Endodiabology February 2013
ENDODIABOLOGY
Endodiabology.blogspot.com
NORTHEAST
NEWSLETTER
FOR SPECIALTY TRAINEES AND BOSSES TRAPPED
IN THE NORTHERN DEANERY
February 2013
Editors:
Shaz Wahid , Petros Perros and ArutchelvamVijayaraman
Associate Editor: Atif Munir
StR PLACEMENTS (NTN year of training from
1st August 2012)
Newcastle Hospitals
Anjali Shanthakumar (4) (LTFT)
Stuart Little (4)
Hamza Ali Khan(4)
Catherine Napier (4)
Atif Munir(5)
Anna Mitchell ( to start in April)
James Cook University Hospital
Jehangir Abbas (2)
Sviatlana Zhyzhneuskaya (2)
NorthTyneside/ Wansbeck
Kathryn Stewart (4)(LTFT)
Nimantha DeAlwis (5) job share with
NGH community diabetes post
South Tyneside Hospital
Sajid Ethol Kalathil (5)
Gateshead
Naveen Aggarwal (3)
Sunderland
Ali Aldibiati
NorthTees/ Hartlepool
Muhammad Asam (3)
Darlington memorial Hospital
David Bishop(1)
Durham
Dr Gulfam (To start in February2013)
Maternity Leave
Rohana Wright
Research with numbers
Anna Mitchell (Simon Pearce)
Earn Gan (Simon Pearce)
Alison Heggie (Mark Walker)
Sarah Steven (Prof Taylor)
Jakob Buckowzan (Prof Bilous)
Naveen Siddaramaiah (Prof Bilous)
MEETINGS / LECTURES / ANNOUNCEMENTS
·
6th March 2013 SfE Visiting Professor Lynette
Niemann-Newcastle, RVI, James Spence Lecture Theatre 1300-1700 interactive
cases; 1700-1800 Pitfalls and problems in diagnosis of Cushing’s syndrome.
Contact Steve Ball
·
13th March 2013 ½ day SpR G(I)M teaching, Freeman
Hospital. Contact Sue Archibald 0191 223 1247
·
9th April 2013 North East Obesity Forum, University of
Sunderland 0930-1600.
·
24th April 2013 Acute Medicine Conference, Freeman
Hospital. Contact Sue Archibald 0191 223 1247
·
15th May 2013 ½ day SpR G(I)M teaching, Freeman
Hospital. Contact Sue Archibald 0191 223 1247
·
15th-18th June 2013 ENDO 2013, San
Francisco, USA. Contact endostaff@endo-societ.org
or www.endo-society.org/scimeetings
.
·
21st – 25th June
2013 American Diabetes Association 73rd Annual Scientific
Sessions, Chicago, USA. Contact meetings@diabetes.org
.
·
3rd July 2013 ½ day
SpR G(I)M teaching, Freeman Hospital. Contact Sue Archibald 0191
223 1247
·
2nd July 2013 Annual Northern Diabetes in Pregnancy
Meeting. Stadium of light, Sunderland. Contact
·
18th September 2013 ½ day SpR G(I)M teaching, Freeman
Hospital. Contact Sue Archibald 0191 223 1247
·
13th November 2013 ½ day SpR G(I)M teaching, Freeman
Hospital. Contact Sue Archibald 0191 223 1247
·
20th November 2013 Northern Endocrine Region Research and
Audit Group meeting, Lumley Castle, Chester-le-street.
·
26th November 2013 RCP Updates in Medicine, Freeman Hospital.
Contact Sue Archibald 0191
223 1247
TRAINING ISSUES
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. See
below for a course.
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 £400 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.
Management
Training A regional
management programme is in place for StRs. Contact Nimantha De Alwis for more information.
From the TPD I wish to thank all the trainers and
trainees for all your hard work. Despite all the difficulties with placement
and trainee shortage, we had a good year. The ARCP performance continued to
remain good as the trainees achieved 100% in the GIM PYA. Our Speciality ARCP
is to be held on May 21, 22, and 23 as planned. I will send a detailed time
table soon. Please follow the ARCP decision aid for both GIM and speciality and
fulfil all requirements by mid April.
Link for GIM ARCP decision aid
http://www.jrcptb.org.uk/trainingandcert/ST3-SpR/Documents/GIM%20(Acute)%20ARCP%20Decision%20Aid.pdf
Link for Diabetes, Endocrinology ARCP Decision aid
All the trainees will submit a 5
minute presentation with 4 slides about their training so far, achievements,
ambitions and plan for the next rotation. The ARCP panel will actively guide
the trainees. Also, all the trainees, please, send a list of 3 choices of
placements for next year by 26 April 2013. As usual your training requirements
should be married with your choice of placement and I will try hard to place
you with your choice in mind. Please keep in touch with me if you have any
queries.
The STC continuously strive to
maintain high quality of training in the region and we actively promote
research. I am glad to inform that we got funding to pay the full salary for 1
SpR for a full year (Sanofi Diabetes fellowship) with an expectation to be
involved in active diabetes research, service development or to develop an
innovative diabetes management project. This programme has potentials to
continue for the next few years. I am liaising with the trainers currently, and
will come out with the logistics of choosing the trainee/Trainer beneficiary
for the project. I will be grateful if you could write to me with any ideas. We
believe, these will strengthen our programme further. I will contact you all
with full details very soon.
Please write to me, if there are any
issues, concerns and complaints. With the trainee revalidation in place, it is
important to have prompt communication. I promise that I will reply to your e
mails within 24 hours, unless I am away.
Training Committee Programme Director- Arutchelvam Vijayaraman Education CME Lead- Steve Ball ; Quality Management lead-Dr Peter Carey Consultant
member-Shaz Wahid ; Consultant member- Richard Quinton, ; Consultant member-Jean MacLeod, ; Consultant member-Simon Eaton, Consultant member-Salman Razvi ; Consultant
member-Paul Peter ;Consultant member-Jeevan Mettayil ; Consultant Member-Sath Nag ; Consultant member-Nicky Leech ;
StR representative-Sajid Ethol Kalthil ; StR representative-Stuart Little
NEWS FROM THE NORTHEAST
·
Many of you probably missed my (Shaz)
celebrity appearance on Tyne Tees and Look North on 2nd Jan 2013
asking the public to only attend hospital if they have to. It worked and I have
been asked about a regular weekly slot!
·
Congratulations to Jeevan Mettayil on
his award of the Post Graduate Certificate (with Distinction) in Medical
Leadership through the University of London.
·
Richard Quinton is far too clever by
half. He wrote an interesting article on the “Red Aristocracy” in the Economist
(Quinton R. China’s red aristocracy. The
Economist. 2012; Nov 10-16: 18) linking it to the “English”. He is
following in the foot steps of Prof Home who got a letter published in the
Economist 3 years ago on the economics of business class air travel.
·
Congratulations to Dr Suresh Vaikkakara who has been
promoted from Associate to full Professor at: Department of Endocrinology, Sri
Venkateswara Institute of Medical Sciences, Tirupati (AP), India.
·
Teresa Fortune is the new manager for the North East and Cumbria
Diabetes LRN .
LETTERS
SCE
MRCP INTERACTIVE COURSE-If you are planning to sit the SCE MRCP (Endo) or
have a trainee who is doing so, this course will be a very useful interactive
update. We plan to cover all aspects of Endocrinology and Diabetes and we have
gone through a lot of past questions. This is the Fifth Annual Imperial Course
and will be held on Monday 11th March and Friday 3rd May
2013. For details, see http://mrcpendo.com
Karim Meeran
Professor of Endocrinology
Imperial College Faculty of Medicine
Raz Nayar-Regional meeting which should be of
great interest for all our SpRs in clinical practice, research plus
Consultants. The meeting is very popular and regularly attended by all
specialities with an interest in Diabetes and Maternal Health.
They invite
world class speakers to present the latest information and help guide practice
– hence an excellent teaching opportunity for all
Save the date: 2nd July 2013 – Stadium of Light
Annual
Northern Diabetes in Pregnancy meeting via the RMSO (Regional Maternity Survey
office)
Chair/Lead
– Dr Ruth Bell –Senior Lecturer and Prof Rudy Bilious
AM –
Session on Pre-Conceptual Care in Diabetes – Setting Standards and establishing
best practice
PM –
Session – Key Note Speaker, Regional Audit Data via the RMSO and current
regional research projects undertaken are presented. Contact .
Atif
Munir-Young Diabetologist Forum (YDF) Diabetes and Endocrinology taster
session, Hilton Gateshead, 22nd Nov 2012. Event report.
The taster was organised with the firm
belief that our specialty has much more to offer the next generation of doctors
apart from the portrayed doom and gloom of lack of procedures and consultant
posts and that a true insight into the fascinating world of hormones can
certainly spark enthusiasm to attract those who are yet to give their careers a
definite path to join the specialty.
With the above mentioned intention
Young Diabetologist Forum in collaboration with Diabetes UK, Association of
British Clinical Diabetologists and Society for Endocrinology has held a chain
of taster events around UK over the last few months and North East was the next
venue for the event.
Myself and Sajid helped out Stuart
Little (who is a YDF committee member) organise this taster evening with the
kind sponsorship from a leading pharmaceutical company. As expected we found
consultants around the region more than willing to enthuse young trainees by
sharing the diversity and excitement of our work as Diabetologists and
Endocrinologists. Trainee colleagues were equally eager to contribute and add a
trainee perspective to the event. Medical staffing and education departments
around the region helped us ensure that the event invitation was mailed to
every foundation and core medical trainee working in the Deanery. The event was
also advertised on e-portfolio.
On the day trainees were welcomed with
information packs and drinks. The programme compromised of a medley of brief
presentations. Dr Perros welcomed the trainees and his expression of passion
for his work provided a befitting start to the evening. Professor Marshall`s
reassurance about the need for tomorrow's Diabetologists and a glimpse of the
numerous research opportunities in the region was stimulating. Srikanth
demystified the false monotony that is usually attributed to our day to day
job. Form a trainee perspective Nimantha gave the trainees a flavour of what
working life is like as a specialist Diabetes & Endocrine trainee, Kathryn
spoke about how being a flexible trainee enables her maintain an excellent work
life balance and Gus gave a very personal perspective of what made him join
Diabetes & Endocrinology which was scintillating and inspirational.
Over dinner the attending juniors had
a chance to mingle with speakers and organisers and have a very informal chat
which all of them and us thoroughly enjoyed. The feedback from the taster was
positive. We may not have influenced many to apply for our specialty during the
forthcoming application round but I guess we have made an effort of informing
our juniors of “what lies beneath”.
Francesca
Swords-I wanted to make you aware of some developments with
Endobible.com, which may be of benefit to your trainees. As you may recall, I
developed this online training tool for junior doctors and non-specialists to
aid the diagnosis and treatment of endocrine conditions a couple of years ago.
We've recently expanded Endobible.com with a new section on
Paediatric Endocrinology, and refreshed the design a little. I’d particularly
like to thank Professor Martin Savage and Dr Helena Gleeson for their helpful
comments on this. We are also in the process of writing new sections on
endocrine emergencies and on congenital adrenal hyperplasia in response to various
queries.
The site remains free to access, but we are currently seeking
feedback from visitors to www.endobible.com to help
improve it in the future. I’m also hoping this will help us to keep the service
free!
Please forward this email to your trainees if you feel it would
be of use, and if you do have a couple of minutes to visit the site and fill in
the survey, it would be greatly appreciated.
Furthermore, its sister training tool - www.diabetesbible.com - has recently
had its section on gestational diabetes updated. Trainees might also want to
have a look at this. http://www.diabetesbible.com/condition/gestational-diabetes-mellitus/
Many thanks for your help and comments on this.
RECENT PUBLICATIONS FROM THE NORTHEAST
1.
Christopher
J. Boos,Pete D. Hodkinson, Adrian Mellor, Nick P. Green, Daniel Bradley, Kim
Greaves, David R Woods. The Effects
of Prolonged Acute Hypobaric Hypoxia on Novel Measures of Biventricular Performance. Echocardiography in press, 10.1111/echo.12088
2.
Balasubramanian R & Quinton R. Secondary hypogonadism. In Oxford Endocrinology
Library: Testosterone Deficiency in Men, TH Jones, Ed.
Oxford University Press [ISBN 978-0-19-965167-2]; 2013; Chapter 5: pp45-56.
3.
Jones TH
& Quinton R. Puberty & Fertility. In Oxford Endocrinology
Library: Testosterone Deficiency in Men, TH Jones, Ed. Oxford
University Press [ISBN 978-0-19-965167-2]; 2013; Chapter 5: pp83-88.
4.
Smith N, Quinton
R. A patient’s journey: Kallmann syndrome. BMJ. 2012; 345:
e6971.
5.
Gan EH, Macarthur K, Mitchell AL, Pearce SH The role of functionally defective rare germline variants of
sialic acid acetylesterase in autoimmune Addison's disease. Eur
J Endocrinol. 2012 Dec;
167(6):825-8
6.
Gan EH, Pearce SH. Clinical review: The thyroid in mind: cognitive function and low
thyrotropin in older people. J Clin Endocrinol Metab. 2012 Oct;97(10):3438-49.
7.
J Hoffmann,
K Fiser, Jolanta Weaver et al. High-Throughput 13-Parameter
Immunophenotyping Identifies
Shifts in the Circulating T-Cell Compartment Following Reperfusion in Patients with Acute
Myocardial Infarction.
PLOS one 2012;7:e47155.
RECENT PUBLICATIONS IN DIABETES & ENDOCRINOLOGY THAT HIT THE NEWS OR
THAT MAY HAVE A SIGNIFICANT IMPACT ON MANAGEMENT
How to avoid precipitating an acute adrenal crisis. JAH
Wass and W Arlt. BMJ 2012;345:e6333. A very timely
editorial well worth a read. It was also discussed at NERRAG in relation to
presentation.
Calcium intake and risk of primary hyperparathyroidism
in women: prospective cohort study. JM Paik et al. BMJ 2012;345:e6390. A well designed study supporting calcium supplementation in reducing
the risk of primary hyperparathyroidism. Its generalisability is an issue. The
accompanying editorial by James Norman (BMJ 2012;345:e6646) is well worth a
read.
Fracture risk and zoledronic acid therapy in men with
osteoporoses. S Boonen et al. NEJM 2012;367:1714-1723. Effective evidence that zoledronic acid reduces vertebral fracture risk
in men with osteoporoses by 67%.
C-Reactive protein, fibrinogen and cardiovascular
disease prediction. The emerging
risk factors collaboration. NEJM 2012;367:1310-1320. During this time of frugality should we use CRP and fibrinogen in
patients deemed at intermediate risk for cardiovascular disease to reduce 1 death
in every 400-500 people screened? Answers on a post card.
Associations of kidney disease measures with mortality
and end-stage renal disease in individuals with and without hypertension: a
meta-analysis. BK Mahmoodi et al. Lancet 2012;380:1649-61.
Associations of kidney disease measures with mortality
and end-stage renal disease in individuals with and without diabetes: a
meta-analysis. CS Fox et al.
Lancet 2012;380:1662-73. eGFR comes to the risk
equivalent party! Both trials show that individuals with even mild to moderate
CKD without either hypertension or diabetes have just as high a mortality and
ESRD risk as those with either hypertension or diabetes. We should remember the
lessons of Steve Haffner’s seminal study in the NEJM in 1998. I still remember
citing it at my NTN interview. The panel thought it was a refreshing change as
everyone had talked about UKPS. 15-yrs fast forward and I think we can say that
Type 2 Diabetes is not a cardiac disease/MI risk equivalent condition?? The
accompanying editorial by Paul Stevens and Christopher Farmer (Lancet
2012;380:1628-1629) I think gives a very balanced perspective.
Use of HbA1c in the diagnosis of diabetes. A Farmer.
BMJ 2012;345:e7293. Overall an editorial that extols the
virtues of HbA1c alone. I still struggle with using HbA1c alone and indeed our
local guidelines recommend the use of both HbA1c and Fasting Glucose together,
leaving the OGTT to situations where HbA1c can be misleading or where there is
incongruity. Using HbA1c alone still will only identify 1/3rd of the
population with diabetes and although I keep hearing “you will eventually get
your man!” with repeat testing I struggle with that concept hence why we have
gone for 2 better than 1 as our guiding principle. Happy to debate…………………………………………………………………………
Atorvastatin with or without an antibody to PCSK9 in
primary hypercholesterolaemia. EM Roth et al.
Treatments that target serum proprotein convertase subtilisin/kexin 9 to reduce
the degradation of LDL receptors, hence mopping up more cholesterol from the
circulation are truly exciting. The latest trial demonstrates that the compound
SAR236553 added to wither 80mg or 10mg Atorvastatin can effectively reduce LDL
to target levels.
Screening for type 2 diabetes and population mortality
over 10-yrs (ADDITION-Cambridge): a cluster-randomised controlled trial. RK
Simmons et al. Lancet 2012;380:1741-1748. In this
well designed study screening high-risk individuals for Type 2 diabetes
resulted in no effect on all-cause, cardiovascular or diabetes related
mortality over 10-years. As the accompanying editorial by Engelgau and Gregg
(Lancet 2012;380:1716-1718) rightly points out screening could be justified by
reducing complications and improving quality of life, so that part of the equation
still deserves attention complex as it might be to study!
Resistant hypertension. A Myat et al. BMJ
2012;345:e7473. Well worth a read. I am engaging with my
local Renal colleagues in their resistant hypertension pathway as
(commissioners approval pending) they have the ability to undertake sympathetic
denervation of the renal arteries. Something else to add to ones renal diabetes
service.
Effects of Dalcetrapib in patients with a recent acute
coronary syndrome. NEJM 2012;367:2089-2099. Another
nail in the coffin for cholesteryl ester transfer protein inhibitors that raise
HDL.
The spectrum of thyroid disease and risk of new onset
atrial fibrillation: a large population cohort study. C Selmer et al. BMJ
2012;345:e7895. This study demonstrates a rather
continuous risk of thyrotoxicosis through the spectrum of high normal
euthyroidism, subclinical hyperthyroidism and throtoxicosis with the reverse
applying got low normal euthyroidism, subclinical hypothyroidism and
hypothyroidism with dependency on TSH level.
Vitamin B12 deficiency. SP Stabler. NEJM
2013;368:149-160. An interesting read with a rather American
flavour. It does make me question our B12 assay and will fuel the debate I plan
to have with our local haematologist.
Exenatide once weekly versus liraglutide once daily in
patients with type 2 diabetes (DURATION-6): a randomised, open-lable study. JH
Buse et al. Lancet 2013;381:117-124. Not a fan of once weekly exanatide and
yet to use it. Interestingly liraglutide shaded it. The accompanying editorial
by Theti and Fonseca (Lancet 2013 381:93-94) well worth a read.
Managing delayed puberty or altered puberty in boys.
Nelly Pitteloud. BMJ 2013;345:e7913. An excellent
editorial supporting the accompanying papers on Klinefelter’s and Kalllmann’s
syndromes (BMJ 2013;345:e7558, BMJ
2013;345:e6938, BMJ 2013;345:e6971).
Lomitapide for homozygous familial
hypercholesterolaemia. FJ Raal. Lancet 2013;381:7-8. An excellent editorial for the accompanying trial (Lancet
2013;381:40-46) discussing a new class of drug that targets microsomal transfer
protein, with its inhibition reducing the production ApoB-containing
lipoproteins that are the precursors of LDL.
Strategies for multivessel revascularisation in
patients with diabetes. ME Farkough et al. NEJM 2012;367:2375-2384. Diabetes will certainly keep our Cardiothoracic Surgeons in a job with
another trial showing the benefit of CABG instead of PCI in diabetes. The
accompanying editorial (NEJM 2012;367:2437-2438) adds to the discussion.
NEXT NEWSLETTER Due out beginning of June 2013 so keep
the gossip coming.
posted by Arutchelvam at 11:00 PM
