srikanth Mada (srikanth.mada@nhs.net) or Rohana Wright rohanawright@doctors.org.uk
• 27th November 2012 RCP Updates in Medicine, Freeman Hospital. Contact Sue Archibald 0191 223 1247 sue.archibald@nuth.nhs.uk .
• 28th November 2012 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Sue Archibald 0191 223 1247 sue.archibald@nuth.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.
Registering with PMETB It is essential that all new StRs (even LATs) register with the PMETB through the Joint Royal Colleges of Physicians Training Board on www.jrcptb.org.uk. Not doing so means your training is not counted.
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.
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 G(I)M PYAs.
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.
The Kelly-Young MRCP Diabetes & Endocrinology Prize This prize is awarded annually at NERRAG to the youngest in terms of training year StR passing the MRCP Diabetes & endocrinology exam. Richard Quinton secures the funding of £800 and it is named after 2 distinguished former Endocrinologists in the region, Bill Kelly and Eric Young.
Critical incident/complaint If you are involved in a critical incident or if reporting an incident concerning training issues please inform your supervisor and the TPD. Ensure they are reflected upon in your portfolio
Portfolio Completion It is essential for trainees to engage with their portfolio on a regular basis and record learning. It is also essential to record the numbers of patients seen as news or reviews for clinics, on-call, ambulatory care. It is essential to record the number of specialty clinics undertaken. Undertaking this activity means that your Educational Supervisor should be able to engage with the portfolio so as to provide you that assessment for ARCP purposes. Please see Jacob’s article.
MERRIT The regional training for StRs is in place and has been delivered on 3 occasions. Contact Stuart and Srikanth for future dates. I really enjoyed preparing for and delivering the South Tyneside session. I was disappointed by the poor attendance given that I (Shaz) cancelled a clinic and then overbooked the preceding clinic by 100% to deliver the session. Hopefully attendance will improve.
Management Training A regional management programme is in place for StRs. Contact Nimantha De Alwis nimdeal@googlemail.com for more information.
Call For Mentors Please read the information in the letters section from Baldev Singh sent to the Editorial Team from Gillian Hawthorne.
Training Committee Chair- Nicky Leech nicola.leech@nuth.northy.nhs.uk; Regional Speciality Advisor- Shaz Wahid, shahid.wahid@sthct.nhs.uk; Programme Director- Arutchelvam Vijayaraman Vijayaraman.Arutchelvam@stees.nhs.uk; Consultant member- Richard Quinton, Richard.Quinton@nuth.nhs.uk; Consultant member-Jean MacLeod, Jean.Macleod@nth.nhs.uk; Consultant member-Dr Peter Carey; Consultant member-Simon Eaton, simon.eaton@northumbria-healthcare.nhs.uk; Consultant member-Salman Razvi salman.razvi@ghnt.nhs.uk ; Consultant member-Paul Peter paul.peter@cddah.nhs.uk ; SpR representative-Srikanth Mada srikanth.mada@nhs.net ; SpR representative-Stuart Little stuartlittle@doctors.org.uk
NEWS FROM THE NORTHEAST
• Congratulations to Arut on his formal appointment as TPD. Please read his article below.
• Congratulations to Sarah Stevens on her Research Fellowship award.
• Welcome to Gus Brookes, who has joined Jim Shaw as a research fellow from Bristol.
• Philip Home is retiring from his NHS post in Newcastle with effect from 31 December 2011. He continues in part time employment from Newcastle University thereafter. A personal thank you to him for his support over the years.
• Congratulations to Terry Aspray on his award of a grant from Arthritis Research UK to study the effects of vitamin D supplementation on bone health in men and women aged over 70: "Optimising Vitamin D Status in Older People: A Randomised Controlled Trial of Vitamin D Supplementation" Grant Code 19544 ; Lead Applicant Name Dr Terence Aspray; Total Amount Requested £ 660,398.
• Congratulations to Srikanth Mada on his appointment as Consultant Endocrinologist for County Durham & Darlington NHS FT.
LETTERS
10 top tips for the e-portfolio-Jacob Bukowczan
1.Don’t get hung up on where to put what.
2. Try and write in your natural style.
3. It’s all about quality not quantity.
4. Visit your e-portfolio regularly: making entries in a timely way and reviewing
the “whole picture” regularly.
5. Don’t put if off until tomorrow, there is never enough time to do it.
6. Review the range of your competencies on a regular basis.
7. Reflection is everything – do it at least once a month.
8. Use your on-calls wisely – ask consultant for an ACAT form after each post take ward round and keep record of all the patients you reviewed that day/night.
9. Use your library – scan and upload all your certificates, presentations, feedback forms early.
10. Link assessments/experiences to the curriculum as soon as possible.
The British Thyroid Association Meeting 30th November & 1st December 2011-Prof Simon Pearce
The BTA meeting in London includes a new half day SpR clinical teaching session on the Wednesday afternoon followed by the full-day clinical and scientific session the day after. Once again, we have a great programme of international speakers for both thyroid cancer and thyroid eye disease, as well as the usual suspects from Newcastle... Registration will be snip- most likely forty or 50 quid for SpRs: see the BTA website for a registration form shortly.
SpRs with interesting 'grey cases' in hyperthyroidism are welcome to submit a short synopsis to myself or Bijay Vaidya.
Call for Mentors: The National Diabetes Consultant Mentorship Programme (NDCMP)-Baldev Singh
May I update you regarding the NDCMP which is to run under the full regulation of the Association of British Clinical Dialectologists with Eli Lilly as the funding body?
Taking up a new consultant post in diabetes and endocrinology is both exciting and challenging. Acquiring experience, expertise and wisdom to develop in this role takes time and such development is not always best met by the standard processes of CME and CPD. Mentorship programmes are valued for their ability to offer independent, trusted and expert support, advice and guidance in relationship to professional development. Mentorship programmes already exist but they vary in their structure and quality, they are not always offered locally and there are none available that are specific to the speciality. Universally, senior SpRs express a high desire for effective Mentorship.
Arrangements are now formalised and the NDCMP will be fully established in early 2012. It will be well structured, well governed and sustained in to the long term. The programme will be systematically offered to all newly appointed consultants in Diabetes and Endocrinology. Mentees will be able to access ABCD accredited Mentors from within their own region and avail themselves of the benefits of a mentoring relationship lasting between 12 to 24 months.
Crucially to NDCMP will be our expert Mentors. They will be drawn from amongst established colleagues who have respect and reputation within the speciality. They will have:
• a minimum of 5 years service experience in substantive posts
• expertise in key other areas such as teaching and training, leadership and management, and service development and perhaps have undertaken extension roles such as (but not limited to) Clinical Director, College Tutor, Clinical Tutor, Undergraduate Lead, Specialist Training, Research, relevant District / Regional / National Committees.
Could those colleagues who feel they fit the bill and who are enthusiastic to be NDCMP Mentors please make themselves known to me (baldev.singh@nhs.net). A brief self nomination form will subsequently be dispatched. Please note that a Mentor group meeting is planned for the 18th (Friday late afternoon) and 19th of November 2011 at a central location (provisionally Coombe Abbey, Warwickshire, www.coombeabbey.com).
A message from our new TPD Arut
From October 1st, I will be taking over as the TPD, (I heard that this is the most desired and thankful job in the whole world, hence I applied!) I join you all in thanking Nicky Leech for managing the programme so well in the last few years. Despite all the challenges ahead, I am quite thrilled to take up this position and keen to work with everybody to uphold the high standards.
The main challenge is to continue to recruit high quality candidates into the specialty-training programme. Looking at the application ratios, our specialty is one of those with a lower ratio. Our region being for away from London does not help. However having highly reputed trainers and high standard research programmes available in the region, I expect will continue to make it attractive. We need to work further on popularising our specialty. I will be very grateful for your suggestions.
The other issue is, high number of outcome 2 in the ARCP, particularly in GIM. It is disheartening to note that some excellent trainees got this adverse outcome, simply because of issues with the e portfolio. This was distressing both for the trainers and the concerned trainees. We will work on continuously finding ways to engage with the e portfolio, by learning from each other’s good practice. I welcome trainees and trainers to share their practices. For example, our trainees at JCUH regularly bring cases for discussion and a NHS topic every fortnight to the educational supervisor and will do an assessment at the end. I noticed the trainees have done a large number of assessments by this way. We also encourage do get the SpR to lead the ward round frequently and do an ACAT at the end. Reviewing the validity of ALS is essential. I suggest that we have a target that no one fails in the forthcoming ARCP except for major training reasons.
We have the next round of interviews in October and we hope to recruit enough candidates, which will fill most gaps in the training programme. I thank all of you in advance for your help, support and guidance in the forthcoming years. Please keep in regular touch with your suggestions.
Regional Insulin Safety and Knowledge Programme-Jan Finn
This project is an initiative to review insulin safety and knowledge in the region. It is going to have a board which will meet 1-2hours bi-monthly (1st meeting 18th Oct 4-6pm venue tbc) so it would be beneficial for each service to have representation at this - someone who leads on diabetes/insulin safety.
There will also be 3 work streams
1/ Hospital insulin charts –An attempt to standardise common features on the hospital insulin charts across the region.
2/ National Insulin Passport-following NPSA guidance.
3/ Professional training - this work stream is going to develop a regional training programme for hospital based health care professionals. Ultimately it will work towards this training programme becoming a mandatory aspect of all health care workers training requirements.
Please send comments to jan.finn@nhs.net
RECENT PUBLICATIONS FROM THE NORTHEAST
1. Mellor A and Woods D. Serum Neutrophil Gelatinase Associated Lipocalin in Ballistic Injuries: A comparison between blast injuries and gunshot wounds. Journal of Critical Care, 2011.
2. Tornberg J, Sykiotis G, Keefe K, Plummer L, Hoang X, Hall JE, Quinton R, Seminara SB, Hughes VA, van Vliet G, van Uum S, Crowley WF, Jr., Habuchi H, Kimata K, Pitteloud N, Bülow H. 2011 Proceedings of the National Academy of Sciences of the United States of America. 108: 11524-11529.
3. Wahab F, Quinton R, Seminara SB. The kisspeptin signaling pathway and its role in human isolated GnRH deficiency. Molecular & Cellular Endocrinology. 2011; June 17 [epub ahead of print].
4. Chan YM, Broder-Fingert S, Paraschos S, Lapatto R, Au M, Hughes V, Bianco SD, Min L, Plummer L, Cerrato F, De Guillebon A, Wu IH, Wahab F, Dwyer A, Kirsch S, Quinton R, Cheetham T, Ozata M, Ten S, Chanoine JP, Pitteloud N, Crowley WF Jr, Martin KA, Schiffmann R, Van der Kamp HJ, Nader S, Hall JE, Kaiser UB, Seminara SB. GnRH-Deficient Phenotypes in Humans and Mice with Heterozygous Variants in KISS1/Kiss1. J Clin Endocrinol Metab. 2011 Aug 31. [Epub ahead of print].
5. A Munir, SL Toh, V Arutchelvam. Insulinoma in a patient with Type 2 Diabetes-Case report, published in Practical Diabetes , Volume 28 Issue 5 (June 2011).
6. Gan EH, Mitchell AL, Macarthur K, Pearce SH 2011 The role of a nonsynonymous CD226 (DNAX-accessory molecule-1) variant (Gly 307Ser) in isolated Addison's disease and autoimmune polyendocrinopathy type 2 pathogenesis. Clin Endocrinol (Oxf), 75(2):165-8.
7. Yarnall AJ, Hayes L, Hawthorne GC, Candlish CA, Aspray TJ. Diabetes in care homes: current care standards and residents' experience. Diabet Med. 2011 Jul 25. doi: 10.1111/j.1464-5491.2011.03393.x. [Epub ahead of print] 2.
8. Aspray TJ, Francis RM. Calcium and vitamin D supplementation and cardiovascular disease: quo vadis? Maturitas. 2011 Aug;69(4):285-6.
9. Sinclair AJ, Aspray TJ et al ; Task and Finish Group of Diabetes UK. Good clinical practice guidelines for care home residents with diabetes: an executive summary. Diabet Med. 2011 Jul;28(7):772-7. doi: 10.1111//.1464-5491.2011.03320.x.
10. Martin-Ruiz C, Jagger C, Kingston A, Collerton J, Catt M, Davies K, Dunn M, Hilkens C, Keavney B, Pearce SH, Elzen WP, Talbot D, Wiley L, Bond J, Mathers JC, Eccles MP, Robinson L, James O, Kirkwood TB, von Zglinicki T. Assessment of a large panel of candidate biomarkers of ageing in the Newcastle 85+ study. Mech Ageing Dev. 2011 Aug 16. [Epub ahead of print]
11. Vanderpump MP, Lazarus JH, Smyth PP, Laurberg P, Holder RL, Boelaert K, Franklyn JA; British Thyroid Association UK Iodine Survey Group (including Razvi S, Pearce SH). Iodine status of UK schoolgirls: a cross-sectional survey. Lancet. 2011 Jun 11;377(9782):2007-12.
12. Newby PR, Pickles OJ, Mazumdar S, Brand OJ, Carr-Smith JD, Pearce SH, Franklyn JA; Wellcome Trust Case-Control Consortium (WTCCC), Evans DM, Simmonds MJ, Gough SC. Follow-up of potential novel Graves' disease susceptibility loci, identified in the UK WTCCC genome-wide nonsynonymous SNP study. Eur J Hum Genet. 2010 Sep;18(9):1021-6.
RECENT PUBLICATIONS IN DIABETES & ENDOCRINOLOGY THAT HIT THE NEWS OR THAT MAY HAVE A SIGNIFICANT IMPACT ON MANAGEMENT
Management of hypertension: summary of NICE guidance. T Krause et al. BMJ 2011;343:d4891. An excellent summary of the guidelines with implications for our patients and services. Get ambulatory monitoring entrenched!
Investigating mixed hyperlipidaemia. A Viljoen and AS Wierzbicki. BMJ 2011;343:d5146. A useful clinical practice paper.
Electronic Health Records and Quality of Diabetes Care. RD Cebul et al. NEJM 2011;365:825-833. An excellent article that can be extrapolated to the UK and provides ammunition for those of us wishing to develop an interactice web-based system for both clinical interactions and register use.
Autoimmune encephalitis. SR Irani et al. BMJ 2011;342:d1918. An excellent editorial detailing 2 condition sthat we should be far more vigilant for than we are.
Multiple endocrine abnormalities. CMPG van Durne et al. Lancet 2011;378:540. An excellent case report of a rare cause for pituitary hypophisitis.
Weighing the benefits of high-dose Simvastatin against the risk of myopathy. A Egan & E Colman. NEJM 2011365:285-287. A perspective well worth a read and a reminder that we should no longer be going to Simvastatin 80mg.
Intensive glucose lowering treatment in type 2 diabetes. D Preiss & KK Ray. BMJ 2011;343:d4343. A thought provoking editorial and rather controversial?
Salt reduction lowers cardiovascular risk: meta-analysis of out come trials. FJ He & GA MacGregor. Lancet 2011;378:380-382. An excellent editorial reviewing the effectiveness of salt reduction. Make sure you have salt-reduction leaflets for your hypertensive patients in clinic.
Glycaemic control in type 1 diabetes during real time continuous glucose monitoring compared with self monitoring of blood glucose: meta-analysis of randomised controlled trial using individual patient data. JC Pickup et al. BMJ 2011;343:d3805. An excellent article that should change your practice if not already.
Diabetic ketoacidosis at the onset of type 1 diabetes. BMJ 2011;343:d3278. It is still common! The article acts a s a reminder and should provoke some thoughts on how you should reduce it in your locality.
Glucocorticoid-Induced Bone Disease. RS Weinstein. NEJM 2011;365:62-70. An excellent overview on clinical practice that is well worth a read.
The Lancet volume 378 2011 number 9786 9-15th July. This edition of the Lancet is essential reading. It includes 4 wonderful primary research papers on diet & Physical activity vs. usual care on diagnosis of Type 2 DM by Rob Andrews (some of you may remember Rob) and co, incidence of heart failure in type 1 DM by Lind et al, HbA1c use for pre-diabetes by Heianza et al and MRFIT on screen detected Type 2 DM by Griffin et al. The 4 accompanying Editorials add to the essential read.
National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2.7 million participants. G Danaei et al. Lancet 2011;378:41-40. A mammoth and impressive study adding to the world perspective of diabetes.
Anti-CD3 antibodies for Type 1 diabetes: beyond expectations. JF Bach. Lancet 2011;378:459-460. See linked paper Lancet 2011;378:487-497.
Arresting type 1 diabetes after diagnosis: GAD is not enough. C Mathieu & P Gillard. Lancet 2011;378:291-292. see linked paper Lancet 2011;378:319-327.
New hope for immune intervention therapy in type 1 diabetes. BO Roep. Lancet 2011;378:376-378. See linked paper Lancet 2011;378:412-419.
The above 3 editorials with their linked primary research papers are a must read for an update on immunotherapy in type 1 diabetes.
Bardoxolone Methyl and Kidney Function in CKD with Type 2 Diabetes. PE Pergola et al. NEJM 2011;365:327-336. An antioxidant inflammation modulator useful in CKD. However a very mixed group of CKD patients.
Sharp: a stab in the right direction in chronic kidney disease. KK Stevens, AG Jardine. Lancet 2011;377:2153-2154. See linked paper Lancet 2011;377:2181-2192. An excellent editorial that critically reviews the linked paper and statin therapy in CKD.
Iodine status of UK schoolgirls: a cross-sectional survey. MP Vanderpump et al. Lancet 2011;377:2007-2012. An excellent study with a thought provoking conclusion. This should be a call to action.
Diagnosis, classification, and treatment of diabetes. A Farmer & R Fox. BMJ 2011;342:d3319. An excellent practical editorial.
Time trends in mortality in patients with type 1 diabetes: nationwide population based cohort study. V Harjutsalo et al. BMJ 2011;343:d5364. An interesting study demonstrating improving mortality in early onset type 1 diabetes but increasing mortality in type 1 late onset type 1 diabetes. Read on……………………………………………………………………………………….
NEXT NEWSLETTER Due out beginning of February 2012 so keep the gossip coming.
posted by Arutchelvam at 9:44 PM
