Monday, February 25, 2013

Endodiabology 2013 Issue 1 February


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  

·       26th February 2013 SfE Clinical Cases. London. Contact www.endocrinology.org/meetings
·       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 
·       13th-15th March 2013 Diabetes UK APC. Manchester. Contact www.diabetes.org.uk/conference
·       18th-21st March 2013 BES 2013. Harrogate. Contact www.endocrinology.org/meetings .
·       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 
·       4th-6th November 2013 SfE Clinical Update, Bristol. Contact www.endocrinology.org/meetings
·       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
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 EndocrinologySri Venkateswara Institute of Medical SciencesTirupati (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 ALPearce SH The role of functionally defective rare germline variants of sialic acid acetylesterase in autoimmune Addison's disease. Eur J Endocrinol2012 Dec; 167(6):825-8
6.      Gan EHPearce SHClinical 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.