Endodiabology October 2013
ENDODIABOLOGY
October 2013
NORTHEAST NEWSLETTER
FOR SPECIALTY TRAINEES AND BOSSES TRAPPED
IN THE NORTHERN DEANERY
Editors:
Shaz Wahid (shahid.wahid@stft.nhs.uk)
and
Petros
Perros (petros.perros@ncl.ac.uk)
and Arut
Vijayaraman (riarut@aol.com )
Associate Editor: Atif Munir
StR PLACEMENTS
Royal Victoria Infirmary
Rohana Wright LTFT from July 2013
Anna Mitchell
Zehangir Abbas
Jakub Bukowczan
Sviatlana Valeryevna Zhyzhneuskaya
Muhammed Asam
Vacant post
James Cook University Hospital
Naveen Aggarwal
David Bishop
Vacant post
North Allerton/ JCUH
Yasir Mamooji-7 August 2013 till 1 Jan
2014
Mavin MacCauley from 2.1.14
NorthTyneside
Hamza Ali Khan
Wansbeck
Jakub Bukowczan For the month of August
from 7.8.13 to 1.9.13
Anjali Shanthakumar- LTFT From 2 Sep 2013 to 28th February 2014
Stuart Little From 1st March 2014 till 2nd September
2014
Community Diabetes
Stuart Little From 2 September 2014 till 28th Feb 2014
Anjali Shanthakumar- LTFT From 1
March 2014 For 6 months/ Till CCT
Queen Elizabeth Hospital
Murali Ganguri from 2 September 2013 to
1ST January 2014
Sarah Steven- From 2nd Jan 2014
South Tyneside Hospital
Earn Hui Gan
Durham
Taimur Gulfam
Darlington
Ali Aldibiat
North Tees Hospital
Artham Sathish
Hartlepool Hospital
Yasir Mammoji - from 1.2.14
Sunderland
Nimantha De Alwis
Murali Ganguri from 2nd
January 2014
Research with numbers
Naveen Siddaramaiah (Prof Rudy Bilous)
Alison Heggie (Prof Mark Walker)
Catherine Napier (Prof Simon Pearce)
MEETINGS / LECTURES / ANNOUNCEMENTS
·
10th October 2013 Northern
Endocrine & Diabetes Autumn CME, JCUH, Middlesbrough. Contact naveensidd@doctors.org.uk
·
16th October 2013 North East Obesity Forum: Commissioning obesity intervention in
the new public health era. Research Beehive, Newcastle University (Room 2.02,
4-6pm). http://www.aso.org.uk/events/
·
7th-8th November
2013 ABCD autumn
meeting, London. Contact www.diabetologists.org.uk
followed by SpRs meeting.
·
13th November 2013 ½ day SpR G(I)M teaching, Freeman
Hospital. Contact Sue Archibald 0191 223 1247 sue.archibald@nuth.nhs.uk
.
·
20th November 2013 Northern Endocrine Region Research and
Audit Group meeting, Lumley Castle, Chester-le-street. Contact Shahid.wahid@stft.nhs.uk
·
21st & 22nd
November 2013 Insulin
Infusion Pump Course, Middlesbrough, JCUH. Contact nicky.scippon@stees.nhs.uk
·
26th November 2013 RCP Updates in Medicine, Freeman Hospital.
Contact Sue Archibald 0191
223 1247 sue.archibald@nuth.nhs.uk .
·
15th January 2014 ½ day SpR G(I)M teaching, Freeman
Hospital. Contact Sue Archibald 0191 223 1247 sue.archibald@nuth.nhs.uk
.
·
13th March 2014 ½ day SpR G(I)M teaching, Freeman
Hospital. Contact Sue Archibald 0191 223 1247 sue.archibald@nuth.nhs.uk
.
·
30th April 2014 Acute Medicine Conference, Freeman
Hospital. Contact Sue Archibald 0191 223 1247 sue.archibald@nuth.nhs.uk
.
·
14th May 2014 ½ day SpR G(I)M teaching, Freeman
Hospital. Contact Sue Archibald 0191 223 1247 sue.archibald@nuth.nhs.uk
.
·
13th – 17th June
2014 American Diabetes Association 74th Annual Scientific
Sessions, San Francisco, USA. Contact meetings@diabetes.org
.
·
21st – 24th June
2013 ENDO 2014 incorporating International Congress of Endocrinology,
Chicago, USA. Contact endostaff@endo-societ.org
or www.endo-society.org/scimeetings
·
2nd July 2014 ½ day SpR G(I)M teaching, Freeman
Hospital. Contact Sue Archibald 0191 223 1247 sue.archibald@nuth.nhs.uk
.
·
17th September 2014 ½ day SpR G(I)M teaching, Freeman
Hospital. Contact Sue Archibald 0191 223 1247 sue.archibald@nuth.nhs.uk
.
·
12th November 2014 ½ day SpR G(I)M teaching, Freeman
Hospital. Contact Sue Archibald 0191 223 1247 sue.archibald@nuth.nhs.uk
.
·
25th November 2014 RCP Updates in Medicine, Freeman Hospital.
Contact Sue Archibald 0191
223 1247 sue.archibald@nuth.nhs.uk .
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 nimdeal@googlemail.com for more information.
From the TPD Thanks for all your hard work,
we had another good year. We achieved 100% recruitment for NTN and 100%
outcome1 in ARCP both in GIM and speciality and received accolades from the
Medical School. Now, we have the tougher task of maintaining the high
standards, you all set.
Ongoing quality
improvement projects for the training programme
1- Development of
Deanery induction pack and strengthening the speciality website within the
deanery umbrella, with guidance from the HENE
2- Successfully
achieved a fellowship within the training programme, undertaking a good quality
research
3- Strengthening
our teaching programme- MERIT and full day CMEs will be back in place. You will
get the full timetable soon. I request you all to engage with once a month
teaching for your trainees. Shaz has put a nice programme in place which is
impressive. The trainees hugely value these focussed teachings.
4- Trainee
Representative, Stuart Little, is undertaking a trainee survey. I will be
grateful if all the trainees fill a survey for each unit they worked in. This
will be hard work, but your input will have a great impact on our training
programme
5- Steve Ball,
Jeevan, Sath , Ashwin, Praveen, Anna and the team are working on developing and
consolidating the Northeast Endocrine Network, which is an exciting regional
development
6- We will be
developing post - CCT fellowships within the region with sub-specialities
(Example Pituitary, In patient diabetes, Etc). The National SAC is working on
getting educational accreditation for these posts
7- We all should
work further on our research profile. One of the quality standards we will
assess is the number of presentations and publications our trainees achieve.
Please let me know, if you have any
suggestions, and I assure you that I will work on them promptly.
Meet you all in Lumley Castle in
November.
Training Committee Programme Director- Arutchelvam Vijayaraman Vijayaraman.Arutchelvam@stees.nhs.uk;
Education CME Lead- Steve Ball s.g.ball@ncl.ac.uk
; Quality Management lead-Dr Peter Carey Peter.Carey2@chs.northy.nhs.uk; Consultant
member-Shaz Wahid Shahid.wahid@stft.nhs.uk
; Consultant member- Richard Quinton, Richard.Quinton@nuth.nhs.uk; Consultant member-Jean MacLeod, Jean.Macleod@nth.nhs.uk; 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
;Consultant member-Jeevan Mettayil jeevan.mettayil@stft.nhs.uk
; Consultant Member-Sath Nag sath.nag@stees.nhs.uk
; Consultant member-Nicky Leech nicola.leech@nuth.northy.nhs.uk;
StR representative-Sajid Ethol Kalathil sajidek@hotmail.com
; StR representative-Stuart Little stuartlittle@doctors.org.uk
NEWS FROM THE NORTHEAST
·
Congratulations to Naveen Siddaramaiah
who has won the North East Sanofi Diabetes fellowship this year-see letters
section.
·
Welcome to Dr
Vasileios Tsatlidis, who has started working at the QE as a new consultant in
diabetes and endocrinology in a locum capacity for the next 3 years. Vasileios
trained in Greece and more recently in Sheffield.
·
Some of you
may remember Subir Ray, a former trainee on the rotation, who went to India
post training. He is visiting the UK to attend his FRCP ceremony.
LETTERS
Dealing with difficult people-a reflection by Shaz Wahid
Developing
my skills in dealing with difficult people has been in my PDP for 2 years. Due
to time and finances targeting this developmental need with a course/workshop
has not been possible. Hence, I have read around the area and reflected on this
issue. The book by Karen Mannering: Dealing with difficult people, Hodder
Education, 2008; was my starting point. The book clearly has a business flavour
and slant; however the principles can easily be applied to healthcare and
certainly my roles a Clinician, Leader and Follower.
When
dealing with difficult people there is one universal truth: “There is no quick
fix or magic wand that changes the behaviour of others”.
There is
always a dynamic when dealing with difficult people that is often changed by
ones intervention however subtle. A difficult person can be described as:
· Aggressive
· Know-it-all
· Selfish
· Negative
· Passive and passive aggressive
· Overly accommodating
· Insecure
· High maintenance
, and
importantly oneself. Reading the description of the above behaviours has given
me an insight into understanding such people and how to deal with them in my
interactions.
The one
concept that has been eye opening is an introduction in body language and how
applying some simple principles can allow me to better manage difficult
interactions. There are 5 basic visual tells that can be recognised from facial
expressions:
· Disgust
· Anger
· Sadness
· Happiness
· Fear
,
remembered by the mnemonic DASHFear. Remember this diagramme when looking at
eye movements:
There is
one basic over-riding approach when dealing with difficult people that I should
apply, and that is to adjust my approach verbally, bodily and mentally in a
positive manner that reflects positive behaviours that should be mirrored by
difficult individuals that I deal with. When dealing with difficult individuals
that I manage as their leader I should bear in mind the team personality that
is illustrated below:
I believe I
have the knack of juggling myself, the needs of my organisation and the needs
of the team to meld a team personality that is effective. My work within
A&E is demonstrable evidence of this where I had to manage a “difficult
team” with “difficult” people due to the important needs of my organisation.
The journey from 2009 has had ups and downs and indeed if I had been armed with
what I have learnt in the last 2 weeks I would have probably hit the ground
running. The negative experiences have allowed me to turn them into positives.
Having read
how Karen Mannering would deal with:
· Difficult employees
· Difficult managers
· Difficult colleagues
· Difficult customers
· Difficult suppliers
· Difficult people from other countries and cultures
, and
utilised the case studies supplied I have learnt some new techniques to manage
and cope with the above scenarios within a health care setting in my various
roles and interactions.
Being
self-aware of when I can be difficult has been fruitful to learn about having
read Karen Mannering’s approach. I already undertake a lot of self-reflection
from feedback. It has been the more subtle techniques to remember that have
been useful. Furthermore, I am not always the leader and being the follower is
an important corporate role I have within my Trust. I would highly recommend
reading this web link:
, sent to me by a friend (RQ).
Followership styles can be summed up in the diagramme below:
, I see myself as an exemplary
follower although my experience has taught me to be a pragmatist at times just
to survive.
The approach described by Karen
Mannering in dealing with conflicting team members:
· Keeping an eye on the balance
· Taking a helicopter or meta view
· Divorcing the situation from the emotion
· Identifying core team objectives
· Reinforcing the benefits of a positive outcome
, has been
a welcoming read as I indeed dealing with this scenario on a relatively
frequent basis following some management changes. Having read Karen’s book the
suggested 12-point tool box of ideas and techniques that I shall remember to
utilise in dealing with difficult people are:
1.
Don’t take
it personally or get personal.
2.
Plan for
emotion, it is only natural.
3.
Listen, acknowledge
and validate.
4.
Be calm and
assertive.
5.
Putting the
onus on yourself.
6.
Leave them
the bus fare home.
7.
Make a
break-changing body language.
8.
Take ten.
9.
Own your
feelings.
10.
Levelling
technique.
11.
Know the
“rules” in your organisation.
12.
Stay
positive.
Reviewing
the resources that Karen used for her books: Time management; 7-habits of
highly successful people; neurolinguistic programming and body language;
coaching; along with another gift from a friend (RQ sending me a pocket
management book on emotional intelligence) I have a clear plan of where to go
from here.
I think I
do at some point need to undertake the Trust training available on customer
care and conflict resolution. A free resource, but time is a commodity. Perhaps
in next year’s PDP?
I have invested in the following
pocket management books:
·
Body Language Pocketbook
·
Time Management Pocketbook
·
The Resolving Conflict Pocketbook
·
Teambuilding Activities
Pocketbook
·
Leadership Pocketbook
, that I
shall read and review for future ENDODIABOLGY editions. Check out the website: www.pocketbook.co.uk . I do hope you have enjoyed reading this article and it invokes
more inquisitive behaviour.
Update from Mark Walker on Clinical Research Networks
As many of you will be aware, the comprehensive local
research networks are to be replaced by 15 Regional Clinical Research Networks.
Ours is the North East and North Cumbria CRN which maps geographically to our
diabetes network. We are currently undergoing a process of transition, by which
our local topic and comprehensive networks re-structure into the new CRN. At
this stage, the Newcastle Hospitals NHS Foundation Trust has been appointed
host to our CRN. The new structure arranges the specialties into 6 Divisions.
Diabetes, metabolic medicine, endocrinology, renal stroke and cardiovascular
are grouped into a single division. The other 5 divisions bring together other
specialties. This divisional structure is replicated nationally across all 15
CRNs. The new structure is due to be in place by April 2014-ie very soon
although there is a lot of work to be done in appointing managers and staff.
Our diabetes team will work with the research staff drawn together from
the other specialties that comprise our Division. How all this
works across the trusts across the Region needs to worked out, but the overall
principle will be the same-the delivery of portfolio studies to time and
target. I’ll keep you posted as the process evolves, but if you have any
queries in the meantime I can be contacted by e-mail.
RADS2
trial-Catherine Napier
We would be grateful if you could
consider any patients with a new diagnosis of autoimmune Addison’s disease
(AAD) for inclusion in the ongoing RADS2 trial. The summaty for RADS2:
-Patients aged between 10-65 years of
age, with a diagnosis of AAD within the preceding 4 weeks.
-Open-label,
pilot study involving administration of B lymphocyte depleting immunotherapy
(Rituximab) with depot Synacthen to stimulate adrenocorticotrophic drive.
-Primary endpoint is restoration of
steroidogenic function.
-Part B is a non-interventional
observational study of the natural history of conventionally treated Addison’s
disease. It is appropriate for patients who fulfil the inclusion criteria for
the above trial, but are unsuitable (e.g. chronic asthma) or unable to
participate.
We are happy to discuss potential
patients, or any aspect of the study. If you do diagnose a patient who may be eligible, please put the
patients in contact with us. In the first RADS study, around half of the
potential patients who attended the Clinical Research Facility for an initial
visit, entered the trial. We value the opportunity to arrange to meet with
patients at this stage so we can discuss the study in more detail and perform a
full eligibility assessment.
Many thanks, Catherine
Napier and Simon Pearce
RECENT PUBLICATIONS FROM THE NORTHEAST
1. Thyroid and Aging or the Aging Thyroid?
An Evidence-Based Analysis of the Literature. Naveen Aggarwal and Salman
Razvi. Journal of Thyroid Research, Volume 2013 (2013), Article
ID 481287, 8.
2. Wilkes
S, Pearce S, Ryan V, Rapley T, Ingoe L, Razvi S. Study of Optimal Replacement of Thyroxine in the ElDerly
(SORTED): protocol for a mixed methods feasibility study to assess the clinical
utility of lower dose thyroxine in elderly hypothyroid patients: study protocol
for a randomized controlled trial. Trials.
2013 Mar 22;14:83.
3. Taylor
PN, Razvi S, Pearce SH, Dayan CM. A review of the clinical consequences of variation in thyroid
function within the reference range. J Clin
Endocrinol Metab. 2013 Sep;98(9):3562-71.
4. Napier C, Pearce SHS. How should I approach
standard endocrine evaluation in patients with coeliac disease? Clin
Endocrinol (Oxf). 2013; 79: 464–467.
5. Gan EH, Pattman S, Pearce
SHS, Quinton R. A UK epidemic of
testosterone prescribing, Clin Endocrinol (Oxf). 2013; 79: 564–570
6. Quinton
R. The usefulness of metformin for
diabetes control in older people. BMJ.
2013. 346:f3077. doi: 10.1136/bmj.f3077.
7. Costa-Barbosa FA, Balasubramanian R, Keefe KW, Shaw
ND, Al-Tassan N, Plummer L, Dwyer AA, Buck CL, Choi JH, Seminara SB, Quinton
R, Monies D, Meyer B, Hall JE, Pitteloud N, Crowley WF Jr. Prioritizing genetic testing in patients with Kallmann syndrome
using clinical phenotypes. J Clin Endocrinol
Metab. 2013. 98:E943-53. doi:
10.1210/jc.2012-4116.
RECENT PUBLICATIONS IN DIABETES & ENDOCRINOLOGY THAT HIT THE NEWS OR
THAT MAY HAVE A SIGNIFICANT IMPACT ON MANAGEMENT
INCRETINS Well what do I
say. Worth reading these citations: BMJ 2013;346:f3680. BMJ 2013;346:f3617. MBJ
2013;346:f3692. BMJ 2013;347:f4379. BMJ 2013;346:f4382. BMJ 2013;347:f4383. BMJ
2013;347:f4386. I am using them, educating patients and avoiding where
appropriate.
Cardiovascular effects of intensive lifestyle
intervention in type 2 diabetes. The look AHEAD Research Group. NEJM
2013;369:145-154. One of my colleagues (a Stroke Physician)
took this to mean exercise and weight loss do not matter in diabetes after he
read the on-line article. Imagine my embarrassment as I wait to read the
articles in print. I put him right though and the excellent editorial by
Hertzel Gesrstein (NEJM 2013;369:189-190) is well worth a read. The message I
have put out is that we should more effectively target our pre-diabetic
patients and introduce similar initiatives to DESMOND. I just got to get the
commissioners to listen.
Threshold-based insulin-pump interruption for reduction
of hypoglycaemia. RM Bergenstal et al. NEJM 2013;369:224-232. A well designed study demonstrating the benefit of sensor augmented
insulin pump therapy for reducing nocturnal hypoglycaemia.
Teriparatide and denosumab, alone or combined, in women
with postmenopausal osteoporosis: the DATA study randomised trial. JN Tsai et
al. Lancet 2013;382:50-56. The combination of these 2
therapies is promising and impressive. More long term data is required though
and the accompanying editorial by Richard Eastell and Jennifer Walsh is well
worth a read on this area (Lancet 2013; 382:5-7).
Association of maternal vitamin D status during
pregnancy with bone-mineral content in offspring: a prospective cohort study.
DA Lawlor, et al. Lancet 2013;381:2176-2183. A
negative study adding to the inconsistent data available for this area. It
reinforces the need for targeted supplementation in line with NICE guidance,
although I can see the e-mail being composed by RQ to myself already! The
accompanying editorial by Philip Steer (Lancet 2013;381:2144-2145) provides a good overview on this area.
Mutations affecting G-protein subunit alpha-11 in
hypercalcaemia and hypocalcaemia. MA Nesbit, et al. NEJM 2013;368:2476-2486. I have always found g-protein related pathology easy to understand and
not go over my head at the molecular level. This paper adds to the growing list
and the accompanying editorial by Allen Spiegel (NEJM 2013;368:2515-2516) is an
excellent read.
Central precocious puberty caused by mutations in the
imprinted gene MKRN3. AP Abreu et al. NEJM 2013;368:2467-2474. For you gene geeks-says he living in a glass house! The editorial by
Ieuan Hughes (NEJM 2013;368:2513-2514) puts it into perspective for me.
Risk of incident diabetes among patients treated with
statins: population based study. AA Carter, et al. BMJ 2013;346:f2610. High potency satins compared to pravastatin increase risk of new onset
diabetes in this database review.
The editorial by Risto Huupponen and Jorma Viikari (BMJ 2013;346:f3156)
adds some balance.
Mechanisms of hypoglycaemia-associated autonomic
failure in diabetes. PE Cryer. NEJM 2013;369:362-372. An essential read that adds to ones clinical practice.
Thyroid cancer: zealous imaging has increased detection
and treatment of low risk tumours. JC Morris, VM Montori. BMJ 2013;347:f4706. A controversial series of articles. After the one devoted to CTPAs and
PEs it was suggested to me by one of our radiologist we should leave small PEs
alone-“even I am not that brave” was my reply. So, do we leave nodules 0.5-15mm
without features of malignancy alone?
Glucose levels and risk of dementia. PK Crane, et al.
NEJM 2013;369:540-548. An interesting take on
another risk factor for dementia. Personally I say take up chess and playing
the piano.
Estimated GFR and risk of death-is cystatin C useful?
JR Ingelfinger, PA Marsden. NEJM 2013;369:974-975. An excellent editorial on the linked article by MG Shlipak et al (NEJM
2013;369:932-943). Adding cystatin C to the eGFR equation is coming and I think
adds value.
SGLT2 inhibitors for diabetes: turning symptoms into
therapy. M Diamant, LM Morsink. Lancet 2013;382:917-918. Editorial linked to the article by WT Cefalu et al (Lancet
2013;382:941-950). A useful overview, although many of you will probably be
well versed with these new therapies. I have 3 patients on dapaglifozin, so
will see how it goes.
Gonadal steroids and body composition, strength and
sexual function in men. JS Finkelstein et al. NEJM 2013;369:1011-1022. An essential read that utilises classical endocrinology of block and
replace as the study method. The accompanying editorial by David Handelsman
(NEJM 2013;1058-1059) adds to the study results and poses more questions for
future study.
posted by Arutchelvam at 10:49 PM
