Endodiabology February 2011 Issue 1
ENDODIABOLOGY
Endodiabology.blogspot.com
NORTHEAST
NEWSLETTER
FOR SPRs AND BOSSES TRAPPED
IN THE NORTHERN DEANERY
February 2011
Editors: Shaz Wahid (shahid.wahid@sthct.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- Atif Munir (2), Sajid Ethol Kalathil (2), Catherine Napier (2), Naveen Aggarwal (2), Hamza Ali Khan (2), Agnieska Sawiecicka (1), Vacant
• North Tyneside/Wansbeck- Alison Heggie (1), Vacant
• South Tyneside- Nimanthe De Alwis (2)
• Gateshead- Eeelin Lim (5)
• Sunderland- Jacog Buckovan (1), vacant
• North Tees/Hartlepool- Sudeep Manohar (4), vacant
• Middlesbrough- Arif Ullah (4), Naveen Siddaramaiha (4), Shunmugam Nelliyappan (1)
• Bishop Auckland/Darlington/Durham- Sathia Rajhavan(1), Vacant
• NGH- Srikanth Mada(4),
• 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),
• Maternity Leave Rohana Wright (3), Anjali SanthaKumar (3), Kathryn Stewart (3)
MEETINGS / LECTURES / ANNOUNCEMENTS
• 1st March 2011 SfE National Clinical Cases Meeting, Royal Society of Medicine, London. Contact conferences@endocrinology.org NOTE submissions deadline is 25th October 2010.
• 16th March 2011 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247 Lorraine.waugh@tfh.nuth.northy.nhs.uk
• 24th March 2011 Newcastle Magnetic Resonance Centre Symposium, Lindisfarne Room, 1st Floor, Kings Road Centre, NCLE. Contact beverly.hailstone@ncl.ac.uk We have both Hannele Yki-Jarvivnen and Michael Roden, two of the world’s most sought after speakers talking about the cutting edge of diabetes knowledge. There is no registration fee.
• 30th March – 1st April 2011 DUK Annual Professional Conference, London, ExCel ICC. Contact www.diabetes.org.uk NOTE abstract submission deadline 31st October 2010.
• 7th & 8th April 2011 Insulin Infusion Pump Course, JCUH, Middlesbrough. Contact nicky.skippon@stees.nhs.uk
• 11th-14th April 2011 SfE British Endocrine Societies annual conference, Birmingham ICC. Contact conferences@endocrinology.org NOTE abstract submissions deadline 15th November 2010.
• 13th April 2011 Northern Region Acute Medicine Study Day, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247 Lorraine.waugh@tfh.nuth.northy.nhs.uk
• 5th-6th May 2011 ABCD spring meeting, London. Contact www.diabetologists.org.uk
• 11th May 2011 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247 Lorraine.waugh@tfh.nuth.northy.nhs.uk
• 17th May 2011North East Obesity Forum, Obesity and Pregnancy, Stockton, Durham University, Queens Campus. Contact Louisa.ells@nepho.org.uk or Helen.moore@durham.ac.uk or Rachel.gallo@newcastle.ac.uk
• 18th May 2011 Northern Endocrine & Diabetes Summer CME, University Hospital of North Durham. Contact Sarah Steven sarah.steven@doctors.org.uk or Srikanth Mada srikanth.mada@nhs.net
• 4th-7th June 2011 ENDO 2011, Boston, USA. Contact endostaff@endo-societ.org or www.endo-society.org/scimeetings .
• 16th June 2011 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247 Lorraine.waugh@tfh.nuth.northy.nhs.uk
• 24th – 28th June 2011 American Diabetes Association 71st Annual Scientific Sessions, San Diego, USA. Contact meetings@diabetes.org .
• 13th July 2011 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247 Lorraine.waugh@tfh.nuth.northy.nhs.uk
• 12th - 16th September 2011 47th EASD annual meeting, Lisbon, Portugal. Contact www.easd.org
• 14th September 2011 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247 Lorraine.waugh@tfh.nuth.northy.nhs.uk
• 12th October 2011 Northern Endocrine & Diabetes Autumn CME, JCUH, Middlesbrough. Contact Sarah Steven(sarah.steven@doctors.org.uk ) or Srikanth Mada (srikanth.mada@nhs.net )
• 16th November 2011 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247 Lorraine.waugh@tfh.nuth.northy.nhs.uk
• 24th & 25th November 2011 Insulin Infusion Pump Course, JCUH, Middlesbrough. Contact nicky.skippon@stees.nhs.uk
• 30th November 2011 RCP Updates in Medicine, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247 Lorraine.waugh@tfh.nuth.northy.nhs.uk.
TRAINING ISSUES
STOP PRESS: NEW Assessment tools Please see www.jrcptb.org.uk; it is the trainee’s responsibility to make sure that the appropriate assessments are available in their portfolio for ARCP purposes. For 2011 there are 3 new work based assessment tools available: Patient Surveys, Audit Assessment and Teaching Observation. It is essential that you review the web site and make arrangements to utilize these new assessment tools as evidence for your ARCP.
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 completion deadline is Friday May 13th 2011 therefore you must have worked with your supervisors well in advance of this (book time in their diary now!). This year an incomplete portfolio is likely to result in non-progression through training therefore please all do more than the minimum!
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.
INFORMATION for QA Could each individual trainer send the following to Simon Pearce: educational qualifications, any training positions held and any educational courses attended.
MORE INFORMATION for QA Could each unit’s Training Lead please send to Simon Pearce a completed training unit information report and an updated SpR/StR job description.
Trainers & Trainees meeting The next T&T is on 14th June 2011. Details to be confirmed nearer the time, but please note in your diary.
ARCPs 2011 Mon 23rd, Tues 24th, Weds 25th May 2011. SpRs keep these dates free and volunteers for the panel please contact Nicky Leech. Minimal requirements will be: thorough portfolio documentation, 4 Case based Discussions, Reflective accounts, Personal library evidence of teaching attendance and reflection, 4 new Mini-CEXs since last ARCP, MSF from current unit with at least 12 returns and 3 consultants, Updated PDP This should be drawn up and discussed with your supervisor within 4 weeks of starting your new post and Supervisors sign off and report. PLEASE NOTE, add patient survey (use the RCP survey forms), audit assessment/reflection and teaching observation to the minimal requirements.
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
Medicine ARCP Will remain separate next year. Date 17th May 2011. Continue to add evidence to the curriculum and demonstrate progression. Keep detailed anonomised logs and link them. Make the portfolio easy to navigate. You will need a MSF, Patient survey, 6 ACATs, 6 CEX s, 4 CBDs, and be involved in a medical audit cycle.
Training Committee Chair- Simon Pearce, s.h.s.pearce@ncl.ac.uk; Regional Speciality Advisor- Shaz Wahid, shahid.wahid@sthct.nhs.uk; Programme Director- Nicky Leech nicola.leech@nuth.northy.nhs.uk; Consultant member (SAC rep)- Richard Quinton, Richard.Quinton@nuth.nhs.uk; Consultant member-Jean MacLeod, Jean.Macleod@nth.nhs.uk; Consultant member (TPD elect)-Arutchelvam Vijayaraman Vijayaraman.Arutchelvam@stees.nhs.uk ; Consultant member-Simon Eaton, simon.eaton@northumbria-healthcare.nhs.uk; SpR representative-Srikanth Mada srikanth.mada@nhs.net ; SpR representative-Stuart Little stuartlittle@doctors.org.uk
NEWS FROM THE NORTHEAST
• April 5th 2011- Professor James Fegan is the SFE visiting professor this year. He will be visiting Newcastle on this day. There will be a series of case presentations on that afternoon followed by his lecture at 17.00. Meeting will be held at Freeman Hospital Education centre. Clinical session will be followed by a Networking dinner. This will be an excellent opportunity for regional SpR’s to present cases and attend the networking meeting. For more details contact Steve.ball@nuth.nhs.uk, srikanth.mada@nhs.net
• Congratulations to Latika Sibal on her new Consultant appointment at Addenbrooke's Hospital.
• Welcome to Dr Shunmugam Nelliyappan as new StR in the region.
• Congratulations to Stuart Little as the new trainee rep on the STC.
• Congratulations to Arut on his nomination by the STC as our next TPD. His name will be forwarded to the Deanery. The aim will be for him to take over from Nicky in June 2011. Nicky will move into the Chair of the STC. We would like to thank Simon Pearce for his excellent work whilst the Chair of the STC.
• Philip Home has been invited by the ADA Programme Committee to talk in their annual meeting San Diego 2011 - this will be the fourth such invited lecture in 5 years. This time the topic is “Biosimilar insulins”.
• Congratulations to Terry Aspray on his recent appointment as Consultant in Metabolic Bone Disease at Freeman Hospital from 1st March 2011.
• It was an absolute pleasure to have Bill Kelly and Eric Young say a few words at NERRAG when presenting the prize named after their esteemed selves. Their words will live long in the memory.
• David Carr has now fully retired. ENDODIABOLOGY would like to wish him all the best and thank him for his contribution to the specialty in the region.
• Congratulations to Chandima Idampitya on her new Consultant appointment in Cumbria.
• Congratulations to Jola Weaver on being appointed a visiting Professor to King Abdulaziz University, Jeddah, SA.
• Congratulations to Roy Taylor on 5 yrs of the MRC, see meeting symposium details above, publication of a paper which was featured in the No. 1 spot on the cover of Dec Diabetes Care and shortly in the correspondence columns of DC and the award of a grant from the European Foundation for the Study of Diabetes. Evaluation of pancreas structure and function during return to normal glucose tolerance in type 2 diabetes. Euro 95,000.
LETTERS
Medical Leadership training on-line SHAZ WAHID
I personally am undertaking further management and leadership training using the Medical Leadership programme available on the e-learning for healthcare website www.e-lfh.org.uk . It is free! It is for all stages, whether you are experienced or a beginner. There are 6 folders: introductory modules, effective leadership, quality improvement, effective management in healthcare, ensuring effective health care, concluding modules. Each folder is further divided into modules to complete. I am partway through the introductory folder and can only highly recommend it to everyone. I would expect all StRs in Diabetes&Endo or Acute Medicine rotating to STNHSFT to undertake this programme as part of their management training under my supervision. This programme would highly complement the “7-habits of effectiveness” course that I encourage StRs under my supervision to attend at STNHSFT, again this is free other than the personal time you will have to give up over a weekend.
Book review-Textbook of Diabetes. 4th Edition, 2010. RI Holt, CS Cockram, A Flyvberg, BJ Goldstein. Wiley-Blackwell. SHAZ WAHID.
This was my staple reading when in SpR training. I invested in the new edition in November 2010 and I am not disappointed. The content is exceptional covering basic and clinical science with a focus on clinical application and healthcare delivery. There is both fun historical context and an international flavour to this new edition. Furthermore, the on-line access to the content and figures (for down load) adds value and prolongs the life of this edition. I have read about 1/3rd of the content (adolescent & transitional diabetes, monogenic diabetes, all the historical and social context section, diabetic nephropathy as examples) and have been impressed. I would highly recommend this new edition to both trainees and trainers.
My experience of on-line Recruitment & Selection training. SHAZ WAHID.
I was pleasantly surprised at how much I enjoyed the above training that is available on www.elearningworkpsychology.com/northern/ . It is mandatory for all interviewers and it will take no longer than 1-hour to complete. The FOCUS mnemonic sticks in the memory: Familiarise, Observe, Record, Classify, and Evaluate. Not only is useful for interviews but I would suggest when you next attend a service meeting or indeed any meeting! What I got most out of this training is the time I saved by not allocating a half day to the activity. If only Trust Mandatory training could be condensed into 1 hour………………………….
King’s Fund Diabetes Specialist Registrars Leadership Programme: May 09-13th 2011. Sponsored by the YDF- Srikanth Mada
I had the pleasure of attending the leadership course last year along with two other colleagues in the region. The course is held at Oxford and run by very experienced kings fund faculty over 5 days. A number of management issues such as Myers Briggs Personality indicator and preferred style of working, NHS finance (Macro financial flows & Micro budgeting), Belbin team roles, team working, and working across organization were covered in detail with practical workshops. Health policies and diabetes policies were dealt with Dr Sue Roberts. We had the opportunity to understand the principles of business case and developing new services, and a practical workshop to develop and present a new business case as a team.
Later half of the course concentrates on personality development, advanced communications skills, negotiating skills and presentation skills. Professional actor facilitated these sessions. Final day concentrates on preparing oneself for the consultant job, interview preparation and video recorded mock interview.
This is an excellent opportunity for every registrar to develop leadership skills mainly for those who are in their final 2 years. A Unique opportunity to meet colleagues from different regions which helps to establish networking. The course is free of cost including stay but one has to be a member of ABCD.
MERIT (Master class in Endocrinology and diabetes; Regional Interactive Teaching) Programme: Srikanth Mada, Stuart Little, Sarah Stevens.
The recent PMETB survey by the specialty trainees in this region identified areas of excellent training as well as areas where training opportunities could be improved.
As trainee representatives we invited constructive feedback from all trainees and subsequently a number of enthusiastic colleagues suggested ways of improving training opportunities. As a result of all the feedback obtained a pilot training programme (MERIT: Master class in Endocrinology and diabetes; Regional Interactive Teaching) has been drafted and was presented at the STC meeting in December. The revamped CME, which is mapped to cover all the aspects of curriculum has been a huge success and received a positive feedback. We do not want to replicate similar programme, instead we plan to give the responsibility of this programme to the trainees themselves i.e. a trainee led, consultant facilitated site specific teaching programme.
The location of the teaching will rotate between all training hospitals in the region and will take place in the first week of each month starting April 2011. It will be the responsibility of the resident trainee at each respective hospital to host the teaching and liaise with the consultant (host consultant) to agree the training programme for the afternoon. The session will consist of a trainee presentation (Hot topic/ topic over view etc) followed by a consultant facilitated master class/tutorial. Management topics can also be included within the programme.
It will be mandatory for every trainee to attend the sessions and if attendance is not possible it is each trainee’s responsibility to inform either of the trainee STC representatives (Srikanth or Stuart) so that it can be documented in the report to the STC panel. This will mean discussing with the consultants to make necessary arrangement so that clinical care is not impacted and consultants reducing the clinics on the day. Further information regarding the proposed programme will be circulated in due course.
The STC chair and the panel have agreed to implement the programme, the success of which will be reviewed at the next STC meeting.
GAINS (Grants for attending International & National symposium) Programme.
Srikanth Mada, Sarah Stevens, Stuart Little.
The SPARROWS programme has been an excellent and unique training opportunity for the year 3-5 SpR’s to attend the ADA followed by a presentation at the trainers and trainee meeting to share the experience and updates with rest of the colleagues. Unfortunately because of the financial constraints and ABPI rules of the funding bodies have withdrawn their support to the programme. We as the CME & STC committee are keen to keep this unique opportunity available as long as possible to all the registrars. The committee would be able to part fund two registrars to attend one diabetes and one endocrine symposium per year. A grant of £ 1000/ per SpR / year is available as a part of this programme. Application and the selection process remain same as before followed by a SpR presentation at the trainers and trainee meeting. Applications and further information to follow…
Are you proactive enough regarding your future?
An Honorary Research Assistant post at Newcastle University and Gateshead Trust will be advertised in the near future. Research area: vascular stem cells and endocrine disorders. The post will commence in August 2011 and is aimed to lead to MD/PhD (as a staff member of the Institute for Cellular Medicine reduced postgraduate degree fees will be payable). The first RA appointed to this post was Salman Razvi. He was then followed by Akheel Syed, Abdul Shakoor, Asgar Madathil, all as part of Out Of Programme Research (OOPR) scheme. For informal enquiries please contact Jola Weaver J.U.Weaver@ncl.ac.uk
My experience of the Specialty Examination MRCP Diabetes&Endo-Atif Munir
The SCE is now a compulsory component of assessment for CCT for all UK trainees in Diabetes & Endocrinology. Trainees who have gained the Certificate in Endocrinology and Diabetes and who are recommended for a CCT will be entitled to apply for the post nominal MRCP (UK) (Endocrinology and Diabetes).
The SCE in Endocrinology and Diabetes is delivered once a year & is a computer-based two-paper test with a total of 200 questions. Each paper contains 100 questions and lasts three hours. The papers are based on the MRCP (UK) ‘best of five’ multiple choice questions format & there is no negative marking. The exam fee has been increased from £800 to £825 for 2011. Candidates can attempt the Specialty Certificate Examination as many times as they wish, subject to continuing satisfaction of the eligibility criteria.
Although The Royal College guidance states that trainees should have at least attempted the examination once before their penultimate year assessment I would strongly encourage colleagues to take it when they feel confident. This would to quite an extent depend upon your clinical experience as this is purely a clinically oriented examination & most of the scenarios I thought were from everyday clinical practice. Hence clinical experience in my view would take preference over theoretical knowledge for this particular examination.
Royal college does not recommend any specific reading material however I can share my personal experience. Exam blueprint & sample questions can be downloaded from the MRCP website (www.mrcpuk.org/SiteCollectionDocuments/SCEEandDSampleQs.pdf) (www.mrcpuk.org/SiteCollectionDocuments/SCE_ED_blueprint.pdf). If you are pushed for time, which all of us are these days I would recommend going through Oxford Handbook of Diabetes & Endocrinology (Turner & Wass) which was perhaps my key to success. This is the most comprehensive tool to cover a wide range of high yield topics in a short span of time. WWW. Endotext.org would be my second resource for preparation. Going through up to date NICE guidance, in particular guidance related to management of diabetes during pregnancy is a must as there were quite a few questions directly based on current guidance. DVLA guidance regarding driving and Diabetes is worth a glance. Apart from NICE, publications for professionals by societies like ABCD, SFE, and BTA & DUK should be read to polish your preparation apart from keeping abreast of updates in core specialty topics. I would not recommend subscribing to online websites to access their questions banks as the exam is still in its early years and hence there is not a large pool of questions out there. I found such an endeavour a waste of time and money. There were a few pituitary MRI scans & retinal screening photographs hence familiarizing yourself with these can earn a few bonus points.
Last but not the least, I would strongly urge all appearing for the exam to try and take a few days off as study leave immediately before the examination day to revise and regroup your scattered thoughts.
I wish all my colleagues best of luck for their examination.
RECENT PUBLICATIONS FROM THE NORTHEAST
1. Rodondi N, den Elzen WP, Bauer DC, Cappola AR, Razvi S, Walsh JP, Asvold BO, Iervasi G, Imaizumi M, Collet TH, Bremner A, Maisonneuve P, Sgarbi JA, Khaw KT, Vanderpump MP, Newman AB, Cornuz J, Franklyn JA, Westendorp RG, Vittinghoff E, Gussekloo J; Thyroid Studies Collaboration. Subclinical hypothyroidism and the risk of coronary heart disease and mortality. JAMA. 2010 Sep 22;304(12):1365-74.
2. Simms RJ, Sayer JA, Quinton R, Walker M, Ellard S, Goodship TH. Monogenic diabetes, renal dysplasia and hypopituitarism: a patient with a HNF1A mutation. QJM. 2010 Nov 4. [Epub ahead of print].
3. Quinton R, Ball SG, Sayer J, Pearce SHS. Primary hyperparathyroidism: just how “primary” is it really? Therapeutic Advances in Endocrinology & Metabolism. 2010; 1: 191-196.
4. Here comes the sun, good news for bone health. Aspray TJ, Francis RM. Age Ageing. doi: 10.1093/ageing/afq164 Epub 2010 Dec 22.
5. Diabetes, falls and fractures. Mayne D, Stout NR, Aspray TJ. Age Ageing. 2010 Sep;39(5):522-5. Epub 2010 Jul 14.
6. Vitamin D and fractures: where are we now? Aspray TJ, Francis RM. Maturitas. 2010 Jul;66(3):221-2. Epub 2010 Apr 7.
7. Increased maternal homeostasis model assessment of insulin resistance (HOMA-IR) associated with older age at diagnosis of Type 1 diabetes in offspring. NJ leech, JO O Sullivan, P Avery, C Howey, K Burling, S Iyer, L Pascoe, M Walker and T Cheetham. Diabetic Medicine Dec 2010 Vol 27; 12 ; 1450.
8. Chen MJ, Jovanovic A, Taylor R. Utilizing the Second-Meal Effect in Type 2 Diabetes: Practical Use of a Soya-Yogurt Snack. Diabetes Care 33: 2552-4, 2010
RECENT PUBLICATIONS IN DIABETES & ENDOCRINOLOGY THAT HIT THE NEWS OR THAT MAY HAVE A SIGNIFICANT IMPACT ON MANAGEMENT
Bisphosphonates for Osteporoses. MJ Favus. NEJM 2010;363:20272035. A practical review article well worth a read for an update.
Safer administration of insulin: summary of a safety report from the National patient Safety Agency. TA Lamont et al. BMJ 2010;341:c5269. A useful summary of this essential reading report. Many of you have probably or are in the process of producing action plans for the recommendations.
Managing diabetic retinopathy. Z Okcrim, D Yorston. BMJ 2010;341:c5400. A useful read for an update. It is worth reading the individual seminal papers cited in this update.
Teriparatide for bone loss in the jaw. A Grey. NEJM 2010;363;2458-2459. An excellent editorial citing the evidence behind this therapy for osteonecrosis of the jaw. Well worth a read along with the linked letter.
Glycemic control in the ICU. BP Kavanagh, KC McCowen. NEJM 2010;363:2540-2546. An update that I do not entirely agree with. I believe the ADA guidance is spot on for this issue. Debate welcome………………………
Vitamin D Insufficiency. Clifford J Rosen. NEJM 2011;364:258-254. An excellent review and well worth a read.
Diagnosis and management of hereditary haemochromatosis. MA van Bokhoven et al. BMJ 2011;342:218-223. An excellent practical update that is essential reading for trainees and trainers.
Cholesterol efflux capacity, high-density lipoprotein function, and atherosclerosis. Khera AV, et al. NEJM 2011;364;127-135. The authors hypothesized that the capacity of HDL to accept cholesterol from macrophages would serve as a predictor of atherosclerotic burden. This is termed as cholesterol efflux capacity, and was measured in 203 healthy volunteers who underwent assessment of carotid artery intima-media thickness, 442 patients with angiographically confirmed coronary artery disease, and 351 patients without such angiographically confirmed disease by using a validated ex vivo system involving incubation of macrophages with apolipoprotein B-depleted serum from the study participants. The levels of HDL cholesterol and apolipoprotein A-I were significant determinants of cholesterol efflux capacity but accounted for less than 40% of the observed variation. An inverse relationship was noted between efflux capacity and carotid intima-media thickness both before and after adjustment for the HDL cholesterol level. Furthermore, efflux capacity was a strong inverse predictor of coronary disease status (adjusted odds ratio for coronary disease per 1-SD increase in efflux capacity, 0.70; 95% confidence interval [CI], 0.59 to 0.83, p<0.001). This relationship was attenuated, but remained significant, after additional adjustment for the HDL cholesterol level (OR 0.75[0.63-0.90], p=0.002) or apolipoprotein A-I level (OR 0.7[0.61-0.89], p=0.002). Additional studies showed enhanced efflux capacity in patients with the metabolic syndrome and low HDL cholesterol levels who were treated with pioglitazone, but not in patients with hypercholesterolemia who were treated with statins. The authors conclude that cholesterol efflux capacity from macrophages, a metric of HDL function, has a strong inverse association with both carotid intima-media thickness and the likelihood of angiographic coronary artery disease, independently of the HDL cholesterol level. It is well worth reading the accompanying editorial by Jay Heinecke that along with this article suggests that we will be in a better position to see whether raising HDL cholesterol with pharmacotherapy in individuals would be of any benefit utilising this method in the future or allow us to better target pharmacotherapy.
Selective vitamin D receptor activation with paricalcitol for reduction of albuminuria in patients with type 2 diabetes (VITAL study): a randomised controlled trial. de Zeeuw D. Lancet 2010;376:1543-51. In this placebo-controlled, double-blind trial, the investigators enrolled patients with type 2 diabetes and albuminuria who were receiving ACE inhibitors or angiotensin receptor blockers. Patients were assigned to receive 24 weeks’ treatment with placebo (n=88),1 μg/day paricalcitol (n=92), or 2 μg/day paricalcitol (n=92). The primary endpoint was the percentage change in geometric mean urinary albumin-to-creatinine ratio (UACR) from baseline to last measurement during treatment for the combined paricalcitol groups versus the placebo group. Change in UACR was: –3% (from 61 to 60 mg/mmol;95% CI –16 to 13) in the placebo group; –16% (from 62 to 51 mg/mmol; –24 to –9) in the combined paricalcitol groups, with a between-group difference versus placebo of –15% (95% CI –28 to 1; p=0.071); –14% (from 63 to 54 mg/mmol; –24 to –1) in the 1 μg paricalcitol group, with a between-group difference versus placebo of –11%(95% CI –27 to 8; p=0.23); and –20% (from 61 to 49 mg/mmol; –30 to –8) in the 2 μg paricalcitol group, with a between-group difference versus placebo of –18% (95% CI –32 to 0; p=0.053). Patients on 2 μg paricalcitol showed a nearly, sustained reduction in UACR, ranging from –18% to –28% (p=0.014 vs placebo). Incidence of hypercalcaemia, adverse events, and serious adverse events was similar between groups receiving paricalcitol versus placebo. This study suggests that the addition of 2 μg/day paricalcitol to RAAS inhibition safely lowers residual albuminuria in patients with diabetic nephropathy. I guess we should have vitamin D in the water supply! The accompanying editorial by Merlin Thomas and Mark Cooper is well worth a read to look into this novel therapy for diabetic nephropathy.
NEXT NEWSLETTER Due out beginning of June 2011 so keep the gossip coming.
Endodiabology.blogspot.com
NORTHEAST
NEWSLETTER
FOR SPRs AND BOSSES TRAPPED
IN THE NORTHERN DEANERY
February 2011
Editors: Shaz Wahid (shahid.wahid@sthct.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- Atif Munir (2), Sajid Ethol Kalathil (2), Catherine Napier (2), Naveen Aggarwal (2), Hamza Ali Khan (2), Agnieska Sawiecicka (1), Vacant
• North Tyneside/Wansbeck- Alison Heggie (1), Vacant
• South Tyneside- Nimanthe De Alwis (2)
• Gateshead- Eeelin Lim (5)
• Sunderland- Jacog Buckovan (1), vacant
• North Tees/Hartlepool- Sudeep Manohar (4), vacant
• Middlesbrough- Arif Ullah (4), Naveen Siddaramaiha (4), Shunmugam Nelliyappan (1)
• Bishop Auckland/Darlington/Durham- Sathia Rajhavan(1), Vacant
• NGH- Srikanth Mada(4),
• 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),
• Maternity Leave Rohana Wright (3), Anjali SanthaKumar (3), Kathryn Stewart (3)
MEETINGS / LECTURES / ANNOUNCEMENTS
• 1st March 2011 SfE National Clinical Cases Meeting, Royal Society of Medicine, London. Contact conferences@endocrinology.org NOTE submissions deadline is 25th October 2010.
• 16th March 2011 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247 Lorraine.waugh@tfh.nuth.northy.nhs.uk
• 24th March 2011 Newcastle Magnetic Resonance Centre Symposium, Lindisfarne Room, 1st Floor, Kings Road Centre, NCLE. Contact beverly.hailstone@ncl.ac.uk We have both Hannele Yki-Jarvivnen and Michael Roden, two of the world’s most sought after speakers talking about the cutting edge of diabetes knowledge. There is no registration fee.
• 30th March – 1st April 2011 DUK Annual Professional Conference, London, ExCel ICC. Contact www.diabetes.org.uk NOTE abstract submission deadline 31st October 2010.
• 7th & 8th April 2011 Insulin Infusion Pump Course, JCUH, Middlesbrough. Contact nicky.skippon@stees.nhs.uk
• 11th-14th April 2011 SfE British Endocrine Societies annual conference, Birmingham ICC. Contact conferences@endocrinology.org NOTE abstract submissions deadline 15th November 2010.
• 13th April 2011 Northern Region Acute Medicine Study Day, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247 Lorraine.waugh@tfh.nuth.northy.nhs.uk
• 5th-6th May 2011 ABCD spring meeting, London. Contact www.diabetologists.org.uk
• 11th May 2011 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247 Lorraine.waugh@tfh.nuth.northy.nhs.uk
• 17th May 2011North East Obesity Forum, Obesity and Pregnancy, Stockton, Durham University, Queens Campus. Contact Louisa.ells@nepho.org.uk or Helen.moore@durham.ac.uk or Rachel.gallo@newcastle.ac.uk
• 18th May 2011 Northern Endocrine & Diabetes Summer CME, University Hospital of North Durham. Contact Sarah Steven sarah.steven@doctors.org.uk or Srikanth Mada srikanth.mada@nhs.net
• 4th-7th June 2011 ENDO 2011, Boston, USA. Contact endostaff@endo-societ.org or www.endo-society.org/scimeetings .
• 16th June 2011 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247 Lorraine.waugh@tfh.nuth.northy.nhs.uk
• 24th – 28th June 2011 American Diabetes Association 71st Annual Scientific Sessions, San Diego, USA. Contact meetings@diabetes.org .
• 13th July 2011 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247 Lorraine.waugh@tfh.nuth.northy.nhs.uk
• 12th - 16th September 2011 47th EASD annual meeting, Lisbon, Portugal. Contact www.easd.org
• 14th September 2011 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247 Lorraine.waugh@tfh.nuth.northy.nhs.uk
• 12th October 2011 Northern Endocrine & Diabetes Autumn CME, JCUH, Middlesbrough. Contact Sarah Steven(sarah.steven@doctors.org.uk ) or Srikanth Mada (srikanth.mada@nhs.net )
• 16th November 2011 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247 Lorraine.waugh@tfh.nuth.northy.nhs.uk
• 24th & 25th November 2011 Insulin Infusion Pump Course, JCUH, Middlesbrough. Contact nicky.skippon@stees.nhs.uk
• 30th November 2011 RCP Updates in Medicine, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247 Lorraine.waugh@tfh.nuth.northy.nhs.uk.
TRAINING ISSUES
STOP PRESS: NEW Assessment tools Please see www.jrcptb.org.uk; it is the trainee’s responsibility to make sure that the appropriate assessments are available in their portfolio for ARCP purposes. For 2011 there are 3 new work based assessment tools available: Patient Surveys, Audit Assessment and Teaching Observation. It is essential that you review the web site and make arrangements to utilize these new assessment tools as evidence for your ARCP.
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 completion deadline is Friday May 13th 2011 therefore you must have worked with your supervisors well in advance of this (book time in their diary now!). This year an incomplete portfolio is likely to result in non-progression through training therefore please all do more than the minimum!
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.
INFORMATION for QA Could each individual trainer send the following to Simon Pearce: educational qualifications, any training positions held and any educational courses attended.
MORE INFORMATION for QA Could each unit’s Training Lead please send to Simon Pearce a completed training unit information report and an updated SpR/StR job description.
Trainers & Trainees meeting The next T&T is on 14th June 2011. Details to be confirmed nearer the time, but please note in your diary.
ARCPs 2011 Mon 23rd, Tues 24th, Weds 25th May 2011. SpRs keep these dates free and volunteers for the panel please contact Nicky Leech. Minimal requirements will be: thorough portfolio documentation, 4 Case based Discussions, Reflective accounts, Personal library evidence of teaching attendance and reflection, 4 new Mini-CEXs since last ARCP, MSF from current unit with at least 12 returns and 3 consultants, Updated PDP This should be drawn up and discussed with your supervisor within 4 weeks of starting your new post and Supervisors sign off and report. PLEASE NOTE, add patient survey (use the RCP survey forms), audit assessment/reflection and teaching observation to the minimal requirements.
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
Medicine ARCP Will remain separate next year. Date 17th May 2011. Continue to add evidence to the curriculum and demonstrate progression. Keep detailed anonomised logs and link them. Make the portfolio easy to navigate. You will need a MSF, Patient survey, 6 ACATs, 6 CEX s, 4 CBDs, and be involved in a medical audit cycle.
Training Committee Chair- Simon Pearce, s.h.s.pearce@ncl.ac.uk; Regional Speciality Advisor- Shaz Wahid, shahid.wahid@sthct.nhs.uk; Programme Director- Nicky Leech nicola.leech@nuth.northy.nhs.uk; Consultant member (SAC rep)- Richard Quinton, Richard.Quinton@nuth.nhs.uk; Consultant member-Jean MacLeod, Jean.Macleod@nth.nhs.uk; Consultant member (TPD elect)-Arutchelvam Vijayaraman Vijayaraman.Arutchelvam@stees.nhs.uk ; Consultant member-Simon Eaton, simon.eaton@northumbria-healthcare.nhs.uk; SpR representative-Srikanth Mada srikanth.mada@nhs.net ; SpR representative-Stuart Little stuartlittle@doctors.org.uk
NEWS FROM THE NORTHEAST
• April 5th 2011- Professor James Fegan is the SFE visiting professor this year. He will be visiting Newcastle on this day. There will be a series of case presentations on that afternoon followed by his lecture at 17.00. Meeting will be held at Freeman Hospital Education centre. Clinical session will be followed by a Networking dinner. This will be an excellent opportunity for regional SpR’s to present cases and attend the networking meeting. For more details contact Steve.ball@nuth.nhs.uk, srikanth.mada@nhs.net
• Congratulations to Latika Sibal on her new Consultant appointment at Addenbrooke's Hospital.
• Welcome to Dr Shunmugam Nelliyappan as new StR in the region.
• Congratulations to Stuart Little as the new trainee rep on the STC.
• Congratulations to Arut on his nomination by the STC as our next TPD. His name will be forwarded to the Deanery. The aim will be for him to take over from Nicky in June 2011. Nicky will move into the Chair of the STC. We would like to thank Simon Pearce for his excellent work whilst the Chair of the STC.
• Philip Home has been invited by the ADA Programme Committee to talk in their annual meeting San Diego 2011 - this will be the fourth such invited lecture in 5 years. This time the topic is “Biosimilar insulins”.
• Congratulations to Terry Aspray on his recent appointment as Consultant in Metabolic Bone Disease at Freeman Hospital from 1st March 2011.
• It was an absolute pleasure to have Bill Kelly and Eric Young say a few words at NERRAG when presenting the prize named after their esteemed selves. Their words will live long in the memory.
• David Carr has now fully retired. ENDODIABOLOGY would like to wish him all the best and thank him for his contribution to the specialty in the region.
• Congratulations to Chandima Idampitya on her new Consultant appointment in Cumbria.
• Congratulations to Jola Weaver on being appointed a visiting Professor to King Abdulaziz University, Jeddah, SA.
• Congratulations to Roy Taylor on 5 yrs of the MRC, see meeting symposium details above, publication of a paper which was featured in the No. 1 spot on the cover of Dec Diabetes Care and shortly in the correspondence columns of DC and the award of a grant from the European Foundation for the Study of Diabetes. Evaluation of pancreas structure and function during return to normal glucose tolerance in type 2 diabetes. Euro 95,000.
LETTERS
Medical Leadership training on-line SHAZ WAHID
I personally am undertaking further management and leadership training using the Medical Leadership programme available on the e-learning for healthcare website www.e-lfh.org.uk . It is free! It is for all stages, whether you are experienced or a beginner. There are 6 folders: introductory modules, effective leadership, quality improvement, effective management in healthcare, ensuring effective health care, concluding modules. Each folder is further divided into modules to complete. I am partway through the introductory folder and can only highly recommend it to everyone. I would expect all StRs in Diabetes&Endo or Acute Medicine rotating to STNHSFT to undertake this programme as part of their management training under my supervision. This programme would highly complement the “7-habits of effectiveness” course that I encourage StRs under my supervision to attend at STNHSFT, again this is free other than the personal time you will have to give up over a weekend.
Book review-Textbook of Diabetes. 4th Edition, 2010. RI Holt, CS Cockram, A Flyvberg, BJ Goldstein. Wiley-Blackwell. SHAZ WAHID.
This was my staple reading when in SpR training. I invested in the new edition in November 2010 and I am not disappointed. The content is exceptional covering basic and clinical science with a focus on clinical application and healthcare delivery. There is both fun historical context and an international flavour to this new edition. Furthermore, the on-line access to the content and figures (for down load) adds value and prolongs the life of this edition. I have read about 1/3rd of the content (adolescent & transitional diabetes, monogenic diabetes, all the historical and social context section, diabetic nephropathy as examples) and have been impressed. I would highly recommend this new edition to both trainees and trainers.
My experience of on-line Recruitment & Selection training. SHAZ WAHID.
I was pleasantly surprised at how much I enjoyed the above training that is available on www.elearningworkpsychology.com/northern/ . It is mandatory for all interviewers and it will take no longer than 1-hour to complete. The FOCUS mnemonic sticks in the memory: Familiarise, Observe, Record, Classify, and Evaluate. Not only is useful for interviews but I would suggest when you next attend a service meeting or indeed any meeting! What I got most out of this training is the time I saved by not allocating a half day to the activity. If only Trust Mandatory training could be condensed into 1 hour………………………….
King’s Fund Diabetes Specialist Registrars Leadership Programme: May 09-13th 2011. Sponsored by the YDF- Srikanth Mada
I had the pleasure of attending the leadership course last year along with two other colleagues in the region. The course is held at Oxford and run by very experienced kings fund faculty over 5 days. A number of management issues such as Myers Briggs Personality indicator and preferred style of working, NHS finance (Macro financial flows & Micro budgeting), Belbin team roles, team working, and working across organization were covered in detail with practical workshops. Health policies and diabetes policies were dealt with Dr Sue Roberts. We had the opportunity to understand the principles of business case and developing new services, and a practical workshop to develop and present a new business case as a team.
Later half of the course concentrates on personality development, advanced communications skills, negotiating skills and presentation skills. Professional actor facilitated these sessions. Final day concentrates on preparing oneself for the consultant job, interview preparation and video recorded mock interview.
This is an excellent opportunity for every registrar to develop leadership skills mainly for those who are in their final 2 years. A Unique opportunity to meet colleagues from different regions which helps to establish networking. The course is free of cost including stay but one has to be a member of ABCD.
MERIT (Master class in Endocrinology and diabetes; Regional Interactive Teaching) Programme: Srikanth Mada, Stuart Little, Sarah Stevens.
The recent PMETB survey by the specialty trainees in this region identified areas of excellent training as well as areas where training opportunities could be improved.
As trainee representatives we invited constructive feedback from all trainees and subsequently a number of enthusiastic colleagues suggested ways of improving training opportunities. As a result of all the feedback obtained a pilot training programme (MERIT: Master class in Endocrinology and diabetes; Regional Interactive Teaching) has been drafted and was presented at the STC meeting in December. The revamped CME, which is mapped to cover all the aspects of curriculum has been a huge success and received a positive feedback. We do not want to replicate similar programme, instead we plan to give the responsibility of this programme to the trainees themselves i.e. a trainee led, consultant facilitated site specific teaching programme.
The location of the teaching will rotate between all training hospitals in the region and will take place in the first week of each month starting April 2011. It will be the responsibility of the resident trainee at each respective hospital to host the teaching and liaise with the consultant (host consultant) to agree the training programme for the afternoon. The session will consist of a trainee presentation (Hot topic/ topic over view etc) followed by a consultant facilitated master class/tutorial. Management topics can also be included within the programme.
It will be mandatory for every trainee to attend the sessions and if attendance is not possible it is each trainee’s responsibility to inform either of the trainee STC representatives (Srikanth or Stuart) so that it can be documented in the report to the STC panel. This will mean discussing with the consultants to make necessary arrangement so that clinical care is not impacted and consultants reducing the clinics on the day. Further information regarding the proposed programme will be circulated in due course.
The STC chair and the panel have agreed to implement the programme, the success of which will be reviewed at the next STC meeting.
GAINS (Grants for attending International & National symposium) Programme.
Srikanth Mada, Sarah Stevens, Stuart Little.
The SPARROWS programme has been an excellent and unique training opportunity for the year 3-5 SpR’s to attend the ADA followed by a presentation at the trainers and trainee meeting to share the experience and updates with rest of the colleagues. Unfortunately because of the financial constraints and ABPI rules of the funding bodies have withdrawn their support to the programme. We as the CME & STC committee are keen to keep this unique opportunity available as long as possible to all the registrars. The committee would be able to part fund two registrars to attend one diabetes and one endocrine symposium per year. A grant of £ 1000/ per SpR / year is available as a part of this programme. Application and the selection process remain same as before followed by a SpR presentation at the trainers and trainee meeting. Applications and further information to follow…
Are you proactive enough regarding your future?
An Honorary Research Assistant post at Newcastle University and Gateshead Trust will be advertised in the near future. Research area: vascular stem cells and endocrine disorders. The post will commence in August 2011 and is aimed to lead to MD/PhD (as a staff member of the Institute for Cellular Medicine reduced postgraduate degree fees will be payable). The first RA appointed to this post was Salman Razvi. He was then followed by Akheel Syed, Abdul Shakoor, Asgar Madathil, all as part of Out Of Programme Research (OOPR) scheme. For informal enquiries please contact Jola Weaver J.U.Weaver@ncl.ac.uk
My experience of the Specialty Examination MRCP Diabetes&Endo-Atif Munir
The SCE is now a compulsory component of assessment for CCT for all UK trainees in Diabetes & Endocrinology. Trainees who have gained the Certificate in Endocrinology and Diabetes and who are recommended for a CCT will be entitled to apply for the post nominal MRCP (UK) (Endocrinology and Diabetes).
The SCE in Endocrinology and Diabetes is delivered once a year & is a computer-based two-paper test with a total of 200 questions. Each paper contains 100 questions and lasts three hours. The papers are based on the MRCP (UK) ‘best of five’ multiple choice questions format & there is no negative marking. The exam fee has been increased from £800 to £825 for 2011. Candidates can attempt the Specialty Certificate Examination as many times as they wish, subject to continuing satisfaction of the eligibility criteria.
Although The Royal College guidance states that trainees should have at least attempted the examination once before their penultimate year assessment I would strongly encourage colleagues to take it when they feel confident. This would to quite an extent depend upon your clinical experience as this is purely a clinically oriented examination & most of the scenarios I thought were from everyday clinical practice. Hence clinical experience in my view would take preference over theoretical knowledge for this particular examination.
Royal college does not recommend any specific reading material however I can share my personal experience. Exam blueprint & sample questions can be downloaded from the MRCP website (www.mrcpuk.org/SiteCollectionDocuments/SCEEandDSampleQs.pdf) (www.mrcpuk.org/SiteCollectionDocuments/SCE_ED_blueprint.pdf). If you are pushed for time, which all of us are these days I would recommend going through Oxford Handbook of Diabetes & Endocrinology (Turner & Wass) which was perhaps my key to success. This is the most comprehensive tool to cover a wide range of high yield topics in a short span of time. WWW. Endotext.org would be my second resource for preparation. Going through up to date NICE guidance, in particular guidance related to management of diabetes during pregnancy is a must as there were quite a few questions directly based on current guidance. DVLA guidance regarding driving and Diabetes is worth a glance. Apart from NICE, publications for professionals by societies like ABCD, SFE, and BTA & DUK should be read to polish your preparation apart from keeping abreast of updates in core specialty topics. I would not recommend subscribing to online websites to access their questions banks as the exam is still in its early years and hence there is not a large pool of questions out there. I found such an endeavour a waste of time and money. There were a few pituitary MRI scans & retinal screening photographs hence familiarizing yourself with these can earn a few bonus points.
Last but not the least, I would strongly urge all appearing for the exam to try and take a few days off as study leave immediately before the examination day to revise and regroup your scattered thoughts.
I wish all my colleagues best of luck for their examination.
RECENT PUBLICATIONS FROM THE NORTHEAST
1. Rodondi N, den Elzen WP, Bauer DC, Cappola AR, Razvi S, Walsh JP, Asvold BO, Iervasi G, Imaizumi M, Collet TH, Bremner A, Maisonneuve P, Sgarbi JA, Khaw KT, Vanderpump MP, Newman AB, Cornuz J, Franklyn JA, Westendorp RG, Vittinghoff E, Gussekloo J; Thyroid Studies Collaboration. Subclinical hypothyroidism and the risk of coronary heart disease and mortality. JAMA. 2010 Sep 22;304(12):1365-74.
2. Simms RJ, Sayer JA, Quinton R, Walker M, Ellard S, Goodship TH. Monogenic diabetes, renal dysplasia and hypopituitarism: a patient with a HNF1A mutation. QJM. 2010 Nov 4. [Epub ahead of print].
3. Quinton R, Ball SG, Sayer J, Pearce SHS. Primary hyperparathyroidism: just how “primary” is it really? Therapeutic Advances in Endocrinology & Metabolism. 2010; 1: 191-196.
4. Here comes the sun, good news for bone health. Aspray TJ, Francis RM. Age Ageing. doi: 10.1093/ageing/afq164 Epub 2010 Dec 22.
5. Diabetes, falls and fractures. Mayne D, Stout NR, Aspray TJ. Age Ageing. 2010 Sep;39(5):522-5. Epub 2010 Jul 14.
6. Vitamin D and fractures: where are we now? Aspray TJ, Francis RM. Maturitas. 2010 Jul;66(3):221-2. Epub 2010 Apr 7.
7. Increased maternal homeostasis model assessment of insulin resistance (HOMA-IR) associated with older age at diagnosis of Type 1 diabetes in offspring. NJ leech, JO O Sullivan, P Avery, C Howey, K Burling, S Iyer, L Pascoe, M Walker and T Cheetham. Diabetic Medicine Dec 2010 Vol 27; 12 ; 1450.
8. Chen MJ, Jovanovic A, Taylor R. Utilizing the Second-Meal Effect in Type 2 Diabetes: Practical Use of a Soya-Yogurt Snack. Diabetes Care 33: 2552-4, 2010
RECENT PUBLICATIONS IN DIABETES & ENDOCRINOLOGY THAT HIT THE NEWS OR THAT MAY HAVE A SIGNIFICANT IMPACT ON MANAGEMENT
Bisphosphonates for Osteporoses. MJ Favus. NEJM 2010;363:20272035. A practical review article well worth a read for an update.
Safer administration of insulin: summary of a safety report from the National patient Safety Agency. TA Lamont et al. BMJ 2010;341:c5269. A useful summary of this essential reading report. Many of you have probably or are in the process of producing action plans for the recommendations.
Managing diabetic retinopathy. Z Okcrim, D Yorston. BMJ 2010;341:c5400. A useful read for an update. It is worth reading the individual seminal papers cited in this update.
Teriparatide for bone loss in the jaw. A Grey. NEJM 2010;363;2458-2459. An excellent editorial citing the evidence behind this therapy for osteonecrosis of the jaw. Well worth a read along with the linked letter.
Glycemic control in the ICU. BP Kavanagh, KC McCowen. NEJM 2010;363:2540-2546. An update that I do not entirely agree with. I believe the ADA guidance is spot on for this issue. Debate welcome………………………
Vitamin D Insufficiency. Clifford J Rosen. NEJM 2011;364:258-254. An excellent review and well worth a read.
Diagnosis and management of hereditary haemochromatosis. MA van Bokhoven et al. BMJ 2011;342:218-223. An excellent practical update that is essential reading for trainees and trainers.
Cholesterol efflux capacity, high-density lipoprotein function, and atherosclerosis. Khera AV, et al. NEJM 2011;364;127-135. The authors hypothesized that the capacity of HDL to accept cholesterol from macrophages would serve as a predictor of atherosclerotic burden. This is termed as cholesterol efflux capacity, and was measured in 203 healthy volunteers who underwent assessment of carotid artery intima-media thickness, 442 patients with angiographically confirmed coronary artery disease, and 351 patients without such angiographically confirmed disease by using a validated ex vivo system involving incubation of macrophages with apolipoprotein B-depleted serum from the study participants. The levels of HDL cholesterol and apolipoprotein A-I were significant determinants of cholesterol efflux capacity but accounted for less than 40% of the observed variation. An inverse relationship was noted between efflux capacity and carotid intima-media thickness both before and after adjustment for the HDL cholesterol level. Furthermore, efflux capacity was a strong inverse predictor of coronary disease status (adjusted odds ratio for coronary disease per 1-SD increase in efflux capacity, 0.70; 95% confidence interval [CI], 0.59 to 0.83, p<0.001). This relationship was attenuated, but remained significant, after additional adjustment for the HDL cholesterol level (OR 0.75[0.63-0.90], p=0.002) or apolipoprotein A-I level (OR 0.7[0.61-0.89], p=0.002). Additional studies showed enhanced efflux capacity in patients with the metabolic syndrome and low HDL cholesterol levels who were treated with pioglitazone, but not in patients with hypercholesterolemia who were treated with statins. The authors conclude that cholesterol efflux capacity from macrophages, a metric of HDL function, has a strong inverse association with both carotid intima-media thickness and the likelihood of angiographic coronary artery disease, independently of the HDL cholesterol level. It is well worth reading the accompanying editorial by Jay Heinecke that along with this article suggests that we will be in a better position to see whether raising HDL cholesterol with pharmacotherapy in individuals would be of any benefit utilising this method in the future or allow us to better target pharmacotherapy.
Selective vitamin D receptor activation with paricalcitol for reduction of albuminuria in patients with type 2 diabetes (VITAL study): a randomised controlled trial. de Zeeuw D. Lancet 2010;376:1543-51. In this placebo-controlled, double-blind trial, the investigators enrolled patients with type 2 diabetes and albuminuria who were receiving ACE inhibitors or angiotensin receptor blockers. Patients were assigned to receive 24 weeks’ treatment with placebo (n=88),1 μg/day paricalcitol (n=92), or 2 μg/day paricalcitol (n=92). The primary endpoint was the percentage change in geometric mean urinary albumin-to-creatinine ratio (UACR) from baseline to last measurement during treatment for the combined paricalcitol groups versus the placebo group. Change in UACR was: –3% (from 61 to 60 mg/mmol;95% CI –16 to 13) in the placebo group; –16% (from 62 to 51 mg/mmol; –24 to –9) in the combined paricalcitol groups, with a between-group difference versus placebo of –15% (95% CI –28 to 1; p=0.071); –14% (from 63 to 54 mg/mmol; –24 to –1) in the 1 μg paricalcitol group, with a between-group difference versus placebo of –11%(95% CI –27 to 8; p=0.23); and –20% (from 61 to 49 mg/mmol; –30 to –8) in the 2 μg paricalcitol group, with a between-group difference versus placebo of –18% (95% CI –32 to 0; p=0.053). Patients on 2 μg paricalcitol showed a nearly, sustained reduction in UACR, ranging from –18% to –28% (p=0.014 vs placebo). Incidence of hypercalcaemia, adverse events, and serious adverse events was similar between groups receiving paricalcitol versus placebo. This study suggests that the addition of 2 μg/day paricalcitol to RAAS inhibition safely lowers residual albuminuria in patients with diabetic nephropathy. I guess we should have vitamin D in the water supply! The accompanying editorial by Merlin Thomas and Mark Cooper is well worth a read to look into this novel therapy for diabetic nephropathy.
NEXT NEWSLETTER Due out beginning of June 2011 so keep the gossip coming.
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