Endodiabology Other Communications

Endodiabology October 2009

2009-09-27T20:04:00.000+01:00

ENDODIABOLOGY
Endodiabology.blogspot.com

NORTHEAST
NEWSLETTER
FOR SPRs AND BOSSES TRAPPED
IN THE NORTHERN DEANERY

OCTOBER 2009

Editors: Shaz Wahid , Petros Perros and Arut Vijayaraman

Associate Editors: Shafie Kamarrudin, Ravi Erukulapati

SpR PLACEMENTS (NTN year of training from 1st October 2008)
· Newcastle- Ravi Erukalapati(5), Sudeep Manohar (3), Nimanth De Alwis (1), Arif Ullah (3), Srikanth Mada(3) Naveen Siddaramaiha (2), Sarah Steven (2)
· North Tyneside/Wansbeck- Anjali Santhakumar (3), Kathryn Stewart (3)
· South Tyneside- Rohanna Wright (2),
· Gateshead- Preeti Rao (3)
· Sunderland- Beas Bhattacharya (5) then Naveen Aggarwal (1), Chandima Idampitiya (5)
· North Tees/Hartlepool- Shafie Kamarrudin (4), Hamza Ali Khan (1)
· Middlesbrough- Freda Razvi (5), Dr Munir (1), Sajid Ethol Kalathil (1), Catherine Napier (1)
· Carlisle-
· Bishop Auckland Khaled Mansur-Dukhan (5)
· Durham- Jeevan Mettayil (4)
· NGH/QEH- Vacant
· Research with numbers (supervisor)- Eelin Lim(5-Prof Taylor); Stuart Little (2-Dr Shaw) & Asgar Madathil (4-Dr Weaver)

MEETINGS / LECTURES / ANNOUNCEMENTS
· 12th October 2009 Northern Endocrine & Diabetes Autumn CME, JCUH, Middlesbrough
· 23rd October 2009 Diabetic Foot Teaching day-for medical and surgical trainees. Freeman Hospital
· 31st October 2009 Association of Physicians, Darlington Memorial Hospital.
· 2nd-4th November 2009 Society for Endocrinology Clinical Update 2009, Manchester. Contact www.endocrinology.org
· 2nd November 2009 GIM training ½ day, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247
· 3rd November 2009 RCPL Medicine Update, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247
· 11th November 2009 North East Obesity Forum, 1600-1830, Newcastle University. Contact
· 19th November 2009 1st Joint Meeting of The British Thyroid Association and British Association Of Endocrine and Thyroid Surgeons, St Thomas Hospital. Contact www.british-thyroid-association.org
· 19th-20th November 2009 ABCD autumn meeting, London. Contact www.diabetologists.org.uk followed by SpRs meeting 21-22nd November 2009.
· 25th November 2009 Northern Endocrine Region Research and Audit Group annual meeting, Lumley Castle, Durham 2pm-8pm. Contact
· 26th & 27th November 2009 Middlesbrough insulin pump course. Contact
· 4th December 2009 Society for Endocrinology regional cases meeting, Edinburgh. Contact www.endocrinology.org
· 26th January 2010 Northern Endocrine & Diabetes Winter CME, Freeman Hospital. Contact
· 26th January 2010 Diabetes-A Hospital Perspective, RCPL. Contact conferences@rcp.ac.uk
· 23rd February 2010 SfE National Clinical Cases meeting, venue TBC. Contact www.endocrinology.org
· 3rd- 5th March 2010 DUK Annual Professional Conference, Liverpool. Contact www.diabetes.org.uk
· 15th – 18th March 2010 BES 2010, Manchester. Contact www.endocrinology.org.
· 28th April 2010 RCP Acute Medicine symposium, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247 Lorraine.waugh@tfh.nuth.northy.nhs.uk.
· 6th-7th May 2010 ABCD Spring Meeting, The Hilton, GATESHEAD. Contact www.diabetologists.org.uk
· 8th June 2010 Northern Endocrine & Diabetes Spring CME, Freeman Hospital. Contact mshafie_kamaruddin@yahoo.co.uk
· 19th – 22nd June 2010 ENDO 2010, San Diego, USA. Contact endostaff@endo-societ.org or www.endo-society.org/scimeetings .
· 25th – 29th June 2010 American Diabetes Association 70th Annual Scientific Sessions, Orlando, Florida, USA. Contact meetings@diabetes.org .

TRAINING ISSUES
DIABETES & ENDOCRINOLOGY PIMD WEBSITE Our specialty website is available on http://mypimd.ncl.ac.uk/PIMDDev . Click onto the specialty training tab then follow to Diabetes & Endocrinology. This site is essential reading, especially for ARCP preparation.
A new Trainee Rep With Arut now having his CCT AND Consultant post an opportunity for a new trainee rep has arisen on the STC. SEE OUR TPDs REGULAR LETTER BELOW.
A novel training opportunity Any one interested in working towards a diploma or MSc in Public Health? If yes, SEE OUR TPDs REGULAR LETTER BELOW.
More Consultant members If you would like to be involved with the STC please do contact Nicky Leech ASAP.
ARCP (RITA) The next round is due on Weds 12th, Thurs 13th & Fri 15th May 2010. Trainees please keep these dates free as possible.
Registering with PMETB It is essential that all new SpRs/StRs (even LATs) register with the PMETB through the newly created Joint Royal Colleges of Physicians Training Board (formally the JCHMT) on www.jrcptb.org.uk. Not doing so means your training is not counted.
Log Book/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. The e-portfolio for DM&ENDO is available now for StRs.
Assessment tools Please see www.jrcptb.org.uk; it is the trainee’s responsibility to give all the appropriate forms to their Educational or Clinical Supervisor. It is the trainee’s responsibility to make sure that the appropriate assessment summaries are available in their portfolio for ARCP purposes, e.g. MSF Summary Form.
Acute Care Assessment Tool The ACAT is a tool that is commendable. It provides a method of assessing how Trainees managed their on-call period. It is recommended that at least one is available for ARCP purposes. It can be downloaded from the JRCPTB website.
Case Based Discussions (CbD) The pilot form is available from the JRCPTB website. It is a must for trainers to use as a tool to document feedback in clinic. This has always been done informally, but now there is a method to formally document it. It can be used for when a SpR presents a new case in clinic.
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 Acute Medicine PYAs.
Audit Assessment tool This is now available in draft form on the JRCPTB website. Its use is highly recommended.
General Internal Medicine Curriculum is now updated and available on www.jrcptb.org.uk. All trainees appointed ST3 from August 2009 will be offered entry to train for this CCT. Trainees before this date can easily apply to train in this CCT (i.e. dual accredit), again detailed in the website. Reviewing the new curriculum for G(I)M each trainee will need 6 ACATs, 4-CBDs and 4 Mini-CEXs in G(I)M as well as the specialty work based assessments. The publication of this curriculum and the formation of a National SAC in G(I)M separate from the Acute Medicine SAC really does mean that in practical terms the 2 specialties will be split entirely in 5-10 yrs. Our current G(I)M/Acute Medicine STC is preparing for this split, but will continue to have a dual function up to the point when there are enough Acute Medicine trained Physicians in the region to allow the formation of 2 different STCs. What this space.......................................................................................
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.
Personal Development Plans Each trainee should use their ARCP/RITA report to construct a PDP and discuss with their Educational Supervisor. A copy of the PDP should be sent to Nicky Leech by 26th Nov 2009.
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 as per Nicky Leech’s e-mail.
Trainers & Trainees meeting The next T&T is on 24th June 2010. Details to be confirmed nearer the time, but please note in your diary.
Training Committee Chair- Simon Pearce,; Regional Speciality Advisor- Shaz Wahid; Programme Director- Nicky Leech Consultant member (SAC rep)- Richard Quinton, Consultant member-Jean MacLeod,; Consultant member-Vacant; Consultant member-Simon Eaton,; SpR representative- Vacant; SpR representative- Jeevan Mettayil

NEWS FROM THE NORTHEAST
· Congratulations to Arut on appointment to a Consultant post at James Cook University Hospital in Diabetes&Endo. He already has his feet under the table.
· Congratulations to Jeevan Mettayil on being appointed the Regional Rep for the Young Diabetologists Forum.
· Congratulations to Ravi on his PhD “Postprandial metabolism in health and type 2 diabetes”.
· ABCD is coming to town. Please note that this excellent national meeting will be visiting the region on 6-7th May 2010 at the Hilton in Gateshead. See above.
· Simon Pearce is the new Chair of the STC.
· Keep an eye out for the annual RCP Acute Medicine Symposium on 28th April 2010 at FRH. Yours truly will be presenting with the title “Sugar and Hormones in the Acute Unit”.
· There are a number of new trainees on the scene, welcome to you all: Catherine Napier, Hamza Ali Khan, Naveen Aggarwal, Munir, Sajid Ethol Kalathil, Nimanth De Alwis. Please excuse, any spelling errors. The “drums” are not quite that accurate just yet.
· Congratulation s to Rohana Wright on her recent marriage.

LETTERS

The 8th Habit-From Effectiveness to Greatness-Shaz Wahid
I did warn you I would be writing about this and this is not at all about becoming a megalomaniac! This excellent book by Stephen Covey is a must read once you have read about the 7 habits of effectiveness and more importantly after practicing them for at least 1 year. It is all about finding your own voice and then helping others to find their voice. I have found the principles of the 8th habit very useful in my professional activities of late. I have been involved in a major change project within the Trust. As ever such a project has resulted in much angst, frustration and confrontation. I clearly found my voice in relation to this major project a long time ago and based it on sound principles of quality patient care, safe patient care, cost-effective patient care and quality training all rolled into a MISSION STATEMENT in the form of a VISSION. My organization is aligned towards this vision and the task of getting others aligned towards this vision has begun with everyone accepting the VISSION. The challenge is keeping everyone aligned towards the vision along the curvy path. This is best done by helping others to find their voice in relation to the vision and helping the alignment towards it. I have deliberately kept this description general. Those of you who know me have probably worked out this is about my activities around shaping emergency care at South Tyneside. However, I am also using the same principles in reshaping Diabetes care in the District in negotiations with the commissioners. Once you have got to grips with the 7-habits the 8th habit is a must do.

The dark side-Shaz Wahid
I think I shocked Petros when I met him at the RITAs and let it slip I will be going towards management! I have grown up with a healthy dollop of mistrust when it comes to the management. So what has changed my mind. Well it has all got to do with instituting change. Knowing the workings within my Trust has helped me institute change, although some would say or get what I want or Empire Build. But, to truly effect change and help others in contributing to change I need to be a in a position of influence. So the first steps have started with:
-getting onto the Executive Board as Clinical Lead for the Emergency Care Pathway
-getting onto and actively participating in governance groups such as the Clinical Incident Review Group and Mortality Review Group
-plans to attend a conference titled “Effective Clinical Director”, covering areas such as revalidation, measuring & monitoring clinical outcomes and PROMs, lean thinking, quality metrics and managing poor performance & dealing with difficult Drs
-Subscribing to the Health Service Journal
-Joining the British Association of Medical Managers (BAMM)
They are all first steps and I guess watch this space……………….. Although, it is important to have an escape route otherwise the trap door looms large. This route is the full retirement of an Everton supporter in 2011! For more information visit bamm.co.uk and for you yunguns, here is a plug for BAMMbino:

In recent years, it has become increasingly apparent that the medical profession needs to develop high quality leadership and management skills in order to effectively participate in the great healthcare debate. Work by the Royal Colleges, NHS Institute for Innovation and Improvement and BAMM has called for these skills to be nurtured from an early stage in doctor's careers, but there is little support and advice for those who wish to be the Clinical Directors, Medical Directors and Chief Medical Officers of the future.
At BAMMbino, we intend to create a living network of enthusiastic Junior Doctors who see medical management and leadership as an intrinsic part of their future careers. By acting as a portal for information, advice and support we will be building on the ethos of BAMM to help create a new generation of doctors who will be able to work proactively in and with the ever-changing healthcare environment.
Our intention is to deliver a service that will guide our members through the latest hot topics, encourage their own attempts to improve services for patients, and help mentor them through the ups and downs of their individual careers.
If you are a keen medical student, F1, F2, SHO or SpR who shows an interest in the ‘bigger picture' then let us know by sending their details to BAMMbino@bamm.co.uk This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
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and we will try to make their journey a little smoother than those who have gone before.
GOSSIP FROM THE TPD-Nicky Leech
Congratulations to Arut Arutchelvum on his appointment as a consultant at James Cook University Hospital. This leaves a vacancy for an SPR on the Specialist training committee. This is a position of great responsibility representing the views and needs of Diabetes & Endocrinology trainees across the NE, working with consultant members of the committee to continue to develop training in the NE Deanery. Application is by e-mail . You need to submit a 300 word maximum answer on the question ---

What recommendation would you make to the STC regarding developing the training programme to better prepare trainees for Consultanthood?

Application should be sent by e-mail to me on .. Nicola.leech@nuth.nhs.uk

Closing date: October 30th 2009. The entries will be judged and scored by the STC and the results announced at NEERAG on 18th November 2009.
Also…
I am interested in hearing from any trainees interested in training in and working towards a diploma or MSc in public Health. We have an opportunity to secure funding and supervision through “Darzi” Money for part-time training in public Health. It may be possible to combine this with clinical diabetes but the details of the job may be customised around the wishes and needs of the applicant . Therefore anyone interested at this stage should contact me personally and I will discuss it further with them.

Summer Camp for Kids with Diabetes at Marrick Priory-A Santhakumar
Attending the paediatric diabetes outpatient clinics at James Cook University hospital I got the wonderful opportunity to be a part of their annual kids camp at Marrick Priory and wish to share my experience. Set in the scenic Yorkshire Dales , the Marrick Priory has been hosting this immensely popular children’s camp for years. The enthusiasm of the children and their parents at the diabetes outpatient clinics led me to sign up as part observer/counsellor at this year’s activities camp for children with diabetes. The summer camp had 30-35 kids aged between 9-13 years and for some of them it was the first time away from their parents. The camp staff and counsellors included the camp warden, senior and junior medical officers, diabetes nurses, dieticians, psychologists and junior leaders who had diabetes themselves.

I arrived at the camp early Friday morning to find children being lined up into 4 groups. My group had 8 children and as counsellors the group had a senior paediatrician, a paediatric registrar, an adult diabetes registrar (yours truly) and a dietician. At the camp the staff to kids ratio was maintained at around 1:2 and there was close supervision during all sports and outings. To ensure safety and optimal diabetes management, multiple blood glucose determinations were made throughout each 24-h period
Attempts were made to follow the home insulin regimen of each camper as closely as possible. However, most camps have found it advisable to decrease the home insulin dosage by 10–20% (or more) on arrival at camp, especially in those children under good control who were not active before the camp session.
The day was jam packed with activities like kayaking, archery, rock climbing and obstacle courses to name just a few. The enthusiasm and the excitement of the kids were infectious and we had to remind ourselves that all these kids had type 1 diabetes and could potentially have a hypoglycaemic episode atop a tree or in a kayak!

Meal times provided an excellent opportunity to educate and encourage children about insulin adjustments and carbohydrate counting. Many of the kids gave their first independent insulin shots at the camp. The camp also provided these youngsters an opportunity to help out younger campers and learn to be responsible. Using the active camping environment as a teaching opportunity was an extremely useful way for children with diabetes to gain skills in managing their disease within the supportive camp community. It was all about having a positive experience learning how to manage their diabetes. In fact most of the kids who attend these camps frequently return and often volunteer as counsellors themselves which is indicative of how much they value their time spent in these camps.

On the whole (apart from a terrifying personal moment during a free fall exercise!) it was a thoroughly enjoyable and an extremely enriching experience for me. It gave me a whole new perspective on management of diabetes in the young and I would recommend my fellow registrars to try and attend a similar camp at least once .

What these camps offer the kids
· Diabetes camp is one of the best experiences that a child with diabetes can have. It is a place where the norm is to have diabetes and they no longer feel ‘different’.
· A fun and safe camping experience. Many will meet new friends with whom they will keep in touch for years to come.
· An emphasis on achieving good control of diabetes while adjusting to daily activities.
· Opportunity to develop self confidence and independently manage their diabetes.
· Diabetes education in an informal setting.
· It is an opportunity to gain independence from mom and dad, to be with other kids with diabetes, and simply to have a great time.
· It's also an excellent opportunity for mom and dad to take a break from diabetes!
What the camps can offer us
· Fun practical experience in insulin management during exercise.
· Insight and a whole new perspective into what it means to live with diabetes.
· Opportunity to educate in an informal environment far removed from the clinic setting and to be creative when imparting skills and knowledge!
· Understand the pathos that comes from being responsible for a young person with diabetes.
· Amazing eye opener in how quickly kids grasp new knowledge, accept change and just get on with it!
· Useful tips to incorporate informal teaching techniques in the management of young people in the adult diabetes service.
Diabetes UK has been organizing holidays for children since 1930s with about 500 kids participating each year. Details about similar camps in our region is available on their website. http://www.diabetes.org.uk/Professionals/Resources-for-patients/Care-events/
The Firbush Project, run by Perth Royal Infirmary provides a similar annual adventure camp for 16-21 year olds on Loch Tay. Details are available on NHS Tayside website http://www.diabetes-healthnet.ac.uk/HandBook/DiabetesAndTeenagers.aspx

RECENT PUBLICATIONS FROM THE NORTHEAST
1. Kamaruddin MS, Quinton R, Leech N. 2009 Inpatient diabetes care: first do no harm? Clinical Services Journal. 6: 37-40.
2. Arun CS, Al-Bermani A, Stannard KS, Taylor R. Long term impact of retinal screening upon significant diabetes related visual impairment in the working age population. Diabetic Medicine 26:489-492, 2009.
3. Jovanovic A, Leverton E, Solanky B, Snaar JEM, Morris PEG, Taylor R. The second meal phenomenon is associated with enhanced muscle glycogen storage. Clin Sci 117:119–127, 2009.
4. Al-Ozairi E, Waugh JJS, Taylor R. Termination is not the treatment of choice for severe hyperemesis gravidarum: Successful management using prednisolone. Obstetric Medicine 2: 34-37, 2009.
5. Lim EL, Burden T, Marshall SM, Davison JM, Blott MJ, Waugh JJS, Taylor R. Intrauterine Growth Rates in Pregnancies Complicated by Type 1, Type 2 and Gestational Diabetes. Obstetric Medicine 2: 21-25, 2009.
6. Jovanovic A, Gerrard J, Taylor R. The second meal phenomenon in type 2 diabetes. Diabetes Care 32:1199-1201, 2009.
7. L. Sibal, A. Aldibbiat, S. C. Agarwal, G. Mitchell, C. Oates, S. Razvi, J. U. Weaver, J. A. Shaw and P. D. Home. Circulating endothelial progenitor cells, endothelial function, carotid intima–media thickness and circulating markers of endothelial dysfunction in people with type 1 diabetes without macrovascular disease or microalbuminuria. Editors choice August 09 Diabetologia www.diabetologia-journal.org
8. Wright R J, Frier B M, Deary I J. Effects of acute insulin-induced hypoglycemia on spatial abilities in adults with type 1 diabetes. Diabetes Care 2009; 32: 1503-1506.

RECENT PUBLICATIONS IN DIABETES & ENDOCRINOLOGY THAT HIT THE NEWS OR THAT MAY HAVE A SIGNIFICANT IMPACT ON MANAGEMENT

Denosumab in men receiving androgen-deprivation therapy for prostate cancer. Smith MR, Egerdie B, Hernández Toriz N et al N Engl J Med. 2009 Aug 20;361(8):745-55. Androgen-deprivation therapy is well-established for treating The authors investigated the effects of denosumab, a fully human monoclonal antibody against receptor activator of nuclear factor-kappaB ligand (RANKL) that blocks its effect on the RANK receptor reducing osteoclast activity and hence bone resorption with an intendent increase in bone mineral density, on bone mineral density and fractures in men receiving androgen-deprivation therapy (which increases fracture risk) for nonmetastatic prostate cancer. 734 patients were randomized to receive denosumab 60 mg subcutaneously every 6 months and 734 patients received placebo . The primary end point was percent change in bone mineral density at the lumbar spine at 24 months and secondary end points included percent change in bone mineral densities at the femoral neck and total hip at 24 months and at all three sites at 36 months, as well as incidence of new vertebral fractures. At 24 months, lumbar spine BMD increased by 5.6% in the denosumab group as compared with a loss of 1.0% in the placebo group (P<0.001); Denosumab therapy was also associated with significant increases in BMD at the total hip, femoral neck, and distal third of the radius at all time points. Denosumab reduced the incidence of new vertebral fractures at 36 months by 62% (1.5%, vs. 3.9% with placebo; relative risk, 0.38; 95%CI 0.19 to 0.78; p=0.006). Rates of adverse events were similar between the two groups. In this trial Denosumab was associated with increased bone mineral density at all sites and a reduction in the incidence of new vertebral fractures.

Denosumab for prevention of fractures in postmenopausal women with osteoporosis. Cummings SR, San Martin J, McClung MR N Engl J Med. 2009 Aug 20;361(8):756-65. The investigators enrolled 7868 women between the ages of 60 and 90 years with a BMD T score of < -2.5 but not <-4.0 at the lumbar spine or total hip and randomly assigned them to receive either 60 mg of denosumab or placebo subcutaneously every 6 months for 36 months. The primary end point was new vertebral fracture with secondary end points of nonvertebral and hip fractures. Compared to placebo denosumab reduced the risk of new radiographic vertebral fracture by 68% (cumulative incidence of 2.3% vs 7.2%; risk ratio, 0.32: 95%CI 0.26-0.41; p<0.001). Denosumab reduced the risk of hip fracture by 40% (cumulative incidence of 0.7% vs 1.2%; hazard ratio, 0.60: 95% CI, 0.37-0.97; p=0.04). Denosumab also reduced the risk of nonvertebral fracture by 20% (cumulative incidence of 6.5% vs 8.0%; hazard ratio, 0.80: 95% CI, 0.67-0.95; p=0.01). There was no increase in the risk of cancer, infection, cardiovascular disease, delayed fracture healing, or hypocalcaemia, and there were no cases of osteonecrosis of the jaw and no adverse reactions to the injection of denosumab. The above two trials clearly demonstrate the effectiveness of targeting RANKL to treat osteoporoses in both men and women. Denosumab is an exciting new tool for treating osteoporoses. The accompanying editorial by Sundeep Khosla (NEJM 2009;361:818-820) is well worth a read. The challenge now is construct cost effective pathways for utilising the therapies available for osteoporoses.

Recent developments in hyperthyroidism. Julia Kharlip and David S Cooper. Lancet 2009;373:1930-1932. A reasonable editorial that will point you to the true goodies to read.

Eradication of insulin resistance. Imai J, et al. Lancet 2009;374:264. An excellent case report.

Hyperparathyroidism. William D Fraser. Lancet 2009;374:145-158. An excellent review well worth a read.

A reason to panic in pregnancy. Pearson GAH et al. Lancet 2009;374:756. An excellent case report exploring catecholamine excess in pregnancy.

Insulin glargine and malignancy: an unwarranted alarm. Stuart J Pocock & Liam Smeeth. Lancet 2009;374:511-513. AND Insulin glargine and cancer: another side to the story? Edwin AM Gale. Lancet 2009;374:521. An editorial and correspondence that I think provide food for thought, pause and appraisal............

Rosiglitazone evaluated for cardiovascular outcomes in oral agent combination therapy for type 2 diabetes (RECORD): a multicentre, randomised, open-label trial. Home PD, Pocock SJ, Beck-Nielsen H, et al Lancet. 2009;373:2125-35. The investigators randomized 4447 patients with type 2 diabetes on metformin or sulfonylurea monotherapy with mean HbA1c of 7.9% to the addition of rosiglitazone (n=2220) or to a combination of metformin and sulfonylurea (active control group, n=2227). The primary endpoint was cardiovascular hospitalisation or cardiovascular death. The latter occurred in 321 people in the rosiglitazone group and 323 in the active control group during a mean follow-up of 5.5 years. The Hazard Ratio[95%CI] was 0.84[0.59-1.18]for cardiovascular death, 1.14[0.80-1.63] for MI, and 0.72[0.49-1.06] for stroke. Hospital admission for heart failure or death occurred in 61 people in the rosiglitazone group and 29 in the active control group (HR 2.10[1.35-3.27]) Upper (Risk Ratio[95%CI] 1.57[1.12-2.19], p=0.0095)and distal lower limb (2.6[1.67-4.02], p<0.0001) fracture rates were increased mainly in women assigned to rosiglitazone. Mean HbA1c was lower in the rosiglitazone group than in the control group at 5 years, mean[SE] HbA1c rosiglitazone vs sulfonylurea -0.28[0.03] vs 0.01[0.04], p<0.0001; rosiglitazone vs metformin -0.44[0.03] vs -0.18[0.04], p<0.0001. This trial really does confirm my working practice that glitazones are effective therapy for improving glycaemic control in patients with Type 2 DM, but they should not be used in patients with heart failure or at significant risk of heart failure; the fracture risk of all patients should be assessed before starting therapy AND that they do not increase overall cardiovascular mortality or morbidity. Their use really is guided by discussion with the patient. The generic advice in guidelines or to GPs of a glitazone of your choice remains for me.

The venous thrombotic risk of oral contraceptives, effects of oestrogen dose and progestogen type: results of the MEGA case-control study. van Hylckama Vlieg A, Helmerhorst FM, et al BMJ. 2009 Aug 13;339:b2921. doi: 10.1136/bmj.b2921. This population based case-control study assessed the thrombotic risk associated with oral contraceptive use with a focus on dose of oestrogen and type of progestogen of oral contraceptives in premenopausal women <50 years old who were not pregnant, not within four weeks postpartum, and not using a hormone excreting intrauterine device or depot contraceptive, with a population of 1524 patients and 1760 controls. Currently available oral contraceptives increased the risk of venous thrombosis fivefold compared with non-use (odds ratio 5.0, 95%CI 4.2 to 5.8). The risk clearly differed by type of progestogen and dose of oestrogen. The use of oral contraceptives containing levonorgestrel was associated with an almost fourfold increased risk of venous thrombosis (odds ratio 3.6, 2.9 to 4.6)compared to non-users, whereas the risk of venous thrombosis compared with non-use was increased 5.6-fold for gestodene (5.6, 3.7 to 8.4), 7.3-fold for desogestrel (7.3, 5.3 to 10.0), 6.8-fold for cyproterone acetate (6.8, 4.7 to 10.0), and 6.3-fold for drospirenone (6.3, 2.9 to 13.7). The risk of venous thrombosis was positively associated with oestrogen dose. There was a high risk of venous thrombosis during the first months of oral contraceptive use irrespective of the type of oral contraceptives. Reviewing the results of this study and another study (Hormonal contraception and risk of venous thromboembolism: national follow-up study. Lidegaard O, et al. BMJ 2009;339:b2890doi10.1136/bmj.b2890) along with an excellent review (Contraception for women: an evidence based overview. Jean-Jacques Amy & Vrijesh Tripathi. BMJ 2009;339:b2895 doi10.1136/bmj.b2895) in the same issue of the BMJ show that when discussing oral contraception with women we should recommend those containing levonorgestrel or norethisterone with as low a dose of oestrogen as possible. The accompanying editorial by Nick Dunn (BMJ 2009;339:b3164doi:10.1136/bmj.b3164) is well worth a read.

NEXT NEWSLETTER Due out beginning of February 2009 so keep the gossip coming.

TOPDOC diabetes survey

2009-03-17T00:27:00.001Z

Dear All,

May I request you all, on behalf of the topdocdiabetes (Trainees Own Perception of Delivery Of Care in Diabetes) survey team to help with this nationwide survey looking at the confidence levels among the junior doctors in management of diabetes. One of of our previous SpRs, now a consultant in Glsgow Royal Infirmary, Gerry Mckay leads the national steering committee. The study is sponsored by ABCD.

If you can forward this mail with the information below to all the juniors in your trust and encourage them to complete the online questionnaire, which will take not more than 5 minutes, will be very helpful. There are some prizes for the participants and also we may manage some grants for our CME fund. I particularly request my fellow SpRs to take an active interest and help with this project.

If any further information is needed, please let me know.

Sincere regards
Arut

Arutchelvam
Specialist registrar in Diabetes and Endocrinology
Northern Deanery

May I draw your attention to TOPDOC Diabetes-a national study of foundation and specialty trainees in all specialties looking at their confidence levels in management of diabetes. The study is available at www.topdocdiabetes.org and over 450 juniors have already responded.

This is a UK-wide survey of foundation doctors and specialist trainees from all specialities, looking at their confidence levels in the management of diabetes. The study is funded by Association of British Clinical Diabetologists and follows from a national pilot that showed a lack of confidence in managing aspects of diabetes care, including the management of diabetes emergencies.

All details are available at www.topdocdiabetes.org and the survey takes only 5 minutes to complete. On behalf of the national steering committee, I'll be most grateful if you would forward this email to foundation and specialty trainees in your hospital. -please encourage all your juniors to do this study.

CPD diary for Specialist registrars

2009-02-21T22:51:00.000Z

In case any of you is not aware, we the SpRs can also register for the CPD.

Training version of the CPD Diary is available for use by SpRs enrolled with JRCPTB. This training Diary looks and operates the same way as the Consultant's Diary.

The SpR version of the CPD Diary is available free to all SpRs who are enrolled with JRCPTB, and who have confirmed CCT dates. The SpR Diary is not available to LATS, or SpRs not enrolled with JRCPTB. This is because the CPD Diary is only available to those who contribute to the RCP by paying subscription fees to the college or to JRCPTB.
Once you receive your CCTs, you will need to complete the CPD Registration Form in order to change your status on the Federation CPD Scheme and update your details on our database. You will then be upgraded to the full, consultant version of the CPD Diary. Your Online CPD Diary login details will remain the same and you will be able to continue using the diary as normal to record your CPD. All activities recorded in the SpR Diary will be transferred into the consultant Diary when you upgrade to the full version. The Registration Form may be found on the CPD Registration Page.

How to Get an SpR Diary Password?

If you would like to get a password to be able to use the SpR CPD Diary, then please send an email to cpd@rcplondon.ac.uk, giving your GMC number and you will be issued with your unique login details for the CPD Diary.

Best wishes

Arut

Endodiabology February 2009

2009-02-02T00:07:00.000Z

ENDODIABOLOGY
Endodiabology.blogspot.com

NORTHEAST
NEWSLETTER
FOR SPRs AND BOSSES TRAPPED
IN THE NORTHERN DEANERY

FEBRUARY 2009
Editors: Shaz Wahid (shahid.wahid@sthct.nhs.uk) and
Petros Perros (petros.perros@ncl.ac.uk) and Arut Vijayaraman (riarut@aol.com )
Associate Editors: Shafie Kamarrudin, Ravi Erukulapati

SpR PLACEMENTS (NTN year of training from 1st October 2008)
· RVI- Shafie Kamarrudin (3), Beas Bhattacharya (5), Asgar Madathil (4), Kathryn Stewart (2), Rohanna Wright (1), Chandima Idampitiya (4), Preeti Rao (2)
· North Tyneside/Wansbeck- Ravi Erukalapati(4), Sudeep Manohar (2)
· South Tyneside- Sukesh Chandran(5)
· Gateshead- Arutchelvan Vijayaraman (5)
· Sunderland- Jeevan Mettayil (3), Sarah Steven (1)
· North Tees/Hartlepool- Khaled Mansur-Dukhan (5), Stuart Little (1)
· Middlesbrough- Anjali Santhakumar (2), Arif Ullah (2), Yahya Maghoub
· Carlisle- Naveen Siddaramaiha (1)
· Bishop Auckland Srikanth Mada(2)
· Durham-
· NGH/QEH- Freda Razvi (5)
· Research with numbers (supervisor)- Eelin Lim(5-Prof Taylor)

MEETINGS / LECTURES / ANNOUNCEMENTS
· 10th February 2009 SfE Clinical Cases meeting, London. Contact www.endocrinology.org .
· 11th-13th March 2009 DUK Annual Professional Conference, Birmingham. Contact www.diabetes.org.uk
· 16th – 19th March 2009 BES 2009, Harrogate. Contact www.endocrinology.org .
· 18th March 2009 GIM training ½ day, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247
· 23rd & 24th April 2009 Middlesbrough insulin pump course. Contact
· 29th April 2009 RCP Acute Medical Emergencies, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247
· 30th April 2009 Novo Nordisk Symposium, Lumley Castle Hotel. Contact & see letters section.
· 7th-8th May 2009 ABCD Spring Meeting, Bristol, www.diabetologists.org.uk
· 11th May 2009 GIM training ½ day, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247
· 5th-9th June 2009 American Diabetes Association 69th Annual Scientific Sessions, New Orleans, USA. Contact meetings@diabetes.org .
· 10th-13th June 2009 ENDO 2009, Washington, USA. Contact endostaff@endo-societ.org or www.endo-society.org/scimeetings .
· 24th June 2009 Northern Endocrine & Diabetes Summer CME, Freeman Hospital. Contact
· 1st July 2009 GIM training ½ day, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247
· 10th September 2009 GIM training ½ day, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247
· 27th September-1st October 2009 45th EASD Annual meeting, Vienna, Austria. Contact www.easd.org
· 12th October 2009 Northern Endocrine & Diabetes Autumn CME, JCUH, Middlesbrough. Contact
· 2nd-4th November 2009 Society for Endocrinology Clinical Update 2009, venue TBC. Contact www.endocrinology.org
· 2nd November 2009 GIM training ½ day, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247
· 3rd November 2009 RCPL Medicine Update, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247
· 25th November 2009 Northern Endocrine Region Research and Audit Group annual meeting, Lumley Castle, Durham 2pm-8pm. Contact shahid.wahid@sthct.nhs.uk
· 26th & 27th November 2009 Middlesbrough insulin pump course. Contact Rudy.Bilous@stees.nhs.uk

See www.worlddiabetescongress.org for the IDF world diabetes conference.
TRAINING ISSUES
NEW TPD See letters section for an introduction to our new TPD that also includes training advice.
ARCPs/RITAs/PYAs These are planned for Weds 13th May to Friday 15th May 2009. Nicky Leech will be distributing details. For those of you requiring a PYA keep Thurs 14th May 2009 free.
Acute Medicine Level 2 training for SpRs For this year’s ARCPs/RITAs any SpR who has not had their PYA will be expected to have 4 ACAT assessments and 4 Mini-CEXs/CbDs specifically in relation to Acute Medicine in their portfolio for the panel to review.
Acute Medicine Level 2 training for StRs Any trainee appointed after August 2007 will be considered a StR and for their ARCP they will be expected to have 4 ACAT assessments, 4 Mini-CEXs and 4 CbDs specifically in relation to Acute Medicine, a valid ALS qualification, evidence of achievement of all the procedures deemed necessary for Acute Medicine Level 2 training, Evidence of achievement of all emergency presentations to level 2, Evidence of achievement of 2/3rds top 20 presentations to level 2 and Evidence of ½ of other presentations to level 2. It is recommended to use the pages available from the Acute Medicine e-portfolio to collect the later evidence that CMT (ST1-ST2) trainees should already have. If you do not have access to this then contact your Post-Grad Education Centre Manager who should be able to get you access to the e-portfolio for CMTs.
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. This site is essential reading, especially for ARCP preparation.
Registering with PMETB It is essential that all new SpRs/StRs (even LATs) register with the PMETB through the newly created Joint Royal Colleges of Physicians Training Board (formally the JCHMT) on www.jrcptb.org.uk although it is still possible to link with this site using the old www.jchmt.org.uk link. Not doing so means your training is not counted.
Log Book/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.
Assessment tools Please see www.jrcptb.org.uk; it is the trainee’s responsibility to give all the appropriate forms to their Educational or Clinical Supervisor. It is the trainee’s responsibility to make sure that the appropriate assessment summaries are available in their portfolio for ARCP purposes, e.g. MSF Summary Form.
Acute Care Assessment Tool The ACAT is a tool that is commendable. It provides a method of assessing how Trainees managed their on-call period. It is recommended that at least one is available for ARCP purposes. It can be downloaded from the JRCPTB website.
Case Based Discussions (CbD) The pilot form is available from the JRCPTB website. It is a must for trainers to use as a tool to document feedback in clinic. This has always been done informally, but now there is a method to formally document it. I basically use it for when a SpR presents a new case to me in clinic.
Documenting CCU and ITU experience As of now 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 Acute Medicine PYAs.
Community Diabetes The curriculum is undergoing some slight revision to reflect the importance that trainees gain “practical” experience in issues around commissioning, service delivery with no “walls”, patient centred care in a district and other “political” issues/changes. That is, it is important to be prepared to utilise management skills around these areas upon attaining a CCT.
Training Committee Chair- Jola Weaver,; Regional Speciality Advisor- Shaz Wahid,; Programme Director- Nicky Leech; Consultant member (SAC rep)- Richard Quinton,; Consultant member-Jean MacLeod,; Consultant member (Research Advisor)-Simon Pearce; Consultant member-Simon Eaton,; SpR representative- Arutchelvan Vijayaraman ; SpR representative- Jeevan Mettayil
NEWS FROM THE NORTHEAST
· Congratulations to Nicky Leech as our new TPD, see her letter below.
· Shaz Wahid will be the new Regional Specialty Advisor (service delivery) with Richard Quinton still the regions rep on the national SAC committee (training matters).
· Richard Quinton attended the Endocrine Society of India annual congress, Cochin, Kerala, Dec 2008 as invited speaker on the Genetics of Idiopathic Hypogonadotrophic Hypogonadism. At the conference he met up with Dr V Suresh, who was Visiting Fellow at the RVI with us a few years back & is now Assistant Professor in Endocrinology at Department of Endocrinology at SVIMS, Tirupati, Andhra Pradesh & Dr Muthu Jayapaul, who has only just returned to India to join a newly-formed Endocrinology consortium in Madras (Chennai).
· Congratulations to Roy Taylor in obtaining a research grant from Diabetes UK. Effect of change in pancreas and liver fat content upon beta cell function and hepatic insulin action during weight loss in type 2 diabetes. £126,000. Taylor R., Mathers J, Hollingsworth K.
· Simon Eaton will Chair the Long Term Conditions Group for the SHA and would be very grateful for people to contact him if they are interested in contributing to the work of implementing the “Our Vision Our Future LTC” report.
· Simon Eaton will be relinquishing the NRDSAG chair and would be interested in hearing from someone who may want to take on this role.
· Sue Roberts was awarded CBE in the New Year Honours, congratulations!
· I am pleased to announce that Arut has agreed to become a Senior Editor on the ENDODIABOLOGY team and will continue this role through Consultant hood.
· Congratulations to Rohanna Wright on obtaining a place on the SPARROWS programme for the ADA. She will be joined by Bernadette Woodward a DSN at JCUH.
· Congratulations to John Parr on being asked by the ABCD to be their regional champion for the North East. See the letters section. Hopefully this may well lead to an ABCD meeting being held in the North East in the near future.
· We have appointed 2 NTNs from run-through, Catherine Napier & Atif Munir. Both of whom were excellent at interview. Interviews for vacancies will be held 3rd March 09 and June 09.

LETTERS
“United we stand, divided we fall”-Shaz Wahid
I remember reading about Mike Besser’s lecture at the ABCD several years ago with the above title, where he extolled the virtues of maintaining practice in both Diabetes & Endocrinology without bowing to external pressures and splitting the specialty. I could not agree more at the time and still remember whilst training as an SpR feeling rather puzzled when it was voiced that training in Diabetes & Endocrinology should be split by folk in the higher echelons of the then JCHMT and the DoH. Thankfully, matters have remained quiet in relation to the latter until recently when the PMETB have talked about issues such as credentialing and indeed there has been a comparison between our training curriculum and the Cardiology training curriculum with the intention to demonstrate that we should model training similar to Cardiology. That is, train in the basics (apparently mainly in primary care settings) but be able to choose time limited periods in more specialist areas (e.g. insulin pumps, reproductive endocrinology, obesity, etc) towards the senior years of training. Hence, rather like Cardiologists producing trainees specialised in such areas as electrophysiology we would produce trainees with a CCT in Diabetes & Endocrinology but credentialed in insulin pumps or gynea-fertility-endocrinology. This fills me with dread. Admittedly, when coming out at the other end I had an interest in renal diabetes but I did have enough of a grounding in the specialty and more importantly developed self-management and leadership skills to set up a diabetic foot service, further develop a transitional diabetes service and rubbed shoulders with the community via a number of initiatives without giving away the crown jewels! I remember sitting next to RT shortly after obtaining Consultant hood when he asked “Shaz did we prepare you”, “not for all eventualities, but I have had enough training to have developed the skills to manage all scenarios”, an answer RT was pleased with. It is not surprising Endocrinologists make good Acute Medicine Physicians as we are well versed in looking at disparate issues of patient care and bringing them together across a Trust or a community with the aim of delivering quality patient care. The current processes of care in the NHS do not lend themselves to remodelling training in Diabetes & Endocrinology along the lines of Cardiology so that we always produce “super specialists”. There are mechanisms within the specialty that already allow one to become a “super specialist” without having to reduce exposure to the basic groundings in the speciality that allow development of our unique specialist skills. In summary, going down the line of either splitting the sugar from hormones or compartmentalising the specialty to produce “super specialists” will only be to the detriment of delivering high quality patient care. Thankfully, our SAC thinks along similar lines as me……………………………………………………..

Thoughts of a New Trainee Programme Director. Life after 9/1/09. Dr Nicky Leech Diabetologists and Endocrinologists may be quiet and discerning but they whisper well. As a consequence I think you all know that I have now been officially appointed after a tough competitive interview!! As the only candidate I failed to convince the panel that I was wholly unsuitable as the Northern Deanery Training Programme Director for our specialty.
Why did we all take six paces backwards when Shaz declared his wish to step down? He has been exceptional and perhaps no one had the courage to follow such an act. Our thanks go to Shaz for steering us through the minefield of MMC and run-through training. He has kept engaged with a challenging system and pioneered the robust implementation of annual portfolio based assessment using the breadth of work-place based assessment tools. His excellent leadership is obvious. Look around you at the health of your diabetes and endocrinology training programme compared to equivalent specialities in the region.
Reflecting on the thoughts of a Guru, I will strive for private and public victory but don’t worry I wont forget to sharpen my sword! On a more personal note, thank you Shaz for your continued support and guidance as I try to take hold of the tiller and learn the ropes.
So what is looming on our horizon? I sense the excitement about the prospect of having another professional exam! This will need to have been achieved by PYA for all those entering speciality training after 2007. What about the rest of you? I would want to be “as qualified as the rest of them” wouldn’t you? When should you sit the exam? That is obviously your decision although it makes far more sense to me to sit very early in training. It will equip you with a wealth of knowledge which can then be applied, releases time for more personalised learning and if you fail (not that any of you will!) ensures you have time to resit without jeopardizing your career progression.
Some of you will have been surprised by the suggestion that they have inadequate evidence of GIM, ITU and cardiology at PYA. All trainees are doing enough but it is the documented evidence that counts. I refer you back to this and previous editions of Endodiabology. In summary; log your cases and ensure you have 4 ACATs, 4 Min-CEXs and 4 CbDs in General medicine including documented evidence of exposure in ITU and cardiology.
Now October and Christmas has passed all trainees should ensure they have sat with their supervisors and agreed their personal development plan (PDP) based on the training needs identified in the previous ARCP.
An old Chinese proverb says “if you don’t scale the mountain you cannot view the plain” so keep climbing as we work through the scree slope of change and if it is any comfort to you “today my mountain feels as steep as yours!”

Do you care for a person with diabetes who has problematic / unusual hypoglycaemia?
Would you like to discuss the case with world experts in hypoglycaemia?
You have the opportunity at this year’s NovoNordisk Symposium on Thursday 30 April 2009
To present, please submit an abstract of no more than 200 words, describing the clinical scenario, and indicating what you hope to achieve from the case discussion.
Submit to: Sally Marshall By 1 April 2009.
Northern Region NovoNordisk Symposium- Hypoglycaemia
Thursday 30 April 2009 Lumley Castle Hotel

Programme
1400 - 1430 Registration and Coffee
Chair Sally Marshall
1430 - 1515 Professor Stephanie Amiel, London
Hypoglycaemia and the Brain
1515 - 1600 Professor Brian Frier, Edinburgh
Hypoglycaemia and Life Issues
1600 – 1615 Tea
1615 - 1730 Dr James Shaw, Newcastle, Local Case Presenters and Expert Panel Discussion
Loss of awareness of hypoglycaemia: practical aspects
1730-1815 Dr Lotte Bjerre Knudsen
The Birth of a Molecule: from Conception to Delivery
1830 Close

ABCD-The best CPD in Diabetes? John Parr ABCD (The Association of British Clinical Diabetologists) is now 10 years old. I was sent by the NRDSAG to its inaugural meeting at Windsor to find out “what it was about”, particularly at the time there was great opposition to a potential rival organization from Diabetes UK. I actually found it an extremely beneficial, refreshing and vibrant meeting and have continued to attend meetings ever since.
For me it’s the best Diabetes CPD in town. Why? Firstly it provides twice-yearly specialist, up to date, timely and comprehensive programmes (see enclosed programmes) by expert speakers, directed to Specialist/Consultant Diabetologists, with enough time to question and debate the issues from the floor. Audience participation is one of its strengths and even the great and the good get questioned rigorously.
Secondly the programme addresses issues and challenges that we consultants face in daily practice, and in such a convivial setting talking to and supporting each other is the best psychotherapy around. Thirdly its practical side; through country-wide collaboration, audits on triple oral therapy and glargine use in pregnancy have been undertaken and by achieving substantial numbers have made the results meaningful (current audits are on Charcot’s, Exubera, Osteomyelitis Management and Outcome); the Survey of Inpatient Services and through collaboration with Diabetes UK the UK Specialist Services Survey, have all been important. It submits to NICE and contributes to RCP groups. The organization represents consultants in diabetes and many are members. Fourthly it encourages SpR membership, attendance and participation, through meetings (another venue for posters) and the audit programmes/awards. Indeed a meeting for SpRs follows on from the main meeting – making 2 days of good diabetes education and by taking in the splendid preceding British Thyroid Association meeting in November, extending to 3 days. Is it a meeting just for “old farts”? Not necessarily! It’s also for “young farts” (after all they eventually become “old-farts”) and specialists of all description. Further information is available from http://www.diabetologists-abcd.org.uk/ .

RECENT PUBLICATIONS FROM THE NORTHEAST
1. Langham S, Maggi M, Schulman C, Quinton R, Uhl-Hochgräber K. 2008 health-related quality of life instruments in studies of adult men with testosterone deficiency syndrome: a critical assessment. Journal of Sexual Medicine. 5: 2842-2852.
2. Nicol MR, Papacleovoulou G, Evans DB, Penning TM, Strachan MW, Advani A, Johnson SJ, Quinton R, Mason JI. Estrogen biosynthesis in human H295 adrenocortical carcinoma cells. Mol Cell Endocrinol. 2008 Nov 5. [Epub ahead of print].
3. Igreja S, Chahal HS, Akker SA, Gueorguiev M, Popovic V, Damjanovic S, Burman P, Wass JA, Quinton R, Grossman AB, Korbonits M. Assessment of p27 (cyclin-dependent kinase inhibitor 1B) and AIP (aryl hydrocarbon receptor-interacting protein) genes in MEN1 syndrome patients without any detectable MEN1 gene mutations. Clin Endocrinol (Oxf). 2008 Aug 15. [Epub ahead of print].
4. Ravikumar, B, Gerrard J, Dalla Man C, Firbank MJ, Lane A, English PT, Cobelli C, Taylor R. Pioglitazone decreases fasting and postprandial endogenous glucose production in proportion to decrease in hepatic triglyceride content. Diabetes 57: 2288-95, 2008.
5. Belch JJ, Macuish A, Campbell I, Cobbe S, Taylor R, Prescott R, Lee R, Bancroft J, MacEwan S, Shepherd J, Macfarlane P, Morris A, Jung R, Kelly C, Connacher A, Peden N, Jamieson A, Mathews D, Leese G, McKnight J, O’Brian I, Semple C, Petrie J , Gordon D, Pringle S, MacWalter R. The Prevention of Progression of Arterial Disease and Diabetes (POPADAD): a study of aspirin and antioxidants in patients with Diabetes and asymptomatic peripheral arterial disease. Brit Med J 337:a1840, 2008.
6. Arun CS, Al-Bermani A, Stannard KS, Taylor R. Long term impact of retinal screening upon significant diabetes related visual impairment in the working age population. Diabetic Medicine 2008 in press
7. Jovanovic A, Leverton E, Solanky B, Snaar JEM, Morris PEG, Taylor R. The second meal phenomenon is associated with enhanced muscle glycogen storage. Clin Sci 2008 in press
8. Al-Ozairi E, Waugh JJS, Taylor R. Termination is not the treatment of choice for severe hyperemesis gravidarum: Successful management using prednisolone. Obstetric Medicine 2008 in press
9. Chaturvedi N,Porta M, Klein R,Orchard T,Fuller J,Parving HH,Bilous R,Sjolie AK Effect of candesartan on prevention (DIRECT- Prevent1) and progression (DIRECT-Protect 1) of retinopathy in type 1 diabetes : randomised ,placebo controlled trials. Lancet 2008 372 1394 – 1402.
10. Sjolie AK, Klein R,Porta M, Klein R,Orchard T,Fuller J,Parving HH,Bilous R, Chaturvedi N Effect of candesartan on progression and regression of retinopathy in type 2 diabetes (DIRECT-Protect 2) : a randomised placebo controlled trial. Lancet 2008 372 1385 – 93.

RECENT PUBLICATIONS IN DIABETES & ENDOCRINOLOGY THAT HIT THE NEWS OR THAT MAY HAVE A SIGNIFICANT IMPACT ON MANAGEMENT
Rennekampff H-O, et al. Chronic wound care. Lancet 2008;372:1860-1862. An excellent editorial, well worth a read and provides useful references.

Spurling G and Walsh M. Aspirin type 2 diabetes: is there any evidence base? BMJ 2008;337:1163-1165. A wonderful summary of the evidence that I feel gives a resounding NO, do you agree? It also links in nicely with the POPADAD study below.

Lecky B and Sathasivam S. Statin induced myopathy. BMJ 2008;337:1159-1162. An essential read that provides practical advice.

Stevens P et al. Early identification and management of chronic kidney disease: summary of NICE guidelines. BMJ 2008;337:812-815. AND Haynes RJ & Landray MJ. Commentary: controversies in NICE guidance on chronic kidney disease. BMJ 2008;337:815-816. An excellent summary very pertinent to those involved in leading the diabetic renal service.

Miller jc et al. Definitive characterisation of adrenal lesions. BMJ 2009;338:233-236. An essential read providing a pragmatic update on adrenal imaging.

Belch j, et al. The prevention of progression of arterial disease and diabetes (POPADAD) trial: factorial randomised placebo controlled trial of aspirin and antioxidants in patients with diabetes and asymptomatic peripheral arterial disease. BMJ 2008;337:1030-1034. This multicentre, randomised, double blind, 2x2 factorial, placebo controlled trial recruited 1276 adults aged 40 or more with type 1 or type 2 diabetes and an ankle brachial pressure index of 0.99 or less but no symptomatic cardiovascular disease. Daily, 100 mg aspirin tablet plus antioxidant capsule (n=320), aspirin tablet plus placebo capsule (n=318), placebo tablet plus antioxidant capsule (n=320), or placebo tablet plus placebo capsule (n=318) were the different therapy arms in the trial. The end-points measured were: primary end points of death from coronary heart disease or stroke, non-fatal myocardial infarction or stroke, or amputation above the ankle for critical limb ischaemia; and death from coronary heart disease or stroke. 116 of 638 primary events occurred in the aspirin groups compared with 117 of 638 in the no aspirin groups (18.2% vs 18.3%): hazard ratio 0.98 (95% CI 0.76-1.26). Forty three deaths from coronary heart disease or stroke occurred in the aspirin groups compared with 35 in the no aspirin groups (6.7% vs 5.5%): 1.23 (0.79-1.93). Among the antioxidant groups 117 of 640 (18.3%) primary events occurred compared with 116 of 636 (18.2%) in the no antioxidant groups (1.03, 0.79 to 1.33). Forty two (6.6%) deaths from coronary heart disease or stroke occurred in the antioxidant groups compared with 36 (5.7%) in the no antioxidant groups (1.21, 0.78 to 1.89). A profound NO for the use of aspirin as primary prevention is provided by this trial, admittedly in this group of patients studied. However, adding the other 7 trials with similar results in relation to primary prevention of cardiovascular disease with aspirin into the mix has certainly resulted in a change in my practice. Do you agree…………..

Astrup A, et al. Effect of tesofensine on bodyweight loss, body composition, and quality of life in obese patients: a randomised, double-blind, placebo-controlled trial. Lancet 2008;372:1906-1913. This phase II, randomised, double-blind, placebo-controlled trial in five Danish obesity management centres assessed the efficacy and safety of tesofensine-an inhibitor of the presynaptic uptake of noradrenaline, dopamine, and serotonin-in patients with obesity (originally it was developed as anti-parkinson’s drug). After a 2 week run-in phase, 203 obese patients (BMI 30-40 kg/m2) were prescribed an energy restricted diet and randomly to treatment with tesofensine 0.25 mg (n=52), 0.5 mg (n=50), or 1.0 mg (n=49), or placebo (n=52) once daily for 24 weeks. The primary outcome was percentage change in bodyweight. Analysis was by modified intention to treat (all randomised patients with measurement after at least one dose of study drug or placebo). 161 (79%) participants completed the study. After 24 weeks, the mean weight loss produced by diet and placebo was 2.0% (SE 0.60). Tesofensine 0.25 mg, 0.5 mg, and 1.0 mg and diet induced a mean weight loss of 4.5% (0.87), 9.2% (0.91), and 10.6% (0.84), respectively, greater than diet and placebo (p<0.0001). The most common adverse events caused by tesofensine were dry mouth, nausea, constipation, hard stools, diarrhoea, and insomnia. After 24 weeks, tesofensine 0.25 mg and 0.5 mg showed no significant increases in systolic or diastolic blood pressure compared with placebo, whereas heart rate was increased by 7.4 bpm in the tesofensine 0.5 mg group (p=0.0001). This trial suggests that tesofensine 0.5 mg might have the potential to produce a weight loss twice that of currently approved drugs. However, further trials are awaited.

Drucker DJ, et al. Exenatide once weekly versus twice daily for the treatment of type 2 diabetes: a randomised, open-label, non-inferiority study. Lancet 2008;372:1240-1250. In this 30-week, randomised, non-inferiority study the authors compared a long-acting release formulation of exenatide 2 mg administered once weekly to 10 mcg exenatide administered twice a day, in 295 patients with type 2 diabetes (HbA1c 8.3% [SD 1.0], mean fasting plasma glucose 9 [SD 2] mmol/L, weight 102 [SD 20] kg, diabetes duration 6.7 [SD 5.0] years). The patients were naive to drug therapy, or on one or more oral antidiabetic agents. The primary endpoint was the change in HbA1c at 30 weeks. At 30 weeks, the patients given exenatide once a week had significantly greater changes in HbA1c than those given exenatide twice a day (-1.9 [SE 0.1%] vs -1.5 [0.1%], 95% CI -0.54% to -0.12%; p=0.0023). A significantly greater proportion of patients receiving treatment once a week versus twice a day achieved target HbA1c levels of 7.0% or less (77%vs 61% of evaluable patients, p=0.0039). Hence, exenatide once weekly resulted in significantly greater improvements in glycaemic control than exenatide given twice a day, with no increased risk of hypoglycaemia and similar reductions in bodyweight. Very interesting times in managing Type 2 diabetes with a plethora of new therapies that require careful evaluation and integration in care, obviously led by “specialists”.
Holman, RR, et al. Long-term follow-up after tight control of blood pressure in Type 2 diabetes. NEJM 2008;359:1565-1576. 1148 UKPDS patients with newly diagnosed type 2 DM and hypertension were randomly assigned, over a 4-year period beginning in 1987, to tight or less-tight blood-pressure control regimens. The 884 patients who underwent post-trial monitoring were asked to attend annual UKPDS clinics for the first 5 years, but no attempt was made to maintain their previously assigned therapies. Annual questionnaires completed by patients and general practitioners were used to follow patients who were unable to attend the clinic in years 1 through 5, and questionnaires were used for all patients in years 6 to 10. Seven prespecified aggregate clinical end points were examined on an intention-to-treat basis, according to the previous randomization categories. Differences in blood pressure between the two groups during the trial disappeared within 2 years after termination of the trial. Significant relative risk reductions found during the trial for any diabetes-related end point, diabetes-related death, microvascular disease, and stroke in the group receiving tight, as compared with less tight, blood-pressure control were not sustained during the post-trial follow-up. No risk reductions were seen during or after the trial for myocardial infarction or death from any cause, but a risk reduction for peripheral vascular disease associated with tight blood-pressure control became significant (P=0.02). This follow-up study has shown that the benefits of previously improved blood-pressure control were not sustained when between-group differences in blood pressure were lost. A seminal study that answers a question my patients often ask “Doc can I stop my BP tablets now that it is controlled?” “NO-and here is why UKPDS”.
Holman RR, et al. 10-Year follow-up of intensive glucose control in Type 2 diabetes. NEJM 2008;359:1577-1589. 4209 UKPDS patients with newly diagnosed type 2 diabetes were randomly assigned to receive either conventional therapy (dietary restriction) or intensive therapy (either sulphonylurea or insulin or, in overweight patients, metformin) for glucose control. In post-trial monitoring, 3277 patients were asked to attend annual UKPDS clinics for 5 years, but no attempts were made to maintain their previously assigned therapies. Annual questionnaires were used to follow patients who were unable to attend the clinics, and all patients in years 6 to 10 were assessed through questionnaires. Seven prespecified aggregate clinical outcomes from the UKPDS on an intention-to-treat basis, according to previous randomization categories, were examined. Between-group differences in HbA1c levels were lost after the first year. In the sulphonylurea-insulin group, relative reductions in risk persisted at 10 years for any diabetes-related end point (9%, P=0.04) and microvascular disease (24%, P=0.001), and risk reductions for MI (15%, P=0.01) and death from any cause (13%, P=0.007) emerged over time, as more events occurred. In the metformin group, significant risk reductions persisted for any diabetes-related end point (21%, P=0.01), MI (33%, P=0.005), and death from any cause (27%, P=0.002). This seminal study has shown that despite an early loss of glycaemic differences, a continued reduction in microvascular risk and emergent risk reductions for MI and death from any cause were observed during 10 years of post-trial follow-up. A continued benefit after metformin therapy was evident among overweight patients. In other words “in the long run improving glycaemic control matters for cardiovascular risk reduction and every little helps”-a true legacy effect in keeping with the follow-up of the seminal DCCT study.

Increased Prevalence of Tricuspid Regurgitation in Patients with Prolactinomas Chronically Treated with Cabergoline. Annamaria Colao et al,(JCEM 93: 3777–3784, 2008). Objective of this observational, case-control study was to evaluate prevalence of cardiac valve regurgitation in cabergoline-treated patients with prolactinomas. Fifty treated patients (44 women and six men) and 50 sex- and age-matched control subjects participated; 20 de novo patients were also studied. In the treated patients, the last cabergoline dose was 1.3 ± 1.3 mg/wk (<1>3 mg/wk in 10%). Treatment duration was 12–60 months in 32% and more than 60 months in 68%. The cumulative (milligrams x months of treatment) dose of cabergoline ranged from 32–1938 mg (median 280 mg). In de novo patients, treated patients, and controls, the prevalence of mild regurgitation of mitral (35, 22, and 12%, P = 0.085), aortic (0, 4, and 2%, P = 0.59), tricuspid (55, 30, and 42%, P = 0.13) or pulmonary (20, 12, and 6%, P = 0.22) valves was similar. Conversely, the prevalence of moderate tricuspid regurgitation was higher in the treated patients (54%) than in de novo patients (0%) and controls (18%, P < 0.0001). Moderate tricuspid regurgitation was more frequent in patients receiving a cumulative dose above the median (72%) than in those receiving a lower dose (36%, P = 0.023). A higher systolic (P = 0.03) and diastolic blood pressure (P < 0.0001) was found in patients with than in those without moderate tricuspid regurgitation. Moderate tricuspid regurgitation is more frequent in patients taking cabergoline (at higher cumulative doses) than in de novo patients and control subjects, but the clinical significance of this finding has not been established. A complete echocardiographic assessment is indicated in patients treated long term with cabergoline, particularly in those requiring elevated doses.

NEXT NEWSLETTER Due out beginning of June 2009 so keep the gossip coming.

ABCD Meeting-28.11.08 Programme 2

2008-10-22T17:19:00.001+01:00

ABCD meeting 27.11.08 Programme

2008-10-22T17:15:00.000+01:00

Message from ABCD regional champion-Dr John Parr

2008-10-22T17:08:00.001+01:00

ABCD-The best CPD in Diabetes?
John Parr Consultant Physician South Tyneside.

ABCD (The Association of British Clinical Diabetologists) is now 10 years old. I was sent by the NRDSAG to its inaugural meeting at Windsor to find out “what it was about”, particularly at the time there was great opposition to a potential rival organization from Diabetes UK. I actually found it an extremely beneficial, refreshing and vibrant meeting and have continued to attend meetings ever since. For me it’s the best Diabetes CPD in town.

Why? Firstly it provides twice-yearly specialist, up to date, timely and comprehensive programmes (see enclosed programmes) by expert speakers, directed to Specialist/Consultant Diabetologists, with enough time to question and debate the issues from the floor. Audience participation is one of its strengths and even the great and the good get questioned rigorously.
Secondly the programme addresses issues and challenges that we consultants face in daily practice, and in such a convivial setting talking to and supporting each other is the best psychotherapy around.

Thirdly its practical side; through country-wide collaboration, audits on triple oral therapy and glargine use in pregnancy have been undertaken and by achieving substantial numbers have made the results meaningful (current audits are on Charcots, Exubera, Osteomyelitis Management and Outcome); the Survey of Inpatient Services and through collaboration with Diabetes UK the UK Specialist Services Survey, have all been important. It submits to NICE and contributes to RCP groups. The organization represents consultants in diabetes and many are members

Fourthly it encourages SpR membership, attendance and participation, through meetings (another venue for posters) and the audit programmes/awards. Indeed a meeting for SpRs follows on from the main meeting – making 2 days of good diabetes education and by taking in the splendid preceding British Thyroid Association meeting in November, extending to 3 days.
Is it a meeting just for “old farts”? Not necessarily! It’s also for “young farts” (after all they eventually become “old-farts”) and specialists of all description. Further information is available from http://www.diabetologists-abcd.org.uk/ .

Comment by Professor Home on ACCORD,VADT and ADVANCE

2008-09-29T23:53:00.001+01:00

Could I just pick up on the ACCORD, VADT, ADVANCE results and the comments in ENDODIABOLOGY please.Firstly there is twice a suggestion that CV deaths were increased in VADT. Though the results have not been published, my memory from the presentations is that there was no different between groups. CV deaths were numerically higher, but the power was way too low for this to be meaningful - indeed the very analysis is dangerous.
Secondly ACCORD did not show increased deaths. It was stopped because of a signal of increased death, which generated a p value of 0.04. This interim observational test should not be regarded as statistically significant. Indeed most of us would not have stopped the study on the basis of the results presented in the paper.
Thirdly you will have seen the UKPDS extension study published since. Attached for those who have not. It is important to realize that ACCORD, ADVANCE and VADT are all consistent with the UKPDS findings, but of course not statistically significant largely because underpowered (VADT always was, ACCORD because stopped early). The consistency and power problems can be seem by considering the headline CV risk reduction in each study :
study HR/RR p ACCORD 0.90 (0.78, 1.04) NS
VADT 0.86 (0.73, 1.04) NS
Advance 0.94 (0.84, 1.06) NS
UKPDS'08 0.84 (0.75, 0.97) 0.01
Someone will no doubt do a meta-analysis on this lot when VADT appears in print - my bet it that it will be statistically significant.Comments, as ever, welcome
Philip Home

Endodiabology-October 2008

2008-09-29T23:47:00.000+01:00

ENDODIABOLOGY
Endodiabology.blogspot.com

NORTHEAST
NEWSLETTER
FOR SPRs AND BOSSES TRAPPED
IN THE NORTHERN DEANERY

OCTOBER 2008
Editors: Shaz Wahid and
Petros Perros (
Associate Editors: Arut Vijayaraman, Shafie Kamarrudin, Beas Bhattacharya, Ravi Erukulapati

SpR PLACEMENTS (NTN year of training from 1st October 2008)
· RVI- Shafie Kamarrudin (3), Beas Bhattacharya (5), Asgar Madathil (4), Kathryn Stewart (2), Rohanna Wright (1), Chandima Idampitiya (4), Preeti Rao (2)
· North Tyneside/Wansbeck- Ravi Erukalapati(4), Sudeep Manohar (2)
· South Tyneside- Sukesh Chandran(5)
· Gateshead- Arutchelvan Vijayaraman (5)
· Sunderland- Jeevan Mettayil (3), Sarah Steven (1)
· North Tees/Hartlepool- Khaled Mansur-Dukhan (5), Stuart Little (1)
· Middlesbrough- Anjali Santhakumar (2), Arif Ullah (2), Yahya Maghoub
· Carlisle- Naveen Siddaramaiha (1)
· Bishop Auckland Srikanth Mada(2)
· Durham- Ravikumar Balasubramanian (5)
· NGH/QEH- Freda Razvi (5)
· Research with numbers (supervisor)- Eelin Lim(5-Prof Taylor)

MEETINGS / LECTURES / ANNOUNCEMENTS
· 6-8th October 2008 Society for Endocrinology Clinical update, Bristol. Contact http://www.endocrinology.org/
· 17th October 2008 DUK 2009 abstract deadline.
· 12th November 2008 North East Obesity Forum meeting. Obesogenic environment.
· 12th November 2008 GIM training ½ day, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247
· 15th November 2008 BES 2009 abstract deadline.
· 26th November 2008 Northern Endocrine Regional Research and Audit Group (NERRAG) annual meeting, Lumley Castle, Durham. Contact
· 27th November 2008 58th British Thyroid Association Annual meeting, London, http://www.british-thyroid-association.org/ .
· 27th and 28th November 2008 (29th November 2008 is SpR meeting) ABCD Autumn Meeting, London, http://www.diabetologists.org.uk/
· 27th and 28th November 2008Insulin Pump Course, James Cook University Hospital. Apply on line at http://www.conferencessouthtees.co.uk/
· 10th December 2008 RCP Updates in G(I)M, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247
· 14th January 2009 GIM training ½ day, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247
· 26th January 2009 Northern Endocrine & Diabetes Winter CME, Freeman Hospital.
· 10th February 2009 SfE Clinical Cases meeting, London. Contact http://www.endocrinology.org/ .
· 11th-13th March 2009 DUK Annual Professional Conference, Birmingham. Contact http://www.diabetes.org.uk/
· 16th – 19th March 2009 BES 2009, Harrogate. Contact http://www.endocrinology.org/ .
· 18th March 2009 GIM training ½ day, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247
· 29th April 2009 RCP Acute Medical Emergencies, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247
· 7th-8th May 2009 ABCD Spring Meeting, Bristol, http://www.diabetologists.org.uk/
· 11th May 2009 GIM training ½ day, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247
· 24th June 2009 Northern Endocrine & Diabetes Summer CME, Freeman Hospital.
· 12th October 2009 Northern Endocrine & Diabetes Autumn CME, James Cook University Hospital

TRAINING ISSUES
Confusing paperwork The transitional period between SpR and StR training remains confusing and is especially hindered by the JRCPTBs poor communication and awful paperwork sent to the trainees. There will have to be separate instructions for the RITAs (old SpRs) and ARCPs (the new StR breed). As an example a new educational supervisor report was published by the JRCPTB the week before this years ARCPs/RITAs. The TPD now at least has some time to look at all the documents and ultimately produce separate instructions for regional use.
Acute Medicine Level 2 training for SpRs For next years ARCPs/RITAs any SpR who has not had their PYA will be expected to have 4 ACAT assessments and 4 Mini-CEXs specifically in relation to Acute Medicine in their portfolio for the panel to review.
Acute Medicine Level 2 training for StRs Any trainee appointed after August 2007 will be considered a StR and for their ARCP they will be expected to have 4 ACAT assessments, 4 Mini-CEXs specifically in relation to Acute Medicine, 4 CbDs in relation to Acute Medicine, a valid ALS qualification, evidence of achievement of all the procedures deemed necessary for Acute Medicine Level 2 training, Evidence of achievement of all emergency presentations to level 2, Evidence of achievement of 2/3rds top 20 presentations to level 2 and Evidence of ½ of other presentations to level 2. It is recommended to use the pages available from the Acute Medicine e-portfolio to collect the later evidence that CMT (ST1-ST2) trainees should already have. If you do not have access to this then contact your Post-Grad Education Centre Manager who should be able to get you access to the e-portfolio for CMTs.
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. This site is essential reading, especially for ARCP preparation.
Registering with PMETB It is essential that all new SpRs/StRs (even LATs) register with the PMETB through the newly created Joint Royal Colleges of Physicians Training Board (formally the JCHMT) on http://www.jrcptb.org.uk/ although it is still possible to link with this site using the old http://www.jchmt.org.uk/ link. Not doing so means your training is not counted.
Log Book/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.
Assessment tools Please see http://www.jrcptb.org.uk/, It is the trainee’s responsibility to give all the appropriate forms to their Educational or Clinical Supervisor. It is the trainee’s responsibility to make sure that the appropriate assessment summaries are available in their portfolio for ARCP purposes, e.g. MSF Summary Form.
ANOTHER CURRICULUM Trainees who have been recently appointed now have a new curriculum for both the specialty, Acute Medicine to Level 2 and a generic curriculum. Essentially there is no difference other than the sections being reorganised into the subsections of OBJECTIVE/COMPETENCY, KNOWLEDGE, SKILLS, ATTITUDE. They are essential reading and can be accessed on http://www.jrcptb.org.uk/ .
The GOLD Guide This replaces the Orange guide, and is the definitive guide to all aspects of training in the UK. It can be accessed on http://www.jrcptb.org.uk/SiteCollectionDocuments/Gold%20Guide.pdf . A massive document that I delve into when the need arises, e.g. interdeanery transfers.
Acute Care Assessment Tool The ACAT is a tool that is commendable. It provides a method of assessing how Trainees managed their on-call period. It is recommended that at least one is available for ARCP purposes. It can be downloaded from the JRCPTB website.
Personal Development Plans (PDPs) Following the ARCPs all trainees will have their report. It is essential that this report is used to construct a PDP when starting your new post from 1st October. The format used should be standard template circulated by Shaz Wahid.
Case Based Discussions (CbD) The pilot form is available from the JRCPTB website. It is a must for trainers to use as a tool to document feedback in clinic. This has always been done informally, but now there is a method to formally document it. I basically use it for when a SpR presents a new case to me in clinic.
Documenting CCU and ITU experience As of now 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 Acute Medicine PYAs.
Training Committee Chair- Jola Weaver,; Regional Speciality Advisor- Richard Quinton, ; Programme Director- TBC ; Consultant member-Shaz Wahid,; Consultant member-Jean MacLeod,; Consultant member (Research Advisor)-Simon Pearce,; Consultant member-Simon Eaton,; Consultant member-Nicky Leech; SpR representative- Arutchelvan Vijayaraman ; SpR representative- Jeevan Mettayil

NEWS FROM THE NORTHEAST
· Congratulations to Simon Ashwell on his recent marriage to Amelia Lake.
· Akheel Syed has moved onto a Locum Consultant post in Salford.
· Welcome to Naveen Siddaramaiha (NTN) and Yayha Maghoub (LAT) onto the rotation.
· Shaz Wahid will be stepping down from 1st November 2008 as TPD having completed his tenure.
· Congratulations to Emma Peralta on winning the Prize for best SPARROWS presentation.

LETTERS
The 7 habits of highly effective people-personal change and management SHAZ WAHID. I recently undertook the latter course and have read the book by Stephen Covey. This is what “management” training should be. It relates to the importance of personal management before moving onto management of others/situations. The first 3 habits are about being “proactive”, “having the end in mind” and “putting first things first”-all add up to a private victory. Once mastered one can practice the habits of “think win-win”, “seek first to understand” and “synergise”-all adding up to an effective public victory. Of course in the NHS we need to know what PCT, PBR, PBC, Foundation Trust, etc stand for and work. But, true “management” is about practicing the 7-habits effectively so that we can fullfil our potential as leaders. The 7th habit is “sharpen the saw” and it is about refreshing ones heart, mind, body and soul on a regular basis so that the 1st 6-habits can be practiced effectively. I have been really impressed by this, to the point I have devised a training programme for the Acute Medicine StR that will be rotating through South Tyneside and not to forget the SpR/StR in DM&ENDO. I hope you are intrigued and will try the 7-habits. I have bought the 7-habits of highly effective teenagers book for my 15 year old daughter, of course, but whether she is one of the frogs who actually jumps off the log or simply chooses to remains to be seen.

Rescue of Addison’s Disease Study (RADS)-Simon Pearce RADS is a groundbreaking Newcastle University study, that has been funded by the Medical Research Council. RADS will examine the possibility that autoimmune Addison's disease (AAD) may be a curable condition, rather than a disease that is simply controlled by hormone replacement. Although we generally assume that the autoimmune attack inevitably destroys all the adrenal cortex in autoimmune Addison’s disease, it is possible that the autoimmune attack could be modified. A key feature of AAD is that it is often diagnosed at a stage when subjects have low but detectable serum cortisol. As adrenal tissue is highly plastic, the residual steroidogenic tissue may be sufficient to regenerate normal steroid secretion under the powerful ACTH drive, if the autoimmune process can be arrested.
RADS is a pilot study of rituximab (B lymphocyte depletion) therapy in an attempt to rescue adrenal steroidogenic capacity in ten subjects with early autoimmune Addison's disease: within 1 month of diagnosis. During the first twelve weeks of treatment, additional glucocorticoid therapy (prednisolone) will be given to ensure wellbeing and to rest the steroidogenic apparatus that is the target of the autoimmune attack. Glucocorticoids will be gradually withdrawn, in a controlled fashion, and adrenal function re-evaluated at 13, 26, 39 and 52 weeks. The primary endpoint will be restoration of steroidogenic function as judged by conventional endocrine indices of adrenocortical function. Additional outcomes; 21-hydroxylase autoantibody titres, B cell counts, adverse events and patient wellbeing will be assessed. B cell depletion may ameliorate the autoimmune attack against adrenal cells, potentially allowing a state of immune tolerance to be restored with subsequent regeneration of adrenal steroidiogenic capacity. The importance of this study lies in the possibility of informing the treatment of type 1 diabetes and other autoimmune endocrinopathies, as well as the potential benefit to the Addison’s participants.
All participant treatment and follow-up will be carried out at the Clinical Research Facility, Royal Victoria Infirmary, Newcastle. There will be no payment to participants, but travel expenses to the RVI will be reimbursed.
If you have a suitable potential participant, please discuss the study with them, let them have the patient information leaflet and contact Simon Pearce, 0191-2418674 (office), 07811-902282 (mob) or s.h.s.pearce@ncl.ac.uk

SPARROWS REPORT-EMMA PERALTA (DSN) PRIZE WINNER
Having the opportunity to be one of the 21,000 attendees at this years American Diabetes Association 68th Scientific Sessions in SanFrancisco created a mix of emotions. Being the only diabetes specialist nurse in the SPARROW group was, at first somewhat nerve-racking, however those feelings were soon replaced with exhilarating thoughts of having such a fantastic opportunity to attend a conference of this size and being able to learn about cutting edge clinical research and studies. The theme of this year’s conference was Type 2 diabetes and cardiovascular disease, with most sessions reflecting this. Although all sessions attended were equally as interesting as each other, one or two were memorable for various reasons. One such session being the Banting Memorial lecture, presented by Ralph DeFronzo, in which he highlighted the need to intervene earlier. He presented his rather controversial (and expensive!) intervention of lifestyle + TZD + Metformin + Exenatide to a crowd of mixed responses.
Another interesting session was that of self-monitoring blood glucose in which it was concluded that the success of this is dependant upon the interest of the patient as well as the interest/ time dedicated by the provider. We need to teach patients not only how to monitor blood glucose levels, but how to translate the results into action in terms of self-care.
Dr Gallen presented a marvellous session on Hypoglycaemia during exercise with practical tips to help manage insulin therapy and blood glucose levels both during and after exercise.
Although the education sessions were plentiful and interesting, opportunities to learn about the latest products serving diabetes were available in the exhibit hall. Being a keen pump enthusiast, I was interested to learn more about the OmniPod, an insulin delivery system launched in the USA in 2005 consisting of an integrated insulin reservoir, personal device manager and blood glucose meter. A system which looks both exciting and at the forefront of pump technology.
Attending the conference, as part of the SPARROW GROUP was a truly superb experience, an opportunity I would urge all DSN’s to take up in the future.

SPARROWS REPORT-Vijayaraman Arutchelvam (SpR)
When I made my itinerary for the scientific programme, I chose to attend the sessions discussing the glycaemic target in Type 2 Diabetes. ACCORD, ADVANCE and VADT were the three studies presented in ADA exploring the benefits (!) of tight glycaemic control.
ACCORD was a randomized controlled trial with a double 2 by 2 factorial design. All cause death rate was high in the intensive therapy group (HR 1.22) prompting the glycaemic arm to be stopped. ADVANCE a factorial randomized trial showed no significant reduction in CV outcome but reduction in nephropathy incidence. VADT, a prospective randomized trial showed increased CV death in the intensive therapy group.
Of the three big studies 2 demonstrated clear negative results with 1 being neutral in terms of macro vascular outcome. This modified my practice that I learn to be reassured with an HbA1c target of 7% rather than 6.5% in long standing type 2 diabetes. These studies also demonstrate the problem with weight gain and the importance of achieving a good glycaemic control early. Table: Three outcome studies in Type 2 diabetes-see appendix A
SPARROWS REPORT-Ravikumat Erukalapati
I am summarising my key learning points from some of the sessions that I attended.
A.) Great Protein Debate
I found the debate stimulating and thought provoking.
Problems with high protein intake in Diabetic patients:
· ↑ proteinuria
· ↑ RBF, GFR, intraglomerular pressure
· ↑ rate of progression of kidney failure
· Increases acid load on kidney
· Promotes osteoporosis (↑ calciuria)
· Induces anorexia
In favour of high protein diet are:
· Not ↑ plasma glucose
· ↑ Insulin response
· No need to ↑ CHO or fat in diet
· ↓ appetite, ↑ satiety
· ↑ weight loss, maintains lean mass
· ↓ Chol, LDL, Trigs
· ↓ BP
· ↓ CV events
My take-home message:
· High protein diet is not necessarily bad for Diabetic patients and might in fact be beneficial. RCTs are needed in this area.
· Protein requirements for patients with Diabetic Nephropathy cannot be generalised. Their protein requirements have to be dealt by a specialist dietician individually.
· Daily protein requirements are better expressed if ‘gm/kg body wt’ is used instead of ‘% of diet’.
B.) Pregnancy sessions
· Evidence available so far suggests that Insulin analogues are safe in pregnancy
Lispro- several Obs. Studies
Aspart- one large RCT
Glargine- Obs. Studies
Levemir- Ongoing RCT
· CI for Metformin- small fetus, severe preeclampsia, sepsis
C.) Newer classes of pharmacologic agents for treatment of Hyperglycaemia.
SGLT2 Inhibitors
· Sodium Glucose Cotransporter Type 2 Inhibitors
· Dopagliflozin, Remogliflozin, Phase 3 trials
· Mechanism of action- Glycosuria
· SE - Transient Hyperkalaemia, salt wasting, dehydration, energy deficit, wt↓, polyuria, polydipsia, recurrent UTIs
Glucokinase Activators
· Potential use in T2DM
· Mechanism of action- ↑ Hepatic glucose utilisation, ↑ Insulin secretion
· SE- Hypoglycaemia , Steatosis, Hepatic Glycogen deposition, weight gain
Glucagon receptor Antagonists
· Gluconeogenesis ( Alanine, Lactate, Pyruvate ) and Glycogenolysis contribute to plasma glucose
· Latest data suggests that 60% of glucose output is due to Gluconeogenesis
· Blocking glucagon action in rodents ↓hepatic glucose production
Sirtuins
· SIRT1 activating compounds
· Anti senility agents
· Resveratrol (GSK)
· Similar products in Red wine- if you can drink 1000 bottles/day !!
Due to space constrains, I have not detailed the other sessions and also my Alcatraz prison experience!

RECENT PUBLICATIONS FROM THE NORTHEAST
1. Taylor R. Pathogenesis of type 2 diabetes: Tracing the Reverse Route. Diabetologia 2008 Aug 26. [Epub ahead of print; Full text available under Open Access]

2. Arun CS, Taylor R. Influence of pregnancy on long-term progression of retinopathy in patients with type 1 diabetes. Diabetologia 2008. Jun;51(6):1041-1045. Epub 2008 Apr 8.

3. Trenell MI, Hollingsworth KG, Lim EL, Taylor R. Walking improves lipid oxidation independent of changes in mitochondrial ATP synthesis in people with Type 2 diabetes. Diabetes Care 2008; 31(8):1644-9. Epub 2008 May 16.

4. Ravikumar, B, Gerrard J, Dalla Man C, Firbank MJ, Lane A, English PT, Cobelli C, Taylor R. Pioglitazone decreases fasting and postprandial endogenous glucose production in proportion to decrease in hepatic triglyceride content. Diabetes 2008 Sep;57(9):2288-95. Epub 2008 Jun 5.

5. Simon G. Ashwell, Clare Bradley, James W. Stephens, Elke Witthaus, and Philip D. Home Treatment Satisfaction and Quality of Life With Insulin Glargine Plus Insulin Lispro Compared With NPH Insulin Plus Unmodified Human Insulin in Individuals With Type 1 Diabetes Diabetes Care 31: 1112-1117, June 2008.

6. Razvi S, Shakoor A, Vanderpump M, Weaver JU, Pearce SH. The influence of age on the relationship between subclinical hypothyroidism and ischemic heart disease: a metaanalysis. J Clin Endocrinol Metab. 2008 Aug;93(8):2998-3007.

7. Falardeau J, Chung WCJ, Beenken A, Raivio T, Plummer L, Sidis I, Jacobson-Dickman EE, Eliseenkova AV, Ma J, Dwyer AA, Quinton R, Na S, Hall JE, Huot C, Alois N, Pearce SHS, Cole LW, Hughes VA, Mohammadi M, Tsai P, Pitteloud N. 2008 Decreased FGF8 signaling causes deficiency of gonadotropin-releasing hormone in human and mice. Journal of Clinical Investigation. 118: 2832-2831.

8. Advani A, Vaikkakara S, Gill MS, Arun CS, Pearce SHS, Ball SG, James RA, Lennard TJW, Bliss RD, Quinton R, Johnson SJ. 2008 Impact of standardised reporting in adrenocortical carcinoma: a single centre clinicopathological review. Journal of Clinical Pathology. 61: 939-944.

9. Cole LW, Sidis I, Zhang CK, Quinton R, Plummer L, Pignatelli D, Hughes VA, Dwyer AA, Raivio T, Hayes FJ, Seminara SB, Huot C, Alos N, Speiser P, Takeshita A, van Vliet G, Pearce SHS, Crowley WF, Jr, Zhou QY, Pitteloud N. 2008 Mutations in Prokineticin 2 (PROK2) and PROK2-receptor (PROKR2) in human gonadotrophin-releasing hormone deficiency: molecular genetics and clinical spectrum. Journal of Clinical Endocrinology & Metabolism. 93: 3551-9.

10. Al-Ozairi E, Quinton R, Advani A. 2008 Therapeutic response to metformin in an underweight patient with polycystic ovarian syndrome. Fertility & Sterility. 2008 Jan 25. [Epub ahead of print].

11. Arutchelvam V & Quinton R. 2008 Anaemia in older patients can be secondary to testosterone deficiency. Geriatric Medicine. 38: 272-273.

12. Quinton R, Pearce SHS, Sievenpiper JL. 2008 Sun and melanoma: time to go to get your hat. BMJ. 337: 309.

13. Sievenpiper JL, McIntyre EA, Verrill M, Quinton R, Pearce SHS. 2008 Lesson of the Week: Unrecognised severe vitamins D deficiency. BMJ. 336: 1371-1374. [with Editorial Comment: Deficiency of sunlight and vitamin D: fortification of foods and advice on sensible sun exposure are urgently needed@, pp1318-1319]

14. Vaidya B, Pearce SHS. Management of hypothyroidism in adults. BMJ
2008;337: 284-89.

15. Skinningsrud B, Husebye ES, Pearce SH, McDonald DO, Brandal K, Boe Wolff A, Lovas K, Egeland T, Undlien DE. Polymorphisms in CLEC16A and CIITA at 16p13 are associated with primary adrenal insufficiency. J Clin Endocrinol Metab 2008; 93:3310-7.

16. Pearce SHS. Section VI. Hyperparathyroidism. In Davies TF. Case-based guide to Clinical Endocrinology. Integra Press, 2008 pp169-193.
Including case contributions from Drs. CS Arun, Ebaa Al Ozairi, Ee Lin Lim, Andy James, Muthy Korada, Reena Thomas & Tim Cheetham.

RECENT PUBLICATIONS IN DIABETES & ENDOCRINOLOGY THAT HIT THE NEWS OR THAT MAY HAVE A SIGNIFICANT IMPACT ON MANAGEMENT
Intensive glycaemic control and cardiovascular disease. Much has been said about this topic following publication of the ACCORD and ADVANCE trials. I would suggest reading Arut’s letter summarising the trials and read from there.
PTH Mutation with primary hyperthyroidism and undetectable intact PTH. Halpern et al. NEJM 2008;359:1182-1183. An interesting case report that should also be read in conjunction with a recent article on the same subject in Clinical Endocrinology.
Extracapsular haemorrhage from a parathyroid adenoma. MC Zillikens & A Wijbenga. NEJM 2008;359:1155. A good clinical picture.

Hypoparathyroidism. Dolores Shoback. NEJM 2008;359:391-403. An excellent practical review well worth a read.

Sievenpiper JL, McIntyre EA, Verrill M, Quinton R, Pearce SHS. 2008 Lesson of the Week: Unrecognised severe vitamins D deficiency. BMJ. 336: 1371-1374. [with Editorial Comment: Deficiency of sunlight and vitamin D: fortification of foods and advice on sensible sun exposure are urgently needed@, pp1318-1319]. An excellent local article that should serve as a reminder to consider vitamin D deficiency.

Precocious Puberty. JC Carel & J Leger. NEJM 2008;358:2366-2377. Essential reading for trainees.

Graves’ Disease. Gregory Brent. NEJM 2008;358:2594-2605. A good update.
A combined presentation of Graves’ disease and Miller-Fisher syndrome. Vetsch et al. NEJM 2008;371:1886. An excellent case report.

Risk assessment and lipid modification for primary and secondary prevention of cardiovascular disease: summary of NICE guidance (Angela Cooper&Norma O’Flynn) & the accompanying controversies report (Francesco Cappucio). BMJ 2008;336:1246-1249. An excellent summary with analysis.

The Addison’s disease dilemma-autoimmune or ALD? M-F Kong et al. Lancet 2008;371:1970. A very good case report that should act as a reminder that not all Addison’s is autoimmune.

Type 1 diabetes, hyperglycaemia, and the heart. Ravi Retnakaran & Bernard Zinman. Lancet 2008;371:1790-1809. A wonderful article reviewing the pathophysiology and possible treatment strategies of heart disease in Type 1 DM-NOT Type 2!

Management of type 2 diabetes; updated NICE guidance (Philip Home et al) & the accompanying controversies report (Stephen Atkin & Chris Walton). BMJ 2008;336:1306-1309. I just could not look at the electronic report hence bought the hard copy, tis big! This is an excellent summary of the guidance with some food for thought. Thankfully, because of my crystal ball gazing the local district guidelines do not need much rewriting.

Diagnosis and management of hypocalcaemia. Mark Cooper & Neil Gittoes. BMJ 2008;336:1298-1302. An excellent review and practical update.Can metabolic syndrome usefully predict cardiovascular disease and diabetes? Outcome data from two prospective studies. Sattar N, McConnachie A et al. Lancet 2008;371:1927-1935. The authors investigated to what extent metabolic syndrome and its individual components were related to risk for cardiovascular disease and diabetes in elderly populations, by relating metabolic syndrome (defined on the basis of criteria from the Third Report of the National Cholesterol Education Program) and its five individual components to the risk of events of incident cardiovascular disease and type 2 diabetes in 4812 non-diabetic individuals aged 70-82 years from the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER); and, in a second prospective study (the British Regional Heart Study [BRHS]) of 2737 non-diabetic men aged 60-79 years. In PROSPER, 772 cases of incident cardiovascular disease and 287 of diabetes occurred over 3.2 years. Metabolic syndrome was not associated with increased risk of cardiovascular disease in those without baseline disease (hazard ratio 1.07 [95% CI 0.86-1.32]) but was associated with increased risk of diabetes (4.41 [3.33-5.84]) as was each of its components, particularly fasting glucose (18.4 [13.9-24.5]). Results were similar in participants with existing cardiovascular disease. In BRHS, 440 cases of incident cardiovascular disease and 105 of diabetes occurred over 7 years. Metabolic syndrome was modestly associated with incident cardiovascular disease (relative risk 1.27 [1.04-1.56]) despite strong association with diabetes (7.47 [4.90-11.46]). In both studies, body-mass index or waist circumference, triglyceride, and glucose cutoff points were not associated with risk of cardiovascular disease, but all five components were associated with risk of new-onset diabetes. The authors conclude that metabolic syndrome and its components are associated with type 2 diabetes but have weak or no association with vascular risk in elderly populations, and that clinical focus should remain on establishing optimum risk algorithms for each disease separately. This point is eloquently argued by Richard Kahn in the accompanying editorial (Lancet 2008;371:1892-1893) as “another nail in the coffin”.Effect of intensive insulin therapy on beta-cell function and glycaemic control in patients with newly diagnosed type 2 diabetes: a multicentre randomized parallel-group trial. Weng J, Li Y et al. Lancet 2008;371:1753-1760. In this multicentre, randomised trial to compare the effects of transient intensive insulin therapy(continuous subcutaneous insulin infusion[CSII] or multiple daily insulin injections [MDI]) with oral hypoglycaemic agents on beta-cell function and diabetes remission rate; 382 patients, aged 25-70 years, were enrolled from nine centres in China. The patients, with fasting plasma glucose of 7.0-16.7 mmol/L, were randomly assigned to therapy with insulin (CSII or MDI) or oral hypoglycaemic agents for initial rapid correction of hyperglycaemia. Treatment was stopped after normoglycaemia was maintained for 2 weeks. Patients were then followed-up on diet and exercise alone. Intravenous glucose tolerance tests were done and blood glucose, insulin, and proinsulin were measured before and after therapy withdrawal and at 1-year follow-up. The primary endpoint was time of glycaemic remission and remission rate at 1 year after short-term intensive therapy. More patients achieved target glycaemic control in the insulin groups (97.1% in CSII and 95.2%in MDI) in less time (4.0 days [SD 2.5] in CSII and 5.6 days [SD 3.8] in MDI) than those treated with oral hypoglycaemic agents (83.5% and 9.3 days [SD 5.3]). Remission rates after 1 year were significantly higher in the insulin groups (51.1% in CSII and 44.9% in MDI) than in the oral hypoglycaemic agents group (26.7%; p=0.0012). Beta-cell function measured by HOMA B and acute insulin response improved significantly after intensive interventions. The increase in acute insulin response was sustained in the insulin groups but significantly declined in the oral hypoglycaemic agents group at 1 year in all patients in the remission group. This study suggests that early intensive insulin therapy in patients with newly diagnosed type 2 diabetes has favourable outcomes on recovery and maintenance of beta-cell function and protracted glycaemic remission compared with treatment with oral hypoglycaemic agents. There are obvious limitations with extrapolating these results to our own patients, but I will not forget Andrew Advani thinking I was a “nut” when I used a similar approach in patients with clinical features of type 2 diabetes presenting with significant hyperglycaemia to the acute take. I think he changed his opinion when he saw the majority come off insulin and onto either oral agents or diet alone.Effect of financial incentives on inequalities in the delivery of primary clinical care in England: analysis of clinical activity indicators for the quality and outcomes framework. Doran T, Fullwood C, Kontopantelis E, Reeves D. Lancet 2008;372:728-736. The quality and outcomes framework (QuOF) has received much praise and some suggest it has done more for diabetes care than insulin! Make what you wish of it, but what is clear financial incentives have helped improved the processes and outcomes of care in the community allowing specialist teams to branch out into areas they can do justice to. Before you pure Endocrinologists switch off monitoring of thyroxine therapy is in the QuOF. However, incentive schemes can increase inequalities in the delivery of care if practices in affluent areas are more able to respond to the incentives than are those in deprived areas. The authors examined the relation between socioeconomic inequalities and delivered quality of clinical care in the first 3 years of QuOF by analyzing data extracted automatically from clinical computing systems for 7637 general practices in England, data from the UK census, and data for characteristics of practices and patients from the 2006 general medical statistics database. Practices were grouped into equal-sized quintiles on the basis of area deprivation in their locality. The overall levels of achievement, defined as the proportion of patients who were deemed eligible by the practices for whom the targets were achieved, for 48 clinical activity indicators during the first 3 years of QuOF were calculated. The median overall reported achievement was 85.1% (IQR 79.0-89.1) in year 1, 89.3% (86.0-91.5) in year 2, and 90.8% (88.5-92.6) in year 3. In year 1, area deprivation was associated with lower levels of achievement, with median achievement ranging from 86.8% (82.2-89.6) for quintile 1 (least deprived) to 82.8% (75.2-87.8) for quintile 5 (most deprived). Between years 1 and 3, median achievement increased by 4.4% for quintile 1 and by 7.6% for quintile 5, and the gap in median achievement narrowed from 4.0% to 0.8% during this period. Increase in achievement during this time was inversely associated with practice performance in previous years (p<0.0001), but was not associated with area deprivation (p=0.062). These results suggest that QuOF has made a substantial contribution to the reduction of inequalities in the delivery of clinical care related to area deprivation. Before, we put another leaf on QuOFs laurel it is essential to read the balanced accompanying editorial by Barbara Starfield (Lancet 2008;372:692-694) that states do these expensive financial incentive schemes truly reduce suffering? I guess my tune may change if HbA1c ever becomes a performance measure for specialists.

NEXT NEWSLETTER Due out beginning of February 2009 so keep the gossip coming.

Congratulations Khalid !

2008-07-16T18:56:00.000+01:00

We had a presentation competition among the regional diabetes, endocrinology SpRs.
Dr Preethi Rao, Dr. Jeevan Mettayil and Dr Khalid Dukhan delivered three wonderful presentations.
The presentations were judged by 5 consultants independantly based on content, presentation techniques, time management and the question answer sessions. In a close contest Dr Khalid Dukhan won the competion .
Following the success of this competition we will make it an annual event in our CME programme.

Northern Endocrine Diabetes CME-16.7.08

2008-07-16T18:54:00.000+01:00

Northern Endoctrine and Diabetes CME
Wednesday 16 , July 2008
Lecture hall 2, Education centre
Freeman Hospital, Newcastle upon Tyne

0930 Registration

Morning session: Clinical Endocrinology

1000 Update on Hyponatraemia Dr Steve Ball
Royal Victoria Infirmary
Senior lecturer, School of
Clinical medical sciences
Newcastle University
1040 Discussion
1050 New SpR assessment tools, Dr Arutchelvam
CARE questionnaire

1105 Annual SpR presentation competition Dr Preethi Rao
Dr Jeevan Mettayil
Dr Khalid Dukhan

1150 Tea break

1210 Pheochromocytoma Dr Steve Ball

1250 Discussion

-----------------------------------------------------------------------------------------------------------------------------------
1300 Lunch

Afternoon session: Clinical Diabetes

1400 Diabetes and Pregnancy Dr Rahul Nayar
Sunderland Royal Infirmary
1440 Discussion

1450 Diabetic Nephropathy Professor Neil Sheerin
Professor of Nephrology
Newcastle University
1530 Discussion
1545 Tea break

1600 Continuous sub-cutaneous Dr Steven Jones,
insulin infusion pump James Cook University Hospital

1640 Discussion

1650 Close

Northern rotation 2008-2009

2008-06-29T23:05:00.000+01:00

Northern Deanery Diabetes & Endocrinology Rotation 1st Oct 2008 - 6th October 2009

UNIT
SPECIALIST REGISTRAR

Royal Victoria Infirmary
Chandima Idampitiya
Asgar Madathil
Preethi Rao
Shafie Kamarrudin

NAVEEN SIDDARAMAIHA 6/08/08 to 30/09/08
NORTHERN ROTATION

Freeman Hospital .
Beas Bhattacharya
Kathryn Stewart
Rohana Wright
STUART LITTLE 6/08/08 to 30/09/08
Northumbria (North Tyneside/Wansbeck)
Ravi Sankar Erukalapati [to start at North Tyneside]
Sudeep Manohar [to swap with Ravi from 30th March 2009]

Carlisle
Naveen Siddaramaiha

Queen Elizabeth Hospital (Gateshead)
Arutchelvan Vijayraman

QEH+Newcastle Diabetes Centre
Freda Razvi (part-time)

South Tyneside District Hospital
Sukesh Chandran

SOUTHERN ROTATION

James Cook University Hospital
Anjali Santhakumar
Arif Ullah
LAT TBA

North Tees & Hartlepool University Hospitals 1.
Khaled Mansur-Dukhan [to start at North Tees]
Stuart Little [to swap with Khaled from 30th March 2009]

Bishop Auckland District Hospital
Srikanth Mada

University Hospital of North Durham
Balasubramanian Ravikumar until 15th May 2009 followed by Eelin Lim

Sunderland Royal Hospital
Jeevan Mettayil
Sarah Steven [to start 6th August 2008]

NEERAG 26 November 2008

2008-06-29T23:02:00.000+01:00

date for your diary-NERRAG annual meeting, 26th November 2008, Lumley Castle, Chester-le-Street, County Durham, 1400-1830
CALL FOR ABSTRACTS-deadline 30th September 2008
Dear Colleague,
The 15th annual meeting of NERRAG is due to take place at this pleasant hotel. We are pleased to announce an update on calcium to be delivered by Professor Simon Pearce and an update on hypogonadism to be delivered by Dr Richard Quinton.
If you have an audit, research topic or an interesting clinical case please complete the section below and return it to me (please do this now even if you have already mentioned a project earlier). Please advertise this meeting within your hospital to any one who is involved in endocrinology in any way by forwarding this e-mail. Hardcopies are in the post to a lot more individuals.
CME approval for 3 hours will be available. Slide projector, overhead projector and Power Point will be available. We look forward to seeing you. Please send me your abstract by 30th September 2008 either by e-mail (preferable) or post. Please return the enclosed attendance slip by 31st October 2008.
Yours sincerely,
Shaz Wahid FRCP
Consultant Diabetologist/Endocrinologist
"_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Northern Endocrine Regional Research and Audit Group Meeting-Wednesday 26th November 2008.
I will / will not be able to attend NAME……………………………. Tel……………………………
I/my team will be able to present data on (Title)………………………………………………………
…………………………………………………………………………………………………………
Please send me a copy of your abstract by post or electronically by 30th September 2008 to:
Dr Shaz Wahid FRCP Consultant Physician & Acute Medicine Lead South Tyneside District Hospital Harton Lane South Shields Tyne & Wear NE34 0PL
Tel No. +44 (0)844 811 3030 Ext. 2855/3238(Off) Fax No. +44 (0)191 203 2934 E-mail shahid.wahid@sthct.nhs.uk

UKI NETS membership

2008-06-02T00:01:00.001+01:00

Dear UKI NETS Committee Members
To help promote UKI NETS membership, please can you circulate the attached notice and UKI NETS application form to your colleagues and students? The notice can be printed on an A4 page so you may also wish to display this on your department’s notice board.
Applicants who apply before 1st July 2008 will benefit from a discounted membership fee and receive a free copy of the Handbook of Neuroendocrine Tumours.
All members will receive priority notification of the next UKI NETS annual conference which is scheduled to take place on 1st December 2008. Members will also benefit from reduced rate registration.
Thank you in anticipation of your help.
Kind regards Pauline Bertrand UKI NETS Secretariat Tel: (+44) (0) 1454 642208 Fax:(+44) (0) 1454 642222 Email: pauline.bertrand@endocrinology.org Website: file://www.ukinets.org/

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2008-02-06T19:48:00.000Z

Dear Colleagues,
I have appended a timetable/agenda for the above meeting on Tuesday 24th June 2008.
1330-1600 STC meeting only
1600-1730 Joint T&T meeting open to all
1730-1845 SPARROWS feedback meeting open to all.

Dr Shaz Wahid

NEOF meeting "Childhood obesity: the size of the problem" 21 May 2008

2008-01-30T13:14:00.000Z

I'm sending you a note to let you know that the next meeting of the North Eastern Obesity Forum (NEOF) will be taking place on Wednesday 21st May 2008, starting at 4.00 pm, this time at the Seminar Room of the Wolfson Research Unit at Queens Campus in Thornaby. (Maps for finding Queens Campus and the Wolfson Unit are: http://www.dur.ac.uk/map/stockton and http://www.dur.ac.uk/map/qc3d/)

The topic for this meeting is "Childhood obesity: the size of the problem", and we are pleased to say that Janet Shucksmith will be chairing, with speakers talking on childhood obesity, the north-east slant; monitoring and the Obesity Observatory; and the practicalities of application.

I'll be sending you a notice for distribution to anyone else you know may be interested in attending the meeting (which is open to all), and also to put on your noticeboards. And I'd be grateful if you'd let me know, by mid-April if possible please, if you'd like to attend and would
like some refreshments prior to the meeting.

The November meeting is scheduled for 12th November, and the theme will be 'obesogenic environments' - watch out for further information.

If you can think of anyone else who would like to be included in the NEOF mailbase, please let me know and I'll add them to the list for future circulations.

Many thanks.

Pat

PA to Nigel Unwin
Professor of Epidemiology
Newcastle University
Institute of Health and Society
Advancing Research in Chronic Disease Epidemiology (ArchEpi) Programme
WHO Collaborating Centre for Diabetes
Medical School
Newcastle upon Tyne NE2 4HH
http://www.ncl.ac.uk/ihs

Trainers-trainees meeting: 24 Jun 2008

2008-01-30T12:55:00.000Z

Dear Colleagues,

I have appended a timetable/agenda for the above meeting on Tuesday 24th June 2008
1330 - 1600 STC meeting only
1600 - 1730 Joint T&T meeting open to all
1730 - 1845 SPARROWS feedback meeting open to all

Best wishes,
Shaz.

AGENDA FOR TUESDAY 24^th JUNE 2008 UNIVERSITY HOSPITAL OF NORTH TEES TEACHING CENTRE

STC meeting - Jola Weaver (Chair), Shaz Wahid, Richard Quinton, Simon Pearce, Nicky Leech, Simon Eaton, Jean MacLeod, Arutchelvan Vijayraman, Jeevan Mettayil.

Venue - Teaching Centre, coffee lounge from 1330 moving to Room 6 at 1400

Apologies
Training issues from last minutes
ARCP update
Recruitment & Selection update
Acute Medicine Training
Longitudinal Supervision
Personal Development Plans
AOB
Date of next STC meeting

JOINT TRAINERS & TRAINEES MEETING - ALL WELCOME

Venue - Teaching Centre, Coffee Lounge 1545, moving to Lecture Theatre 1600

Recruitment & Selection update with circulation of October 2008 rotation
ARCP update
OOPE & OOPR & Acting-up update
Acute Medicine Training/MRCP
Educational supervision

SPARROWS FEEDBACK MEETING - ALL WELCOME

Venue - Teaching Centre, Coffee Lounge 1715, moving to Lecture Theatre 1730

Presentations from SpRs & DSN attending the ADA
Prize for the best presentation

MEETING CLOSE 1845

RCP update on acute medical emergencies, Freeman Hospital: 30 Apr 2008

2008-01-29T13:27:00.000Z

ROYAL COLLEGE OF PHYSICIANS
Northern Regional Office

ACUTE MEDICAL EMERGENCIES

30^th April 2008

Education Centre
Level 1, Freeman Hospital

09:30 Registration and Coffee

Morning session
Chairman: Dr Stephen Bourke, RCP Regional Advisor (Service)

10:00 Management of Patients with Drug Misuse: Dr Eilish Gilvarry, Newcastle upon Tyne
10:40 Pneumonia for Acute Physicians: Dr Wei Shen Lim, Nottingham University Hospital
11:20 Coffee
11:40 The Red Hot Joint: Dr Bridget Griffiths, Freeman Hospital
12:20 Acute Upper Gastro-intestinal Bleeding: Dr John Greenaway, James Cook University Hospital
13:00 Lunch

Afternoon session
Chairman: Dr Nick Linker, RCP Deputy Regional Advisor (Training)

13:45 Acute Medicine Admissions from Nursing Homes, Dr Terry Aspray, Sunderland Royal Hospital
14:30 Workforce Planning Across the Specialties, Professor Roy Pounder, Royal Free Hospital, London
15:20 Tea
15:40 When to call a Neurosurgeon: Mr Patrick Mitchell, Newcastle General Hospital
16:20 Pericardial Problems: Dr Jane Skinner, Royal Victoria Infirmary
17:00 Close

CME approved for 5 credits
All healthcare professionals are welcome to attend

To book your place:

PLEASE PRINT DETAILS CLEARLY

Name .........................................................

Speciality.....................................................

Hospital.......................................................

Contact Tel.................................................

Dietary Requirements?...............................

I enclose my payment of £45.00

Cheques should be made payable to ‘Royal College of Physicians, Northern’

Return to:

Lorraine Waugh
Royal College of Physicians
Northern Regional Office,
Freeman Hospital
Newcastle upon Tyne NE7 7DN

North East Obesogenic Environment Network

2008-01-27T18:12:00.000Z

http://www.neoen.org.uk/

Dear Colleague,

We are writing to invite you to join and be a part of the North East Obesogenic Environment Network (NEOeN).

The term ‘Obesogenic Environment’ relates to the influences that contribute towards obesity, such as our surroundings, opportunities or life conditions. These include eating behaviour, physical activity, urban planning and design, policy, transport, environment, and culture.

North East Obesogenic Environment Network has been recently established to initiate integrated working partnerships within research, practice and the wider community.

The objective of NEOeN is to provide a networking facility across practice, academia and communities. Through cross-sectoral partnerships, there is potential to impact on the rising obesity rates in the North East of England.

NEOeN operates to terms of reference with a steering group, and is open to anyone with an interest in this agenda, regardless of their professional background.

We believe the strength of the network is in our membership and we would like to invite you to join us.

If you would like to join NEOeN or would like any further information, please see our website www.neoen.org.uk

On 17th October 2007 Foresight launched Tackling Obesities: Future Choices. The project aimed to produce a long-term vision of how we can deliver a sustainable response to obesity in the UK over the next 40 years.

In Jan 2008, the National Institute of Health and Clinical Excellence (NICE) will launch Public Health Guidance on Physical Activity and Environment. http://www.nice.org.uk/guidance/index.jsp?action=byID&o=11679
The guidance is for NHS and NON NHS professionals who have a direct or indirect role in and responsibility for the environment. This includes those working in local authorities, education, community, voluntary and private sectors.

Both of these pieces of work mark a new way of working, and NEOeN provides a facility for the North East to support this.

We look forward to hearing from you, and welcoming you to the network!

Janine A Ogilvie
Amelia Lake
Tim Townshend
Roselle Oberholzer
Louisa Ells

Dr Amelia Lake
http://www.ncl.ac.uk/medi/staff/specialism/profile/amelia.lake

Northern Endocrine and Diabetes CME: 29 Jan 2008

2008-01-26T20:28:00.000Z

Northern Endocrine and Diabetes CME
Tuesday, 29.1.08
Lecture Theatre 2, Education Centre, Freeman Hospital, Newcastle upon Tyne

0930 Registration
Morning: Diabetes session

1000 Update on Pancreas transplantation: Professor Mark Walker, Freeman Hospital
1040 Discussion

1050 Hypoglycaemia - An update: Professor Simon Heller, Sheffield Teaching Hospitals
1130 Discussion

1140 Tea break

1155 Debate:'This house believes that newer therapies will change the face of diabetes management in the near future'
Chair: Professor Simon Heller
Against the motion: Dr Ravikumar , Freeman Hospital
Supporting the motion: Dr Arutchelvam, Royal Victoria Infirmary

1300 Lunch

Afternoon: Endocrine session

1400 Diagnosis and management of pituitary disorders - an interactive session: Dr. Andy James, RVI
1440 Discussion

1450 Adrenal insufficiency - diagnosis and management: Professor Simon Pearce, RVI

1545 Management of unhappy hypothyroid patients - T3, T4 and other combinations: Dr Petros Perros, Freeman Hospital
1620 Discussion

1630 Close

Darzi review on using information in the NHS: 27 Feb 2008

2008-01-23T12:45:00.000Z

This event aims to assess NHS frontline staff perceptions on the use of IT and information, with a focus on patient information, in order to identify and act upon priorities moving forward. The event has been organised in conjunction with Connecting for Health as part of the National Review of the NHS led by Lord Darzi.

This 'Using Information in the NHS' event has been organised for the 27^th February 2008 at the Banqueting Hall, Newcastle Civic Centre. Please find attached a briefing letter and booking form. Please also could you forward this to your colleagues as we hope to have a wide range of frontline staff and especially clinical staff representation from across all care settings in this event.

To book a place, please complete the booking form and email to nhscfh.events@nhs.net, or fax to 0113 241 6541. To ensure your place is secured at this important engagement event please book as soon as possible.

Best Wishes

Rob Longstaff

Account Manager & Communications Lead
NHS North East NPFIT Region Wide Team

====================================================

Dear Colleague

Darzi Review on using information in the NHS – how you can influence future work

The need for high quality clinical and management information within the NHS in England has never been greater.

Having the right information is essential to be able to give safe and effective care to our patients

Information is also essential if we are to review our practice and improve it for the future

Currently the NHS has a great deal of data, but insufficient useful information. Much information is only available to limited numbers of people, often inconsistent with that held elsewhere, and often not readily available at the point of need.

Therefore, as noted by Lord Darzi in his 'Next Stage Review' earlier this year, a wide-ranging informatics review is being held to improve the use and sharing of information across the NHS.

We would very much like you to be part of this process and would like to invite you to attend an event to explore the information and informatics implications arising from this review. This will enable us to learn more about how you currently use information in the workplace, how we can help improve your experiences and your priorities for moving forward. It will also enable us to feed into the National Review and 'sense check' our local informatics priorities, which have recently been agreed by the medical and nursing directors.

We will be engaging with a wide range of frontline staff who are directly involved in using information and informatics in their work. This includes doctors, nurses, other clinicians and administrative staff across all care settings and staff whose participation and engagement is critical to the success of IT implementation.

We would ask that you come along and give us your honest views and opinions. In return, we promise to listen and take your views into consideration in developing the information and informatics agenda moving forward.

An event is being held in the Banqueting Hall, Newcastle Civic Centre on the 27^th February and will run from 10am – 4pm. To book a place, please complete the booking form and email to nhscfh.events@nhs.net, or fax to 0113 241 6541. To ensure your place is secured at this important engagement event please book as soon as possible.

Your participation in these important events would be extremely valuable.

Kind regards

Paula Whitty GMC 3100745

Acting Chief Information Officer and Deputy Medical Director

================================================

Using information in the NHS
Date: 27 February 2008
Venue: Banqueting Hall, Newcastle Civic Centre, Barras Bridge, NE99 1RD
Times:	Registration: 09:30	Start: 10:00	Close: 16:00

Currently the NHS has a great deal of data, but insufficient useful information. Much information is only available to limited numbers of people, often inconsistent with that held elsewhere, and often not readily available at the point of need. The need for high quality clinical and management information within the NHS in England has never been greater. Having the right information is essential to be able to give safe and effective care to our patients Information is also essential if we are to review our practice and improve it for the future We will be engaging with a wide range of staff who are directly involved in using information and informatics in their work. This includes doctors, nurses, other clinicians and administrative staff across all care settings and staff whose participation and engagement is critical to the success of IT implementation. For example, lead receptionists, medical record clerks, back office administration staff, ward clerks, and clinical governance leads. We would ask that you come along and give us your honest views and opinions. In return, we promise to listen and take your views into consideration in developing the information and informatics agenda moving forward.

How to Book	Online: TBC
	Email: nhscfh.events@nhs.net	Fax: +44 (0) 113 241 6541
	Post: Events Team, NHS CFH, 1^st Floor, Vantage, 40 Aire Street, Leeds, LS1 4HT

Please complete a new form for each delegate. Photocopies are acceptable.
Title (Mr, Mrs etc)
First Name
Surname
Email Address (essential)
Job Title
Organisation
Postal Address
Postcode
Tel
Special Requirements (diet, access etc)
Places cannot be confirmed without all fields being completed in full

NHS CFH hold the information provided by you on this booking form and use it for purposes connected with the administration of the event which you have applied to attend. Your information is held on an Events Management System (' EMS') and you can access your information in a secure environment by visiting: http://etdevents.connectingforhealth.nhs.uk/d_profile.php. Please note that places are limited for each organisation and will be allocated on a first come, first served basis. There is no cost to eligible NHS staff/employees of NHS and contractor organisations attending this event. NHS CFH is unable to cover travel costs and expense

Hot topics in Thyroidology: 17th March 2008

2008-01-19T14:48:00.000Z

CLINICAL ENDOCRINOLOGY TRUST
VISITING PROFESSOR – GUEST LECTURE

MONDAY 17TH MARCH 2008

“HOT TOPICS IN THYROIDOLOGY”

PAOLO BECK- PECCOZ
PROFESSOR OF ENDOCRINOLOGY
UNIVERSITY OF MILAN

16:30 hours in Room 222/223

In The

British Heart Foundation
Glasgow Cardiovascular Research Centre
126 University Place
Glasgow

Management opportunities within the region

2008-01-13T01:52:00.001Z

Dear Colleague,

I am sure you will be aware of the importance of management in your training. Courses will provide direction but there is nothing like getting practical experience. There are 3 management opportunities in the region at the moment:

1. A Trainee Representative at a level of year 1-3 is needed on the STC urgently. The STC meets about 3 times a year and trainee representatives are regularly canvassed for opinion. This is a very important position.

2. A Trainee Representative is needed to help Arut with the NEDs CME organisation.

3. Another Associate Editor is needed to help Arut with the ENDODIABOLOGY web site.

All of the above positions are very prestigious and highly thought of if they appear on your CV at interview.

Please let me know which position(s) you will be interested in ASAP. If there are more than one of you interested, then I will be in touch with a question!!

Regards,

Shaz.

Diabetes & Endo ARCP / RITAs May 2008

2008-01-13T01:50:00.001Z

Dear Colleague,

I have appended:

1. The finalised timetable for the ARCPs. Please make a note of your date and time for assessment and can I ask trainers to make a note of which panel they will be on. Gillian is trying to winkle out of the JRCPTB who our external assessor will be for the PYAs. If needed I may need to juggle the PYAs, but there is slack in the dates.

<<ARCP 2008 timetable.doc>>

2. Trainee instructions for the ARCP. Those of you due a PYA note the deadline! Furthermore, Gillian goes on maternity leave in Feb hence we will have another contact for the ARCPs.

<<ARCP instructions 2008.doc>>

3. Supporting documentation for the ARCPs.
<<Educational Supervisor Report for ARCP 2007.doc>>

<<SpR Annual Appraisal Record.doc>>

<<STRUCTURED CURRICULUM VITAE FOR RITA.doc>>

Kindest of regards,
Shaz.

=======================================

DIABETES & ENDOCRINOLOGY ANNUAL REVIEW OF COMPETENCY PROGRESSION (ARCP)

WEDNESDAY 14^th MAY 2008-small staff room, Peacock Hall, RVI

Panel-Dr Shaz Wahid, Gillian Conway, Dr Simon Pearce, Dr Vince Connelly (G(I)M)
0915 Jeevan Mettayil
1005 Chandima Idampitiya
1055 Break
1110 Shafie Kamaruddin
1200 Balasubramanian Ravikumar (RITA G)
1250 LUNCH

Panel-Dr Shaz Wahid, Gillian Conway, Dr Jola Weaver, Dr Vince Connelly (G(I)M)
1330 Ravisankar Erukulapati
1420 Sudeep Manohar
1510 Break
1520 Arif Ullah
1610 Asgar Madathil

THURSDAY 15^th MAY 2008-Large staff room, Peacock Hall, RVI

PYA Panel-Dr Shaz Wahid, Gillian Conway, External-TBC, Dr Simon Eaton
0945 Beas Bhattacharya (PYA)
1015 Sukesh Chandran (PYA)
1045 Arutchelvam Vijayraman (PYA)
1115 Eelin Lim (PYA)
1145 Khaled Mansur-Dhukan (PYA)
1230 LUNCH

PANEL-Dr Shaz Wahid, Gillian Conway, Dr Nicola Leech, Dr Nick Roper (G(I)M)
1400 Srikanth Mada
1450 Kathryn Stewart
1540 Break
1550 Anjali Santhakumar

FRIDAY 16 ^th MAY 2008-Large staff room, Peacock Hall, RVI
PANEL Shaz Wahid, Gillian Conway, Dr Richard Quinton
0930 Freda Razvi
1020 Preethi Rao
1100 Break

1115 Flexible session (PYA reserve, ARCP reserve, Counselling, outstanding RITA Gs)

=========================

Diabetes & Endocrinology ARCP Trainee Instructions 2008

The ARCP panels will be held on Weds 14^th, Thurs 15^th and Fri 16^th May 2008. The format will consist of the trainee attending their allocated time 5-minutes before with all the documentation asked for below. The panel will review all the documentation in 40-minutes whilst the trainee waits outside. Ten-minutes will be spent feeding back the ARCP panel's adjudication to the trainee. For those of you undertaking your PYA on the morning of Thurs 15 ^th May 2008 it is essential that the documentation detailed below be forwarded to the Deanery office by Friday 9^th May 2008, 12pm at the latest. The required documentation for your ARCP is:

Portfolio (If you have developed one)
Training Log Book (to include any assessments, e.g. MSF, Mini-CEX)
Three copies of an Educational Supervisor Report (appended electronically)
Three copies of an Annual Appraisal Record (appended electronically)
Structured CV (format appended electronically)
4 mandatory Mini-CEXs (unless you have already had your PYA when they are optional)
A mandatory up to date MSF report (not seen in your last RITA), unless you have already had your PYA
Evidence in your folder/portfolio demonstrating competence in at least 6 Core Diabetes & Endocrinology Topics (not seen at your last RITA). If you are having a PYA you should have evidence of competence in your folder for at least 90% of the core topics

Please note that it is essential any patient identifying details in your log book/portfolio are removed. Patient and Dr anonymous clinic letters should only be submitted if they demonstrate competence in a particular curricular requirement.

Failure to adhere to the guidance can result in a RITA D or outcome 5. It is essential that all the necessary Supervisor Signatures be obtained for the above documentation to count towards your ARCP.

For those of you due a PYA please hand-deliver the above documentation in an envelope/package labelled:

For the Attention of:

Gillian Conway, Specialty Programme Coordinator, Diabetes and Endocrinology RITAs/ARCPs
To the Northern Deanery Office, 10 Framlington Place, Newcastle upon Tyne

When handing in the documentation to the office print your name, indicate that you are leaving it for your Diabetes & Endo RITA/ARCP on 15^th May 2008, the date when left and who it is for in the available register. The receptionist signs to say they have received the documentation.

Shaz Wahid, Training Programme Director

=============================

STRUCTURED CURRICULUM VITAE FOR ARCP-Headings

PLEASE STRICTLY ADHERE TO THESE HEADINGS AND WORD COUNT

Background Details-Name, Age, Address, E-mail, NTN, GMC number, MDU/MPS number, Expected CCT date

Qualifications - include ALS

Current and previous posts POST MRCP-dates , hospitals and trainers only
CLINICAL EXPERIENCE FOR EACH SpR/StR POST(maximum of 1000 words IN TOTAL for this section)

Diabetes

Endocrinology

GIM

Audit and Audit Presentations (maximum of 300 words)
Teaching Experience (maximum of 300 words)
Research Experience (maximum of 300 words)
Management Experience (maximum of 300 words)
Courses/Conferences Attended (include mandatory CME + number of days)
Publications/Presentations
Referees

Annual Pituitary CPC: now in its tenth year!

2007-11-27T23:56:00.001Z

Dear Colleague

Meeting: Tenth National Pituitary Clinico-pathological Conference
Date: Thursday 6th March 2008 (all day).
Venue: Royal College of Physicians, London

Many will be aware of this great event, the annual Pituitary Clinico-pathological Conference - now in its tenth year. It has proved very popular and successful each year, as it gives a unique opportunity to discuss the management of cases of pituitary disease at a national
level and in a multi-disciplinary setting.

Participants come from all specialties involved in the management of pituitary disease, including adult and paediatric endocrinology,
neuroradiology, neurosurgery, neuropathology and radiotherapy. The cases discussed typically represent those situations when the clinical management decisions are not straight-forward. Some cases are interesting because they are unusual, but many cases presented are of the more common forms of pituitary disease, where there are still practical challenges in delivering optimal treatment.

I know that many colleagues really value this opportunity to keep up to date in pituitary disease - recognising that for many clinicians it is a small but important part of clinical practice. The preliminary announcement for the meeting is attached. Now is a good time to mark
the date in your diary, and clear clinical commitments so that you can join us. Why not bring a case to discuss? I'm sure this will be
another very successful pituitary meeting, and look forward to seeing you there.

Best wishes

James Ahlquist PhD FRCP
Consultant Physician and Endocrinologist
Southend Hospital Westcliff on Sea
Essex SS0 0RY
================================================================
For further information or to register for the meeting:
Tel: 01438 751519
Fax: 01438 751520
Email: ali@cfsevents.co.uk
Website: www.cfsevents.co.uk

SPARROWS 2008 applications

2007-11-25T21:59:00.001Z

Dear Colleagues,

I have appended the application form for SPARROWS 2008 (attending the ADA APC) (Editor's note: please check your emails for the application form). Please note the deadline of 5pm 17th December, which must be adhered to. It is essential that you discuss your application with your current Educational Supervisor before submitting. Myself and Jean MacLeod look forward to judging the applications.

Regards,
Shaz.

Dr Shaz Wahid FRCP
Consultant Diabetologist/Endocrinologist
South Tyneside District Hospital

NRDSAG Minutes: 16 Oct 2007

2007-11-25T21:10:00.001Z

Hi everyone,
Please find attached (Editor's note: appended below) the minutes for the NRDSAG meeting from 16th October.
The dates for the NRDSAG and Diabetes Audit meetings next year will be the afternoons of Thursday May 22nd and Monday October 13th 2008 – venues to be confirmed. Please get these dates in your diaries now...
As ever, always interested in your thoughts or ideas on NRDSAG and how we can continue to take this forward. Would particularly like to hear from anyone interested in collaborating in looking at the regional data...
Also, Alan Charlton asked me to specifically highlight the User Involvement training conference on 6th December (Editor's note: appended below).

All the best

Simon

Dr Simon Eaton
Consultant Diabetologist
Northumbria Healthcare NHS Foundation Trust
====================================================================

User Involvement Training Conference
Web address: http://www.diabetes.nhs.uk/
Diabetes NSF Special Briefing
12 October 2007

Diabetes NSF Briefing
You can subscribe online to receive the Briefing directly into your mailbox at www.diabetes.nhs.uk
NDST Regional Events - Update Because of postal delays caused by the strike could anyone who has applied for either Leeds or London NDST event please call Sarah Iveson on 01661 839203 to confirm your place at the event

User Involvement training

Helping you to put people at the heart of diabetes services – free training for you in your region.

A round of training events commissioned by the National Diabetes Support Team (NDST) as part of their programme to support User Involvement is now underway. The training, delivered by specialists in Diabetes UK and London Metropolitan University is targeted at people with responsibility for diabetes within local health systems and aims to provide everything they need to more effectively involve service users in the development and improvement of diabetes services.

The programme has been carefully developed to ensure delegates have command of the methods and information that they need to enable their services to more effectively engage with the people who use diabetes services. It will also provide an introduction to the materials developed to support user involvement by the NDST including a self-assessment tool for services, guidance on involving people whose voices are not normally heard, and information about the other opportunities to be involved for service users and staff.

The training will be delivered regionally to allow as many people as possible to attend. Locations have been chosen because they are central to the region or have the best transport links. Where possible, parking will be provided.

If you can't attend the training day in your region you can sign up in one of the other regions – please get in touch.

For more information and to sign up please email: user.involvement@diabetes.org.uk

If you have any questions please contact David Jones, User Involvement Facilitator on 020 7424 1038 or at david.jones@diabetes.org.uk
===========================================================================

Northern Region Diabetes Service Advisory Group
Tuesday 16th October 2007 1.00 – 2.30pm
Lumley Castle, Chester-le-Street

Minutes

Present: Simon Eaton, Karen Butterfield, Kenvyn Murray, John Parr, K R Narayanan, Kate Latham, Alan Charlton, Chris Emmett (Medical Student), Alan McCulloch, Muthu Jayapaul, Paul Peter

Apologies: Shaz Wahid, Margaret Hunter, Bill Cunningham, Paul McClintock, Sally Marshall, Nicola Leech, Gillian Johnson, Gillian Hawthorne, Jola Weaver, Nick Lewis-Barned, Chris Strey

Previous minutes – accepted

User Representation and User Involvement
Alan Charlton is a member of the NDST Diabetes Reference Group, which is a trained user group along with Margaret Hunter. He discussed the nature of this group and their experiences.
He highlighted the user involvement training that will take place on the 6th December 2007 in Durham and asked us to try to encourage every organisation to encourage people to attend this.

Commissioning and Networks
It was acknowledged that there have been significant problems with networks over the past couple of years with rapid changeover of personnel, a lack of communication and there was a fear that we are losing what had been built up over the years. However some clinicians also reported starting to reform natural networks.
Many people reported a lack of movement from the commissioning perspective. They had had many meetings 12-18 months ago but really have not heard anything more subsequent to that. Simon Eaton briefly outlined the Year of Care Initiative - North Tyneside is one of the pilot sites.

NPfIT and the Diabetes Module
John Parr had hosted a demonstration of the diabetes module in South Tyneside the previous week. The functionality of the module looked good but there are difficulties linking it with other systems that may be in operation in Primary Care (such as EMIS) and also uncertainty how this will link with LORENZO (the Secondary Care system) in the future.

Simon Eaton attended an SHA engagement meeting last week and said that some of these problems were highlighted there. The main outcome of this meeting is to encourage clinicians to engage with NPfIT and the various module developments to ensure that the end product is fit for purpose. The main contacts would be Annette Chambers or Paula Whitty from NHS North East.

Simon Eaton also reported from a meeting he had attended regarding developments of the Diabetes Module particularly relating to the Do Once and Share Project that was held in the North East 2 years ago. This Module had been shared with the NRDSAG (albeit with very short time scales) a few months ago and it was highlighted that there were many limitations from the perspective of engaging people with diabetes in their care. At this meeting these limitations were acknowledged and there is ongoing work to try and redress this.

Linkage with SHA
As a consequence to the discussions around NPfIT there have been linkages formed between the SHA and the NRDSAG. It was agreed that we should work to strengthen these links as there may be much that either can benefit from the other. Simon Eaton will make contact with Paula Whitty to this end.

Diabetes Regional Interest Group
There had been a proposal from Jim Honeyman of GlaxoSmithKline and Steve Burney of Novo Nordisk about the potential positive value of an industry group to support work streams in this region. This may not be purely financial but may be around project management and bringing people together. The Scottish Diabetes Industry Group is an example of a similar forum which has had some successful outcomes.

Broadly it was felt that there was a potential value of this group and there was certainly an advantage to having a multiplicity of Pharma groups involved. There were no specific projects in mind at present. Simon Eaton suggested that he didn't feel this was a specific function for the NRDSAG and if anybody wished to lead or be involved in this then he could pass them on to Jim Honeyman directly.

The Diabetes Information Review
The group read and discussed the latest Diabetes Information Review report which focussed particularly on the Healthcare Commission Service review. A focus on patient education and involvement in care was also presented.

Broadly there was a mixed response to the service review and some centres had experienced stigma for having a "fair" rating. However it is acknowledged that this report had been performed and that it could now potentially be used as a drive to improve services and highlight the need for prioritisation or resource allocation.

Any Other Business
John Parr suggested a repeat of the regional myocardial infarction audit done around 10 years ago. There was support for this and John will contact centres directly.

Date of Next Meeting:
The dates for 2008 are the afternoons of Thursday May 22nd and Monday October 13th – venues to be confirmed.

NERRAG Annual Meeting 2007: 28 Nov

2007-11-10T11:49:00.000Z

NERRAG Annual Meeting 2007
28th November
Lumley Castle, Chester-le-Street, County Durham

1410 Reception
1425 Welcome - Andy James

FIRST SESSION. CHAIR - Shaz Wahid
1435 MEN guidelines-an update Steve Ball, Newcastle University & RVI Newcastle.
1505 Audit of the biochemical detection of phaeochromocytoma - where are we now? Robert Peaston, Freeman Hospital
1525 Endocrine genetics in the North: emerging themes from a joint clinical approach. Paul Brennan & Steve Ball, James Cook University Hospital, RVI Newcastle & Newcastle University
1540 Ten years experience of thirty adrenocortical carcinomas: a case series. Sebastian Aspinall, RD Bliss, TWJ Lennard: Royal Victoria Infirmary, Newcastle upon Tyne; BJ Harrison: Royal Hallamshire Hospital, Sheffield; D Scott-Coombes: University Hospital of Wales, Cardiff
1555 A retrospective study of pre-operative localisation imaging of parathyroid adenomas. Asgar Madathil & Kamal Abouglila, University Hospital of North Durham.
1610 Update on the management of difficult primary hyperparathyroidism. Sukesh Chandran & Simon Pearce, RVI Newcastle.
1625 Tea/Coffee

SECOND SESSION. CHAIR -Tim Cheetham
1645 Thyroid Nodules and Thyroid Cancer Petros Perros Freeman Hospital and Newcastle University
1715 Short stature: Increased in children with severe learning disability. Nadeem Abdullah, Paula Drummond, Nicola Davies, Omer Al-Khalidi, Raymond Barry, Tim Cheetham Department of Paediatrics and Community Paediatrics, Newcastle upon Tyne Hospitals NHS Trust
1730 Management of post-thyroidectomy hypocalcaemia in the immediate post-operative phase. Murray Head, Morris M, Bliss R, Jones N, Johnson S, Lennard T, Stafford F, Welch A, Perros P. Newcastle Hospitals NHS Foundation Trust.
1745 The use of the Harmonic Scalpel in Thyroidectomy: beyond the learning curve. Foreman E H, Aspinall S, Lennard TWJL, Bliss R . Newcastle Hospitals NHS Foundation Trust & Newcastle University.
1800 A retrospective audit of Radioiodine therapy for Thyrotoxicosis. Jeevan Mettayil, S.Ashwell, R.Bilous, V.Connolly, S.Jones, M.Kamaruddin, P.Varra, S.Nag, James Cook University Hospital.
1815 Severe Poikilothermia due to hypothalamic injury managed with a portable external heating vest. Srikanth Mada, S Kamaruddin, J Mettayil, W Kelly, G Young, S Nag, James Cook University Hospital.
1830 Management of Non-Functioning Pituitary Adenomas: A Retrospective Audit at James Cook University Hospital. Ian Coulter & Philip Kane, James Cook University Hospital.
1845 Summary, Discussion, and Thanks - Andy James
1855 Buffet

Training fee restructure with commitment to review

2007-11-02T11:06:00.000Z

The Joint Royal Colleges of Physicians Training Board (JRCPTB) has changed its fee structure to better meet the needs of trainee doctors. The previous fee of £875 which had to be paid in full at entry can now be divided into two elements - £250 for Core Medical Training and £625 for Specialist Training. This will lessen the financial burden for younger doctors as they begin training to be a physician.
The change will take immediate effect, and any ST1 or ST2 trainee who has already paid the full fee of £875 will be refunded £625. ST3s already enrolled may claim back £250.
Trainees wishing to do this should contact the Board on 020 7935 1174 ext 283
This will not affect SpRs, who will continue to pay £875 on entry to specialist training, however, this can be paid in yearly installments as part of a College membership subscription, when it becomes tax deductible.
In addition to the changes, the Board will be reviewing other payment options in future, together with a refund policy.
Further information and future updates will be posted on the JRCPTB website: http://www.jrcptb.org.uk/
Best wishes,
JRCPTB

Motivational Interviewing workshop: 13 Dec 2007

2007-11-01T12:51:00.001Z

An Introduction to Motivational Interviewing

Date: 13^th December 2007

Venue: Springfield Hotel, Gateshead

Chair: Jola Weaver, Senior Lecturer in Diabetes Medicine, Newcastle University

Invited Speaker: Lynne Johnston PhD, Clinical Psychologist

Programme
09:30 – 09:45 Introductions
09:45 – 10:00 Motivational interviewing and behaviour change
10:00 – 10:15 Understanding the process of change
10:15 – 10:45 Understanding and recognising resistance
10:45 – 11:00 Coffee
11:00 – 11:15 General principles of MI
11:15 – 12:30 Developing skills in essential strategies
12:30 – 13:00 Lunch
13:00 – 13:15 Traps to avoid in consultations about change
13:15 – 13:45 Strategies to e licit change talk
13:45 – 14:30 Assessing and exploring readiness to change
14:30 – 14:45 Coffee
14:45 – 15:15 Building motivation for change
15:15 – 15:45 Information exchange and action planning
15:45 - 16:00 Questions and further information

Please contact Sylvia McEwen for further information and registration.
Supported by an educational grant from Sanofi-Aventis.

Trainers and Trainees Meeting, North Tees: 24 Jun 2008

2007-11-01T12:29:00.001Z

Dear Colleague,

The annual Trainers and Trainees meeting will be held at North Tees on Tuesday 24th June 2008 from 1600hrs. The STC meeting will preceed this meeting and from 1730 hrs we will have the important SPARROWS feedback meeting when SpRs who attended the ADA can undertake a presentation related to the ADA.

It promises to be an entertaining evening. Please put it in your diary. I will forward a formal timetable nearer the date.

Regards,
Shaz Wahid.

Registration for YDF Day: 04 March 2008

2007-10-20T16:13:00.000+01:00

Registration for the Young Diabetologists Forum Day on 4th March 2008 is now open. Registration for the YDF Day is free, and comes with free accomodation for the day and the rest of the Diabetes UK annual professional conference. Specialist Registars planning to attend YDF/DUK can find details on how to apply on the YDF website.

NRDSAG & Audit Meeting: 16th Oct 2007

2007-10-14T19:01:00.000+01:00

Just to remind everyone that the next Northern Region Diabetes Service Advisory Group is this Tuesday 16^th October at 1pm at Lumley Castle (lunch 12.30).
It looks like it will be a really interesting and stimulating meeting as there are a lot of hot issues to discuss and debate (see programme below).
I have also put together another Diabetes Information Review, based on the Healthcare Commission Service Review (attached). I would be really interested in your thoughts and ideas about this.
The Diabetes Audit meeting follows on at 2.30 and I attach the programme for that as well. (A reminder for the SpRs – the NRDSAG meeting is open to you and very relevant for your training – please come to both!).
The NRDSAG distribution list is still very short of representation from primary care, particularly with the sadly ever-changing network personnel, so please, please forward this on to anyone you feel appropriate, especially lead GP’s or Practice nurses in your area and other key people. Ask them to let me know if they wish me to include them in the distribution list in the future.

Looking forward to Tuesday

All the best

Simon

========================================================================
Northern Region Diabetes Service Advisory Group
Tuesday October 16^th 2007 1.00 – 2.30pm
Northumberland Room, Lumley Castle, Chester-Le-Street

Thanks to Kate Latham for supporting lunch (12.30 – 1.00), refreshments and venue with an educational grant from Lilly
For further information, or to send apologies, contact Simon Eaton, NRDSAG chair.

Minutes of previous meeting (attached)
Matters arising
User representation and user involvement
Commissioning
The state of the Networks
Linkage with SHA
NPfIT and the Diabetes Module
Diabetes Regional Industry Group – proposal of support for regional projects
Consideration of the Diabetes Information Review (attached)

The Healthcare Commission Service Review
QOF update
Future reports – ideas & opportunities for involvement

Followed by Diabetes Audit Group meeting (2.30 onwards)

PROGRAMME
NORTHERN REGIONAL DIABETES AUDIT GROUP [FOLLOWS THE NRDSAG MEETING]
16 October 2007 (FROM 1430)
LUMLEY CASTLE, CHESTER-LE-STREET

1430 – 1450 Baseline audit of diabetes services for young adults at North Tyneside GH. Emmett C, Lewis-Barned N, Oliver L, Morgan J, Dovey-Pearce G, Young B. North Tyneside General Hospital

1450 – 1510 How good was the person you saw today?: Measuring consultation quality. Al-Ozairi E, Eaton S. Northumbria Health Care NHSFT

1510 – 1530 Baseline audit of care of gestational diabetes in Northumbria Health Care NHSFT. Larman C, Clark S, Eastlake M, Evans D, Guirguis M, McKenzie S, Lewis-Barned N. Northumbria Health Care NHSFT

1530 - 1545 Tea/Coffee

1545 – 1615 Regional data review: patient involvement. Eaton S.

Registration with the Postgraduate Dean in the Northern Deanery

2007-10-11T10:37:00.000+01:00

Dear All

Just to inform you that I have put some information on the welcome page
of your website for all doctors entering run-through training for the
first time and how they go about registering with the Postgraduate Dean.
Link as below. Info can also be found on the front page of the Deanery
website if you have trouble accessing this.

http://mypimd.ncl.ac.uk/PIMDDev/news/form-r-registration-with-the-postgr
aduate-dean

Basically all new run-through trainees need to complete a "Form R" and
return this to the Deanery before they can be issued with a National
Training Number. Would therefore be grateful if you could pass this
information on to those of you who have new ST trainees and need to
register.

Any queries please do not hesitate to give me a call.

Thanks.

Gillian

Gillian Conway
Specialty Programme Co-ordinator
Northern Deanery
NHS North East Education
10 - 12 Framlington Place
Newcastle Upon Tyne
NE2 4AB
Tel: 0191 2226762
www.pimd.co.uk

National Diabetes Support Team 'Showcase' Conference 13 Nov and 13 Dec 2007

2007-10-11T10:23:00.000+01:00

National Diabetes Support Team ‘Showcase’ Conference

Please find attached an Application Form and Outline Programme for the National Diabetes Support Team ‘Showcase’ Conferences due to be held in Leeds 13 November and London on the 13 December.

There is no attendance charge for the conference which will cover the following topics:

Commissioning

Children and Young People

Patient Public Involvement/User Involvement

Diabetes information and the use of data

Care Planning and year of care

Quality Assurance in Diabetes Education

Diabetes Needs Analysis – Understanding Populations

Diabetes In Patients

As well as offering you the opportunity to meet fellow professionals working in the field of diabetes and time to meet and discuss issues with members of the National Diabetes Support Team and the National Diabetes Tsar, Dr Sue Roberts and members of the Department of Health Team.

Places are strictly limited and will be allocated on a first come first served basis, if you would like to attend then please complete the attached application form and forward to:

Sarah Iveson
National Diabetes Support Team
Nomis House
18 South Road, Prudhoe
Northumberland
NE42 5JS

or email it to Sarah Iveson
Tel: 01661 839203

I look forward to seeing you at our event.

Michelle Greenwood
Programme Manager
National Diabetes Support Team

==================================================================== National Diabetes Support Team Conferences
Leeds, Metropolitan Hotel 13^th November
London, Holiday Inn, Kensington Forum, 13^th December

Outline Programme

08.45 – 09.30 Registration

09.30 – 09.30 Introduction Bill O’Leary

09.35 – 09.45 Welcome SHA Representative

09.45 – 10.00 Themes of the day Diabetes Tsar Sue Roberts

10.00 – 10.30 Plenary:

Relaunch of Networks NDST Director Bev Bookless

10.30 – 10.45 Coffee

10.45 – 11.45 Workshop: first rotation

Commissioning
Children and Young People
Patient Public Involvement/User Involvement
Diabetes information and the use of data
Care Planning
Quality Assurance in Diabetes Education
Diabetes Needs Analysis – Understanding Populations
In Patients

11.45 – 12.45 Workshop: second rotation

12.45 – 13.30 Lunch

13.30 – 14.00 Plenary:

Self Management Sue Roberts

14.00 – 15.00 Workshop: third rotation

15.00 – 16.00 Workshop: fourth rotation

16.00 – 16.25 Panel Questions & Answers

Application form

Name: …………………………………………………………………………………...

Job title: …………………………………………………………………………………...

Organisation: …………………………………………………………………………………...

Address: …………………………………………………………………………………...

…………………………………………………………………………………...

Telephone number: …………………………………………………………………………...

Email address: …………………………………………………………………………...

Conference you wish to attend: Leeds, 13^th November □ London, 13^th December □

Workshop preferences – please rate preference 1 to 8 with 1 being your top choice:

Commissioning □
Children and Young People □
Patient Public Involvement/User Involvement □
Diabetes information and the use of data □
Care Planning □
Quality Assurance in Diabetes Education □
Diabetes Needs Analysis – Understanding Populations □
In Patients □

Please send your completed application form to Sarah Iveson, National Diabetes Support Team, Nomis House, 18 South Road, Prudhoe, Northumberland, NE42 5JS or email it to Sarah Iveson
Tel: 01661 839203

Caledonian Society for Endocrinology: Peebles, 30 Nov - 1 Dec 2007

2007-10-11T10:09:00.000+01:00

Caledonian Society for Endocrinology

Advance notice of Annual Winter Meeting 2007 and call for abstracts for Caledonian Society Prize Lecture and Clinical Case Presentation Prize.

Chair: Dr Marie Freel, Clinical Lecturer, Western Infirmary, Glasgow

Dates: Friday 30th Nov & Saturday 1st Dec

Venue: Peebles Hotel Hydro

Northern region endocrine Diabetes CME-8.10.2007

2007-10-01T09:22:00.000+01:00

Northern Endocrine and Diabetes CME
Autumn Meeting 2007
Monday 8 October , 2007 Academic centre
James Cook University Hospital, Middlesbrough

0930 Registration

Morning session: Osteoporosis, Recent developments in Management of Type 2 diabetes

1000 Update on osteoporosis Professor Stuart Ralston
Head of the School of Molecular and clinical medicine &
Professor of Rheumatology
Western general hospital
Edinburgh
1040 Discussion
1050 Which glucose lowering drug, When? Professor Philip Home
Freeman hospital
1130 Discussion
1140 Tea break

1150 Debate
‘ This house believes that thiazolidinediones should not have a role in the
management of Type 2 diabetes ‘

Supporting the motion : Dr.Vincent Connelly

Against the motion : Dr.Simon Ashwell

James Cook University hospital,Middlesbrough

1300 Lunch

Afternoon session: Cushings Syndrome, Hormone replacement therapy

1400 Cushing’s syndrome- Always a problem Professor Ashley Grossman Professor of Neuroendocrinology William Harvey Research Institute Barts and the London School of Medicine, Queen Mary University of London
1440 Discussion
1450 Cushing’s syndrome- Case discussion Dr.Andy James
Dr.Sukesh Chandran
Dr.Ravikumar
Royal Victoria Infirmary
1520 Tea break
1530 Hormone replacement therapy Dr.Gordana Prelevic
–Risks and benefits Senior Lecturer in Reproductive Endocrinology,Royal Free and
University college,London medical school
1410 Discussion
1420 Close

RITA 2008 Timetable

2007-08-17T12:49:00.000+01:00

Dear Colleague,

Because of logistical changes at the PIMD I am having to forward plan the RITAs for 2008, or Annual Review of Competence Progression (ARCP) as they will be known following publication of the "Gold Guide". The ARCP will take place over Weds 14th , Thursday 15th and Friday 16th May 2008. Any one who has a CCT date between May 2008 and 31st Dec 2009 will have a PYA unless you have already had one.

I have appended a time table for each of the dates. I have scheduled the PYAs for Thurs 15th May 2008 morning, the 5 according to my records due a PYA have been slotted in to the times. If you believe you are due a PYA and are not on the list, please contact me. The PYA trainees will need to submit all their paperwork and logbook before their PYA.

Those not due a PYA will be asked to bring all of their paperwork and log book to their scheduled ARCP date and time. The panel will spend 30-40 minutes reviewing the evidence in the absence of the trainee, followed by a 10-15minute review with the trainee to feedback the ARCP report.

Can trainees please get back to me with a date and time that suits them by early November 2007 otherwise I will alot a date and time in December 2007 when the finalised timetables are circulated. I will also circulate exact instructions at this time.

Best wishes,
Shaz.

PROVISIONAL DIABETES &ENDOCRINE ANNUAL REVIEW OF COMPETENCE PROGRESSION (ARCP)

WEDNESDAY 14^th MAY 2008-small staff room, Peacock Hall, RVI

Panel-Shaz Wahid, Gillian Conway, TBC

0915

1005

1055 Break

1110

1200

1250 LUNCH

Panel-Shaz Wahid, Gillian Conway, TBC

1330

1420

1510 Break

1520

1610

THURSDAY 15^th MAY 2008-Large staff room, Peacock Hall, RVI

PYA Panel-Shaz Wahid, Gillian Conway, External-TBC, TBC

0945 Beas Bhattacharya

1015 Sukesh Chandran

1045 Arutchelvam Vijayraman

1115 Eelin Lim

1145 Khaled Mansur-Dhukan

1230 LUNCH

PANEL-Shaz Wahid, Gillian Conway, TBC

1330
1420
1510 Break
1520

FRIDAY 16^th MAY 2008-Large staff room, Peacock Hall, RVI

PANEL Shaz Wahid, Gillian Conway, TBC

0930

1020

1100 Break

1115 Flexible session (PYA reserve, RITA reserve, Counselling, outstanding RITA Gs)

YDF/ABCD travel grants for EASD 2007

2007-07-30T18:57:00.000+01:00

The YDF (Young Diabetologists Forum) is offering travel grants to members who are presenting at EASD 2007 at Amsterdam. The grants will cover travel, registration and accommodation up to a maximum of £700 per head and will be allocated on a first-come-first-served basis. Full details available at the YDF website.
Even if this is not of interest to you, do visit the revamped YDF website. It has been completely redesigned with Web 2.0 technology and hosts many useful diabetes and training-related materials, including newsfeeds from the major diabetes journals. Check it out!

PIMD Course Calendar

2007-07-27T21:20:00.001+01:00

Dear All

I would be grateful if you could please disseminate the attached
course calendar and course specifications to your network.

Many thanks

Trish Hall
QA Co-ordinator
PIMD
Tel 0191 222 7290
------------------------------------------------------------------------------------------------

PIMD Course Calendar available at:
http://mypimd.ncl.ac.uk/PIMDDev/pimd-home/education-development/faculty/c-calendar
------------------------------------------------------------------------------------------------
Education, Development & Governance
FEEDBACK FOR LEARNING
Facilitator: Dr Derek Blades, Effective Professional Interactions
Date:
Venue:
Time: 9.30-4.30
Verifiable CPD hours:

Background
Effective feedback is a critical factor in support of learning in the
workplace. Two specific contexts for feedback are 'in action' (during
the task) and 'following action' (after, yet close to the task) when
discussion may move from an initial task focus to wider
considerations. Clinical tasks themselves differ in the level of
clinical uncertainty, and this affects the nature of feedback. The
focus of this one day course is to develop effective feedback skills
'on-the-job' and 'close to the job'.

Aim
The course will aim to identify and respond to the learning needs of
the group in relation to the provision of 'feedback for learning' in
the context of workplace based learning.
1. To develop a model of good practice.
2. To practise feedback skills within contrasting clinical contexts.
3. To agree how to continue to develop feedback skills in the workplace.

Target Audience
Clinical supervisors who support the workplace learning of doctors and dentists.

Core Content
This will include the following:
* Feedback as a critical component of workplace learning.
* Some principles of feedback for learning.
* Medical and dental contexts; the culture of PGME.
* Models of feedback provision.
* Skill development:
o Enhancing the effectiveness of communication.
o Managing challenge and support for the learner.
o Coping with problems.

Teaching Method
Reflection upon experience and upon models of good practice

Practise

Discussion, analysis, questioning

Expected Learning Outcomes

Delegates will be able to:
1. Demonstrate improved feedback skills of immediate practical value
to their work as clinical educators.
2. Transfer the principles and practices learnt into the workplace in
order to continue to develop their feedback skills.

Booking Information
To book a place contact Julie Callanan: tel: 0191 222 7041
email: julie.callanan@ncl.ac.uk
---------------------------------------------------------------------------------------------
Education, Development & Governance
REFLECTION AS A LEARNING SKILL
Half day interactive workshop

Facilitator: Mrs Sarah Pape, Consultant Plastic Surgeon, RVI
Date (Venue): 4 September 2007 (Newcastle); 5 October 2007
(Newcastle); 8 January 2008 (North Tees Hospital); 13 February 2008
(Durham County Cricket Club)
Venue:
Time: 2.00 – 5.00
Verifiable CPD hours: 3

Background
'Reflective practice' is a term in common use, often spoken of as a
key to professional development. But what does it mean in reality,
and what should we do about it? This half day interactive workshop
explores 'reflection' from the perspective of the busy clinician who
wants to encourage reflection in trainees and assist them to capture
it for their portfolios.

Aim
To explore 'reflective practice', what it means, and how to facilitate
and capture reflection, by learners in the clinical environment.

Target Audience
Educational supervisors, including consultants, doctors and dentists.

Core Content
* Reflection in theory.
* Reflection in practice.
* Strategies for improving and capturing reflection.

Expected Learning Outcomes
By the end of the workshop participants will be able to:
* Explain reflection as a learning skill.
* Assist learners to use reflection in support of their learning.
* Advise learners on how to account for their reflective practice
within their learning portfolios.

Booking Information
To book a place contact Julie Callanan: tel: 0191 222 7041
email: julie.callanan@ncl.ac.uk
--------------------------------------------------------------------------------------------------
2 day residential programme for consultants at the start of their careers
REDWORTH HALL, COUNTY DURHAM
8th & 9th November 2007

Target Group
New/early years consultants; especially those with an interest in
developing their educational skills and knowledge; final year SpRs.

Programme aim
This two day programme is designed to map out the educational models
and principles current in Post Graduate Medical & Dental Education,
provide knowledge of educational techniques, skills and terminology,
explore with other consultants the realities of PGMDE, and position
consultants to recognise and develop their educational capabilities.

Expected Learning Outcomes
On completing this programme we expect that you will:
1. Be equipped with a range of educational techniques and strategies
relevant to your own educational practice.
2. Have increased confidence in your ability to meet the expectations
of your educational role.
3. Understand current developments and educational principles of PGMDE.
4. Have clarified and planned to meet your continuing development need
in relation to your role in PGMDE.

Notes
1. This is a residential event at a prestigious venue with excellent
leisure and catering services
2. There is no charge to participants
3. Booking: Trish Hall, email patricia.hall@ncl.ac.uk tel: 0191 222 7290/7041
4. Further information: Rich Bregazzi, email r.c.bregazzi@ncl.ac.uk
tel: 0191 222 5945

NRDSAG & Diabetes Audit meeting - 2nd October 2007

2007-07-21T22:47:00.001+01:00

The next (Northern Region Diabetes Service Advisory Group (NRDSAG)
and Diabetes Audit meeting will take place on the afternoon of
Tuesday October 2nd 2007 at Lumley Castle

After lots of excellent feedback from many people Narayanan and I
have finalised one or two changes in the format for this afternoon:

We have changed from a Wednesday afternoon as we appreciate that was
difficult for a number of people. We would intend to rotate the
timings of this meeting throughout the week in the future.
The NRDSAG 'business' meeting will start at 1.00 (lunch at 12.30)
The audit meeting will start at 2.00 but will last until approximately
6.00pm. We will attempt to combine the regional data reporting and
local audits into the session.
In October the regional data will be themed to focus on footcare and
involving patients in their care. Any local audits submitted and
accepted on similar subjects will be presented together and there will
be a opportunity to discuss what the implications of these audits are
to our practice regionally. We would therefore encourage good quality
audits on these themes.
There will also be opportunity to present audits on other issues
relating to diabetes, as previously.
We hope this format will allow the usual stimulating discussions and
add greater opportunity to reflect on the significance and
implications to clinical practice.

As usual, Narayanan will be in touch for people to submit local
audits shortly.

If anyone is interested in being involved in analysing the regional
data on the above themes, please let me know.

Once again, there may be many people not currently on this
distribution list who may be interested in attending, particularly
from the diabetes teams or primary care. Please forward this email
onto anyone you feel may wish to know about it.

I hope you feel the suggested changes are appropriate and that you
will continue to support these meetings. Please feel free to get in
touch with either Narayanan or myself if you have any questions or
suggestions. Your feedback and input is vital to making sure these
meetings are of value to our clinical practice.

For your information, the minutes of the last NRDSAG meeting are attached.

All the best

Dr Simon Eaton
===========================

Minutes of NRDSAG Meeting on 16th May at Collingwood College, Durham

Present: Simon Eaton (Chair), Margaret Kerrison, Margaret Hunter, K R
Narayanan, John Parr, Terry Aspray, Reena Thomas, Matthew Hackett,
Linda Woods, Karen Jones

Apologies: Sally Marshall, Tim Butler, Rudy Bilous, Nick
Lewis-Barned, Stuart Bennett, Michelle Greenwood, Kate Latham, Tim
Butler, Jean McLeod, Roy Taylor, Jola Weaver

Previous minutes - accepted

Diabetes UK

MH highlighted that the regional members of the Board of Trustees
and Professional Advisory Council continue to meet twice a year. LW
pointed out that there are 2 vacancies for lay membership on the
PAC. Please ask any interested parties to contact her for further
details.

MH fed back the interesting group being done by the Diabetes
Reference Group, of which she had been a member. Whilst many issues
were recurrent themes, she felt that the structure of the group was
more likely to result in change. MH may bring back further feedback
to the next meeting

Psychology workshops

SE had emailed all SpRs to gauge interest in a course on
consultation skills with only 4 replies (1 positive, 3 very
positive) This was insufficient to justify running course. He will
raise it at Trainees meeting.

Many people, particularly MH and LW, raised ongoing need for people
with diabetes. This is also evident from the Healthcare Commission
survey. Partly this reflected need for moe psychology support and
partly a need for upskilling of diabetes professionals to be able
to offer more support or better consultations to patients. There is
no region why training can't be arranged for Consultant's or other
diabetes professionals as long as there is sufficient interest.

Future role of NRDSAG

JP gave an overview of the history of the NRDSAG. It is now 20
years old. It has had many different focuses in the past.

It was agreed that there is ongoing value in this group and it
should continue. Consideration of the diabetes information review
was accepted as an appropriate focus for the next few meetings.

Diabetes Information Review

SE presented an introduction to the report (previously circulated).

The focus of the report is on constructive reflection towards
improving the quality of diabetes care at a local (or regional)
level.

Discussion of the data focussed on prescribing costs, prevalence
and foot care.

TA acknowledged various limitations of the data. The differences in
undiagnosed diabetes may mean differences in the numbers of "early"
diabetes that may be treated with diet and therefore incur less
costs. SE reinforced the importance of clinicians engaging with the
data for exactly these reasons, and the value of triangulating with
other data sources and what you know about your service.

Future meetings

There have been a number of suggestions about format and timings of
future meetings, which were briefly discussed. This would be
finalised after further discussion and consideration.

Contacting next training unit

2007-07-21T22:36:00.001+01:00

From: Wahid Shahid

Dear Colleague,

You were all informed at your RITA of your next training unit from 3rd October 2007. If you have not done so already can you please contact the Consultant at your next training unit to discuss , as a minimum:

1. Annual & Study leave.
2. Your training requirements.
3. On-call rota.
4. Unit induction.

I will circulate a complete rotation following round 2 interviews on the 24th July 2007.

Best wishes,
Shaz.

NERRAG 28.11.07 - Call for abstracts

2007-07-13T10:22:00.000+01:00

Dear Colleague,
Please send an abstract on any audit, research topic or an interesting clinical case related to any aspect of Endocrinology to myself by 28th September 2007 for consideration for the annual Northern Endocrine Regional Research and Audit Group meeting at Lumley Castle on Weds 28th November 2007.
It should be an excellent meeting as we have the following presentations lined up as well as selected oral presentations:
MEN guidelines update by Steve Ball
Biochemical detection of phaeochromocytoma-where are we now? By Bob Peaston
Thyroid nodules and thyroid cancer-an update by Petros Perros
Best wishes,
Shaz Wahid

LEARNING

2007-07-08T00:00:00.001+01:00

Dear Colleague,

I would recommend reading the attachment dealing with the above I got from Nancy Redfern.
Regards,
Shaz.
<<Education - basic concepts.doc>>

The Challenge of Delivering Professional Medical Education.

How we learn

Professional education is a mixture of learning from books and lectures (academic context), practical clinical experience (practical context) and learning to connect the two from discussions on lists or in meetings (organisational context)¹. Educators should guide trainees in acquiring the relevant range and depth of academic knowledge, learning to apply this to practical clinical situations and to use necessary specialist language. By the time they finish training, trainees must have developed good professional judgment – practical wisdom, about what can and should be achieved.

Knowledge is said to be context specific¹; learning acquired in one context has to be transformed (or re-learned) to make it useful in a different situation. Transferring ideas from one context to another takes time and effort and there are no guarantees that trainees will be able to do this. Someone who is good at passing exams (academic context) may find it difficult to apply to apply this clinically (practice context). In an 'off the job' course, there is so much to cover that little time is spent on each topic. Trainees are left to work out the practical implications of an idea, and how to incorporate it into their clinical practice. Some learning occurs when they come across a concept in a lecture or book, but more happens when the idea is used in supervised clinical practice³. Thus, trainees need sufficient variety of experience to ensure they become proficient in handling the routine and quick to recognise and manage the unexpected or unusual.

Using theoretical knowledge in practice involves four processes; replication, application, interpretation and association². Replication and application are only used in the early phases of trying to master something new. Learning a new technique or changing the way one manages a clinical situation, ideally needs five components, theoretical input, demonstration of skills or behaviour, practice in simulated settings with structured feedback, practice in clinical settings and structured and open-ended feedback about performance³. Although this structure is followed for some training, (e.g. ALS courses), much experience is acquired in a less organised way, on teaching lists, where learning is as much opportunistic as planned. Teaching ward rounds/outpatients/list etc are mostly used to discuss interpretation and association of ideas about practical management of the patient, rather than for mastering new techniques by watching, experimenting, reviewing performance and assimilating new practices.

Added to this, practical "know-how" is usually personal. We all have individual preferences and each trainer's interpretation is different, exposing the trainee to a variety of experience. Practical knowledge is usually private, routines learned through experience and not things we talk about. Asked why s/he does something in a particular way, the experienced practitioner will often reply 'I don't know, I just do.' It is difficult to deconstruct and re-assemble professional know-how we use implicitly, and transform it from practical knowledge to something we can talk about (organisational context). So practical knowledge is difficult to teach, learn and assess.

Eraut¹ divides practical knowledge into 6 categories. These can be useful in identifying in more detail what the trainee might find difficult, and providing a language to discuss what one observes.

Eraut;s categories are

Knowledge about people,

acquiring accurate information – remembering the typical as well as the unusual
knowing how different people might react
making accurate authentic judgements about people

Situational knowledge

reading a situation,

getting on with people,
recognising and adapting to prevalent norms

3. Knowledge of practice

knowing policies and practices and using them appropriately
applying academic knowledge

4. Conceptual knowledge

the individual's set of academic and practical concepts used to analyse and discuss practical clinical problems; remembered as lists or complex frameworks.

(e.g. The concept of what constitutes a good doctor, formed early in our career, which we tend unwittingly to emulate, sometimes even in inappropriate circumstances.)

5. Process knowledge

how to do things

6. Control knowledge – (akin to emotional intelligence (Goleman))

Self-awareness & sensitivity
Self-management e.g. prioritisation, delegation
The ability to reflect and self-evaluate - Knowing one's strengths & weaknesses
The gap between what one says and what one does

Understanding each other

To get the most from a practical teaching session such as a clinic, ward round, or list, both expert and learner need interpersonal and communication skills. Egan⁴ describes these as the skills of the explainer (getting the messages across), of the understander (capturing fully the messages of others), and of the conversation manager (turn taking, connecting and mutual influencing). Each needs to explore what is in the other person's mind and integrate new ideas by making connections with what is already known, (assimilating it into current frameworks), or by making changes to frameworks (accommodating the learner's frameworks) to better fit newly acquired information⁷. A trainee has to explain what s/he already knows, how it is structured, and how they see the new idea. The trainer has to explain the new idea and explore how the trainee sees this fitting into or changing his/her existing understanding, and any misunderstandings.

Both should be open to the other's ideas and to changing their own because of what they hear. Unless the trainee is completely bewildered, s/he will tend to go along with what is said -so as not to seem foolish. The trainee reports back what s/he thinks the trainer wants to hear – i.e. that he or she is following the discussion, and thus the trainer gains a false impression of the trainee's understanding. The trainer, too, may think he understands the concept, but find his grasp rather weaker under the scrutiny of the trainee's questions³. So barriers exist for both trainer and trainee in relating to each others' ideas.

Then there is the matter of willingness to learn. The trainee comes with a set of conceptual frameworks – his or her personal interpretation of how academic ideas relate to his/her work. Learning involves abandoning some of these practices and routines and understanding, accepting and internalising new ideas. This is a daunting prospect; changing practice involves deskilling, the possibility of looking foolish, potential risk to patients, information overload, mental strain and no certainty that the new way will be more functional than the old. It is no surprise that some trainees are cautious about change, perhaps appearing to adopt new practices when working with consultants but reverting to old habits when working alone.

References

1 Eraut M (1994) Developing Professional Knowledge & Competence London The Falmer Press

2 Broudy HS, Smith BO and Burnett J. (1964) Democracy and excellence in American Secondary Education. Chicago Rand McNally

3 Joyce BR & Showers B (1980 ) Improving in-service training; the messages of research Educational Leadership 37 pp 379-85

4 Egan G (2002) The Skilled Helper California. Brookes Cole

Nancy Redfern

Sept 06

INTERVIEWS FOR NTN AND LATS

2007-07-07T23:56:00.001+01:00

Dear Colleague,

The PIMD have assured me that our vacant posts will be advertised on the nhs jobs website today with a closing date for applications of Wed 11th July 2007. I have appended the job description. Could you please forward this e-mail to any of your contacts who may wish to apply and ask them to keep visiting the PIMD and NHS jobs websites.

Best wishes,
Shaz.
<<JD For Diabetes & Endocrinology ST3.doc>>

JOB TITLE: Specialist Trainee Registrar (StR) Diabetes & Endocrinology

LOCATION: Northern Deanery

DEANERY PROFILE

The Northern Deanery is committed to providing excellence in healthcare by:

delivering excellence in postgraduate medical and dental training and
ensuring we have the right number of doctors and dentists with the right skills to meet the needs of our patients and the local NHS.

We are accountable to, and work in partnership with the North East Strategic Health Authority (NESHA) and are responsible for the education and training of around 4000 junior doctors and dentists. We ensure that our training programmes produce:

clinically competent doctors and dentists who put the safety needs of patients first and are capable of being effective independent practitioners and team workers
professionals who understand the duties of a doctor and dentist, the working of the NHS and their role in it
life long learners who are able to respond well to the challenges which their professional career will present

In addition, in General Practice and Dentistry, we also have a role in promoting and overseeing the continuing professional development of career grade general medical practitioners, dental practitioners and their teams.

We operate across a wide and geographically varied area which extends from the Scottish border to Millom in the south west and Northallerton in the south east, working with 11 Acute Trusts (which includes 2 Specialist Trusts providing mental health and learning disabilities services).

At the Deanery office (10-12 Framlington Place, Newcastle upon Tyne) we deliver largely a central function but work closely with our 'delivery arm' colleagues who are our faculty of educators and managers (i.e. tutors, advisors, course organisers, educational supervisors and others ) to deliver good educational programmes and the right support to trainees and trainers.

JOB PURPOSE/SUMMARY

The Northern Deanery has a structured 5 year training programme in Diabetes & Endocrinology managed by the Specialist Training Committee. We are committed to train all trainees in Acute Medicine to Level 2. Our aim as a training region is to produce individuals with an aptitude towards MDT working, with demonstrable practical analytical management skills of clinical situations and who are ultimately rounded individuals equally at home with Trust business development issues and multidisciplinary discussion of patient care issues.

DIMENSIONS OF THE JOB

The rotation provides training in general diabetes and endocrinology, accompanied with sub-specialty training in renal diabetes, diabetic foot , diabetic & thyroid eye disease clinics, insulin pump therapy & other novel therapies, e.g. islet transplantation , adolescent & transitional diabetes & endocrinology, paediatric Diabetes & Endocrinology, thyroid clinics, bone clinics, pituitary clinics, obstetric diabetes and & endocrine clinics, neuroendocrine tumour clinics, reproductive endocrine clinics, lipid & metabolic clinics. The majority of the latter are provided in a district general hospital with some confined to the 3 tertiary centres. We also provide strong training in managerial skills aiding work in the community delivering ambulatory care, e.g. Community Diabetes.

KNOWLEDGE, SKILLS AND EXPERIENCE REQUIRED

Doctors must have achieved foundation competencies.

MAIN DUTIES AND RESPONSIBILITIES

Trainees rotate on the 1^st Wednesday in October every year. Each trainee during their 5 year programme will spend 1-year at the RVI (Newcastle), 1-yr at either James Cook University Hospital (Middlesbrough) or Freeman Hospital (Newcastle), 3-yrs rotating between 3 of the District Training Units every year. Usually trainees will remain in either the Southern Rotation with JCUH being the central unit or the Northern Rotation with Freeman being the central unit, and the RVI is the focal point where all trainees will rotate through. Trainees will be encouraged to undertake research during their programme with the possibility of counting 1-year towards their training. Acute Medicine responsibilities are required during all posts.

The specific posts to be appointed to are:

NTN at James Cook University Hospital from 3rd October 2007 to join the rotation for 5 years

LAT at James Cook University Hospital 3rd October 2007 to 30th September 2008

LAT at Sunderland Royal Hospital 3rd October 2007 to 30th September 2008

LAT at Cumberland Infirmary, Carlisle 3rd October 2007 to 30th March 2008 (there is a strong chance of a contract extension for 6-months)

LAT at University Hospital of North Durham 3rd October 2007 to 30th September 2008 (it is highly likely that this post will start from 3rd October 2007).

COMMUNICATIONS AND WORKING RELATIONSHIPS

Excellent communication is essential in all the specialties and doctors are expected to work well as members of a multidisciplinary team with other professionals. Good communication with patients and relatives is also essential.

IMPROVING WORKING LIVES

All trusts in the deanery are committed to these principles.

PERSONAL AND PEOPLE DEVELOPMENT

Doctors will attend departmental and trust teaching and take study leave in liaison with their clinical and educational supervisors.

HEALTH AND SAFETY RESPONSIBILITY

It is the responsibility of the individual to work in compliance with all current health and safety legislation and the Trust's Health and Safety Policy and to attend any training requirements both statutory and mandatory in line with the Trust's legal responsibility to comply with the Health and Safety and Welfare at Work Act 1974.

To act on and report any untoward incident to the nurse in charge and complete documentation in accordance with the Trust policies, and assist in the risk assessment of the department, equipment and processes of the department.

CLINICAL & CORPORATE GOVERNANCE

Will pay due diligence to Trust guidelines and policies, enhancing the quality of care.

Will assist in the monitoring of incident reports and complaints and in the action planning required arising from such reports.

GENERAL

This job description is intended as a guide to the principal duties and responsibilities for the post and should not be considered an exhaustive list. It is subject to change in line with future development of the service.

TERMS AND CONDITIONS

The Terms and Conditions of Service are those for Hospital Medical and Dental Staff. Please visit NHS Employers website for Terms and Conditions as well as published salary scales www.nhsemployers.org

Appointment is subject to satisfactorily pre-employment checks including CRB, occupational health, GMC and immigration status.

Please note that pay banding for on call will be paid at the intensity rate applicable at the time a trainee rotates into a post.

This is a generic Job Description. More detailed information regarding specific duties a trainee will carry out once in post will be provided at Induction.

26th Regional Bone Density Meeting 6th July 2007

2007-07-03T22:28:00.001+01:00

Regional Medical Physics Department
Bone Mineral Assessment Service
Musculo Skeletal Department
Freeman Hospital
High Heaton
Newcastle upon Tyne
NE7 7DN
www.rmpd.org.uk

Programme 26^th Regional Meeting Bone Density Friday 6^th July 2007
Education Centre, Freeman Hospital
(For those arriving by car from off-site, there will be a limited amount of car parking available in the public spaces)

12:45pm Lunch (Function room – sponsored by Roche Pharmaceuticals) (served until 01:20pm)
01:25pm Welcome and round table introduction (Lecture Room 2) (David Rawlings)
01:30pm Risk factors for reduced bone mineral density in patients with Crohn's disease -Dr Roger Francis, Freeman Hospital
01:55pm Update on Fracture clinic DXA at Newcastle -Sister Karen Loughney, Newcastle General Hospital
02:20pm Paediatric data - revisited -Mr David Rawlings, Freeman Hospital
02:45pm Management of young people with reduced bone density - Dr Tim Cheetham, RVI, Newcastle
03:05pm Tea
03:20pm Things to come? - Mr David Rawlings, Freeman Hospital
03:40pm Update on private DXA provision – open forum (Chair: Alison Mackie)
03:55pm Case studies / discussion on individual DEXA scans (Chairs: Roger Francis; David Rawlings)
04:15pm Arrangements for future meetings
04:20pm Close of meeting

Pancreas transplant meeting 5 July 2007 Freeman

2007-07-01T22:04:00.000+01:00

Whole Organ Pancreas Transplantation

David Sutherland MD PhD
Head, Division of Transplantation
Director of Pancreas Transplant Program
Director of Diabetes Institute for Immunology & Transplantation
University of Minnesota

Thursday 5 July, 16.30 – 17.30
Lecture Theatre 2
Education Centre
Freeman Hospital

Self assessment and laboratory training

2007-06-26T10:35:00.000+01:00

Dear Colleague,

Following the Trainers and Trainees meeting I have given further thought to the issue of a taught programme. The main aim of this programme was to prepare trainees for the self-assessment questions. Observations from the RITA suggested that reflective writing in relation to learning events were not truly reflective. They were mainly a regurgitation of the "knowledge" base with little critical appraisal of the evidence or any national guidance that may have been quoted. This makes undertaking the RITAs difficult. Despite these anxieties it is important that I stick to the principle of adult self directed learning and also make sure that I do not leave an albatross for my successors neck. Hence:

1. I have appended a set of 4 self-assessment essays to guide your self-directed learning. You can direct your learning individually or indeed discuss your answers with your peers or trainers. Also included is an optional essay which you can submitt to myself and Richard Quinton (one HARD copy to each of us) before 2nd February 2008. The winner will be notified at their post-RITA review meeting and the prize will be formally handed to them at the T&T meeting in June 2008. This is good for the CV.

2. I have appended a document providing guidance on laboratory training.

3. In next years RITAs the panels will be marking the reflective cases/writing much harder looking for critical appraisal skills, etc.

4. Given time issues I have abandoned the proposal of circulating self-assessment MCQs.

Kindest of regards,
Shaz.
==========================================================

Self Assessment Essay Questions

Essay 1

A 55 year-old man with a history of paroxysmal AF treated with amiodarone for the last year is referred to you with the following TFTs, TSH less than 0.01 mU/l; fT4 56pmol/l; fT3 22pmol/l. He is thyrotoxic on examination. In no more than 500 words discuss how you would manage him.

A 25 year old woman presents with lethargy, change of voice and leg cramps. Her biochemistry is TSH= 206mU/l, FT4=6pmol/l, FT3=3.7pmol/l. What is the diagnosis, how are you going to treat her? Explain the FT4 and FT3 levels. What information does this patient need to know about her prognosis and ongoing treatment? Restrict your answers to no more than 500 words.

Essay 2

A 32 year-old man with a past history of hypertension treated with bendrofluazide is referred to you by his GP to rule out an endocrine cause. The GP does not think the patient is cushingoid and has already undertaken 2 24-hour urine cortisol measurements which were normal. In no more than 1000 words, discuss adrenal hypertension in relation to this case.

Essay 3

A GP has been struggling with the diabetic control of a 56 year old Caucasian man with Type 2 DM for 5 years, HbA1c 9%, BMI 32 kg/m², waist circumference 96 cm, well controlled BP and lipids. He is on top dose Metformin, gliclazide and was intolerant of rosiglitazone. Orlistat has been ineffective. The GP was wondering what therapeutic options are or would be available for this patient. In no more than 1000 words, discuss novel therapies for the treatment of Type 2 Diabetes in relation to this patient.

Essay 4

A 32 year old woman with a five history of Type 1 DM, background retinopathy and poor hospital attendance attends out-patients following a GP referral because of an eGFR of 29. The GP has advised her she has stage 4 kidney failure and she is very worried. Her HbA1c is 8.5% on bd Novomix 30, LDL-cholesterol is 3.2 and BP is 134/84 mmHg. Her GP advises you these results are typical of her repeat measures over the last year and her creatinine has varied between 120 and 140 micromole/l in the last 18-months. No urine results are available. In no more than 1000 words, discuss how you would manage this lady.

PRIZE ESSAY-If you wish to apply for the best Essay prize for the year submit this essay. In no more than 1000 words, describe the management of patients receiving chronic glucocorticoid replacement therapy, in relation to the available published data and reflect upon any ongoing controversies in the accepted “best practice” for monitoring therapy.

Laboratory Training

To function effectively as a Consultant specialising in Diabetes & Endocrinology it is essential that trainees experience training in laboratory medicine. The curriculum is a little “fuzzy” on this issue, hence the need for this guidance. A number of training units already provide multidisciplinary opportunities to interact with a biochemist, but it is important to arrange exposure to laboratory medicine during each unit attachment backed up by background reading. It is important to cover the following topics:

HbA1c assay measurement, cv, standardisation

Glucose measurements in the lab and meters with causes of errors

Hormone assay methods – Immunometric, RIA, ELISA, Chromatography; Reasons for variability and errors, e.g. hook effect, protein binding

Pitfalls in autoAb measuring, e.g. TBII, thyroid, adrenal

Pitfalls in measuring or assessing the following hormones or endocrine axis – TSH, fT4, fT4, thyroglobulin, total thyroid hormones; Prolactin; Cortisol, ACTH; PTH, calcitonin, calcium, vitamin D; Water & electrolyte handling; electrolytes, osmolality, ADH; GH, IGF1; LH, FSH, Testosterone, SHBG, E2; Renin, aldosterone, PRA; Catecholamines

Out of Programme Experience/Research

2007-06-15T21:29:00.000+01:00

Dear Colleague,

I have forwarded some important information regarding Out of Programme
Experience/Research. Any proposed experienec/research abroad needs
careful planning with atleast 6-month notice to myself.

Regards,
Shaz.

==================================================================

25 May 2007

Letter to all Programme Directors and STC Chairs

Dear Colleagues

Re: PMETB prospective approval of time spent out of programme

PMETB have recently changed their regulations surrounding out of programme experience. From 1 January 2007, all training outside the UK, which is to be part of a rotational programme, and count towards the award of a CCT, will require prospective approval from PMETB.

Background
The legislation establishing PMETB makes it clear that PMETB may approve training outside the UK towards the award of a CCT. To count towards CCT training, the post must be part of an approved CCT specialty training programme, be supervised, and have prospective PMETB approval. These regulations are a change to the current process so the following information will give advice on the process of approval, should a trainee wish to apply for prospective approval to have time spent out of programme count towards their CCT date.

If a trainee has received prospective approval for the out of programme experience (OOPE) / research (OOPR) from the College / Faculty or the deanery prior to 31 December 2006, then this approval will be honoured. If trainees have received retrospective approval for the out of programme experience prior to 31 December 2006, this approval will be honoured. PMETB may seek verification of this when the trainee applies for their CCT.

From 1 January 2007, to prospectively approve a post outside the UK
PMETB have said that they will prospectively approve, towards a CCT, training outside the UK in the following circumstances:

On receipt of a formal application for approval from a deanery for inclusion in a CCT training programme.
Inclusion of the post in a training programme which has the explicit support of the relevant royal college representative(s). Local college representatives must act according to the national policy of their respective royal college and should seek advice from the college where necessary to ensure consistency of standards across the UK.
The application describes the process the deanery used to select the post/programme.
The dean confirms that the training meets PMETB standards.
The dean confirms that the post is subject to similar deanery-managed quality control processes as UK posts.
If the quality control processes are different, the deanery provides a description with the application.
For training in another EEA Member State, the Dean confirms that the post is approved for training in that specialty by that Member State confirmed by a statement/certificate from the relevant European member states’ competent authority.

Transitional arrangements
PMETB issued some further guidance on 16 April 2007 which has extended the time for transitional arrangements. All retrospective recognition of previous overseas training or retrospective recognition for OOPEs / OOPRs that did not receive prospective approval from the Colleges / Faculties will be stopping on 31 July 2007.

If there are any trainees that you are aware of that are currently out of programme and did not seek prospective approval for their OOPE / OOPR, prior to 31 December 2006, they are advised to contact their College / Faculty to seek clarification as to their processes for seeking retrospective recognition.

There will be some doctors who have applied for SpR training programmes with overseas training at basic, and some at higher specialist training level, who have the required entry criteria. Some may have been granted approval for these posts by the relevant College or Faculty but if they have not been appointed to a Specialist Registrar programme by 1 January 2007 and not been given retrospective approval by 31 July 2007 for this training, then these posts cannot be credited towards the award of a CCT. If this happened in the future then such doctors may be eligible for specialist registration at the end of their training through the Article 14 route but could not be awarded a CCT because they have not completed a full UK specialty training programme in PMETB approved posts and programmes.

For the award of a CCT
So that PMETB can decide whether to award a CCT it will require evidence of successful completion of the entire specialist training programme when it undertakes its usual checks on an application. PMETB will require evidence of the date of appointment to the CCT programme. Trainees who have undertaken prospectively approved overseas training as part of their CCT programme will need to be able to provide the necessary evidence demonstrating progression in their training such as trainers’ reports, assessments etc., the same as for those in UK training.

Northern Deanery arrangements
An information sheet detailing the Northern Deanery process for seeking approval from PMETB is attached at appendix 1.

Timeframe
We will add this information to the PIMD website and trainees will be able to download details of the process. As we are unsure of the length of time that PMETB require to approve each application we would urge you and your trainees to start this process well in advance of the proposed out of programme experience / research. We would advise trainees to start this process at least 6 months before they plan to leave the programme.

Out of programme for research
In addition, PMETB have issued guidance on OOPR. The time spent out of programme will be recognised towards the award of a CCT, when the approved curriculum includes research as an optional element. If research is part of the PMETB approved CCT curriculum requirements, the run through training programme should reflect this. Therefore, if research is in a programme, which should be based on an approved curriculum, then trainees may undertake this research and no further approval need be sought from PMETB.

If research is part of the PMETB approved CCT curriculum requirements, but the run through training programme does not offer the possibility of a period of research, prospective approval for individual OOPR posts should be sought from PMETB by the postgraduate deanery. This process is similar to the OOPE process outlined above:

A formal covering letter from the deanery to PMETB seeking prospective approval of the OOPR post and confirming that this post has deanery support. PMETB cannot accept applications from individual trainees or Colleges/ SACs / Faculties.
Confirmation that the OOPR post has the explicit written support of the relevant royal medical college representative(s). Local college representatives must act in accordance with the national policy of their college and should seek advice where necessary from their college to ensure consistent standards across the UK
A statement from the competent authority in the country where the OOPR will take place which details the purpose and structure of the post to the satisfaction of the Deanery and the College.
If the documentation outlined in point 3 above is not provided, then a brief description of the OOPR post which covers the following points: a) where the OOPR is based, b) the structure of the OOPR, c) the educational goals and characteristics of the OOPR, and d) confirmation that the post is subject to quality management in line with PMETB requirements.

What if research is not a requirement of the curriculum?
If a period of research is not a requirement of the approved CCT curriculum, but trainees still wish to undertake it, it is still possible to do so as out of programme experience. This is permissible provided that it has the approval of the postgraduate dean. Time in these posts will not be counted towards the award of a CCT, however, and therefore such posts do not need PMETB approval.

Further information
Links to their full guidance can be found in appendix 1.

If you have received applications from trainees recently for support for an out of programme experience you must alert them to these new processes. These are significant changes to the way out of programme experience is currently approved and no doubt the exact process will become clearer once we have undertaken the first few applications. If you have any questions about this process, please contact Sarah Beecroft sarah.beecroft@ncl.ac.uk.

Yours sincerely

D G Smith
Acting postgraduate Dean

====================================================================

Out of Programme Experience (OOPE)/ Out of Programme Research (OOPR) Procedure
Should a trainee be considering time spent out of programme they must discuss this with their training programme director to ensure that the proposed post meets the educational needs of the trainee.

PMETB have introduced new regulations surrounding OOPE/OOPR from 1 January 2007, therefore, once a post has been applied for and offered to the trainee, the trainee must inform the Northern Deanery so that a prospective approval application can be made to PMETB.

It is recommended that this process is started 6 months prior to the proposed OOPE/OOPR. The trainee must submit an application for OOPE/OOPR to the Specialty Programme Coordinator (please see website for contact details) for their specialty. If the following information is not included in the Deanery OOPE/OOPR form the trainee must submit:

An up to date CV
Offer letter for the OOPE/OOPR
Letter of support from the Programme Director
Educational contract or details of the research project
Timetable (for OOPE only)
Name of supervisor for the OOPE/OOPR
Confirmation that the OOPE/OOPR post has the explicit written support of the relevant royal medical college representative(s).
A statement from the competent authority in the country where the OOPE/OOPR will take place which details the purpose and structure of the post to the satisfaction of the Deanery and the College.

If the trainee is unable to obtain requirement 8, they must submit a brief description of the OOPE/OOPR post which covers the following points: a) where the OOPE/OOPR is based, b) the structure of the OOPE/OOPR, c) the educational goals and characteristics of the OOPE/OOPR, and d) confirmation that the post is subject to quality management in line with PMETB requirements.

It is the responsibility of the trainee to ensure full supporting documentation is sent to the deanery.

Once a complete application is received this will be submitted to the Postgraduate Dean for approval. The Postgraduate Dean will seek prospective approval of the OOPE/OOPR from PMETB and will confirm that the post has Deanery support.

Once the post has received approval from PMETB the trainee will receive confirmation from the Specialty Programme Coordinator, usually via email. This will be copied to the Deanery Human Resources Department, who will write to you informing you of Deanery approval and HR arrangements; they will also inform the Trust and the Programme Director that the trainees’ application for OOPE/OOPR has been successful.

It will be the trainees’ responsibility to inform their Royal College/Faculty of PMETB approval.

PMETB are insistent that applications must come from the Deanery. This is to maintain consistency with PMETB policy for holding the Deaneries responsible for local level quality management of education and training.

Trainees are therefore advised to liaise with their Specialty Programme Coordinator to co-ordinate their applications for approval.

Should applications be made to the deanery Human Resources Department, they will refer the trainee to the Specialty Training Team, so that PMETB approval can be sought.

Retrospective approval for the OOPE / OOPR is essential after completion of the time out of programme, demonstrating evidence of completion of the expected competencies.

Full details of the PMETB guidance can be found on their website:

OOPE: http://www.pmetb.org.uk/fileadmin/user/Policy/Policy_Statements/Prospective_approval_of_overseas_posts_-_Guidance_2_Oct_06.pdf

OOPR: http://www.pmetb.org.uk/fileadmin/user/QA/Post_and_programme_approval/PMETB_guidance_on_research_approval.pdf

Specialty Training Team April 2007

APPLICATION FOR OUT OF PROGRAMME EXPERIENCE (OOPE)/OUT OF PROGRAMME RESEARCH (OOPR)

PERSONAL DETAILS

NAME: ______________________________________________

SPECIALTY: ______________________________________________

HOSPITAL: _______________________________________________

(At time of Leave)

CCT DATE: ___________________

PROPOSED OOPE/OOPR DETAILS

POST/RESEARCH:

____________________________________________________________

________________________________________________________________________________________________________________________

AIMS AND OBJECTIVES OF TIME OUT:

____________________________________________________________

________________________________________________________________________________________________________________________

OOPE/OOPR is funded by_______________________________________

Correspondence address whilst on OOPE/OOPR, including emails/phone number ____________________________________________________________

____________________________________________________________

PROPOSED DATES:

From: _________________________To:_______________________

CONSULTANT SUPERVISOR (Prior to Leave):

Name: _____________________________________________________

ROYAL COLLEGE APPROVAL

Training Approval has been granted by the Royal College/Faculty of __________________________________

Yes/No (Please delete as applicable)

Please indicate the amount of time, which has been approved towards your CCT:

Years: ____________ Months: ___________

My CCT date will not/will be deferred by ____________ years / months

The new CCT date will approximately be ______________________

The minimum requirement here is three months must count towards your CCT date / training (only exception being Nephrology and Gastroenterology). Approval will only be granted by the Postgraduate Dean if this is stipulated clearly in the letter of support from the Royal College or STC Chair.

PROGRAMME DIRECTOR APPROVAL

Please note this OOPE/OOPR Application Form will not be approved without your Speciality Programme Directors Signature below:

Programme Director Name: ____________________________________

Please confirm that the OOPE/OOPR is relevant to this trainee’s level of training and experience and will provide training specified in the curriculum relating to: ___________________________________________________________________________

___________________________________________________________________________

______________________________________________________________________________________________________________________________________________________

Programme Director Signature: __________________ Date: ______

Trainees: UK and overseas

I understand, in order to return to the rotation, that I will require full medical and employment clearances

Trainees Signature: ___________________________ Date: _____

PLEASE RETURN THIS FORM TO YOUR SPECIALTY PROGRAMME COORDINATOR AT THE PIMD

Insulin Infusion Pump Course: 29 - 30 Nov 2007

2007-06-15T21:15:00.000+01:00

Thursday 29 and Friday 30 November 2007

Academic Centre, The James Cook University Hospital,
Marton Road, Middlesbrough, TS4 3BW
www.conferencessouthtees.co.uk

An essential two-day programme for medical staff working with Insulin Infusion Pumps. The course offers the opportunity of a ‘practical hands on approach’ to using Insulin Infusion Pumps with topics including:
Starting insulin infusion pumps ¬ patient experiences on pump therapy ¬ carbohydrate counting ¬ rationale and evidence base for pump therapy ¬ basal and bolus rates ¬ paediatrics ¬ special situations ¬ hypoglycaemia/ hyperglycaemia/ sick day rules and inpatient care

A conference dinner will form part of the learning about estimation of carbohydrate intake which we encourage all members to attend and is included in the delegate fee.

Course fee: £225 per delegate

To register for the Insulin Infusion Pump Course, please complete the following and return to the address below:

Title……… First Name……………………Last Name…………………………………..….

Job title .....……………………………….... Hospital …..……………..……………..………

Address for correspondence ....…………………………………………..…………………...

………………………………………......………………………….............................................

Email………………………………............. Telephone…………………………………….

¨ I enclose a cheque for £225 payable to ‘South Tees Hospitals NHS Trust’

¨ I wish to be invoiced please state address……………………………………………….

…………………………………………………………………….............................................

Conferences and Courses Department
Academic Centre, The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW Telephone: 01642 282534, Email: nicky.skippon@stees.nhs.uk

Regional bone density meeting: 6 Jul 2007

2007-05-28T21:59:00.000+01:00

Dear All

This is to remind you that the next regional bone density meeting is on the 6th July and will be at the Education Centre, Freeman Hospital. All welcome! Please feel free to forward this email to colleagues who may be interested in the content of the meeting. Lunch will be available from 12:30 and presentations will begin at around 1:30pm and finish around 4:30pm. For those not familiar with our meetings, presentations from recent meetings are available on RMPD website .The aim of July meeting, as always, is to highlight developments (either locally or nationally) that are of relevance to all clinical technical, scientific and nursing staff involved either in carrying out and interpreting the measurements or in the management and selection of those patients. I will be sending out a detailed programme shortly - please let me know of any areas of development (or current practice) that you would specifically like to see included. Two such areas/issues have already been suggested:
1) Management of young people with low bone density
2) Update on local DXA through private provider
I would be particularly interested to hear from anyone wishing (or willing) to speak on any appropriate aspect. In addition to more formal presentations, case studies have previously been effective where unusual or difficult aspects may be highlighted (e.g. controversial interpretation or management, abnormal scan image or anatomical feature, etc). I look forward to hearing from you with any contributions/suggestions - please email Dave Rawlings
While we do not have a formal registration for these meetings it is useful to have some idea of the audience (for catering purposes), therefore if you are hoping to come I would appreciate it if you could confirm (by say 29th June) by emailing Lisa Baker or Kerry Myers. Also, if you do not wish to be contacted at any time in the future regarding regional bone density meetings (or if you have any obvious changes or additions to the list) please indicate to either of these addresses.
I look forward to seeing you on the 6th July

David Rawlings
Regional Medical Physics Department
Newcastle-upon-Tyne

Northern region diabetes audit 16.5.2007

2007-05-09T23:54:00.000+01:00

PROGRAMME
NORTHERN REGIONAL DIABETES AUDIT GROUP
16 May 2007 (FROM 1430)
COLLINGWOOD COLLEGE CONFERENCE CENTRE
DURHAM

1430 – 1450 An audit on the use of home blood glucose monitoring in Gateshead: Anne-Marie Bailey, J Stephenson. Gateshead PCT
1450 – 1510 Insulin allergy: A challenge: M S Kamaruddin, J Mettayil, S Mada, R Bilous. James Cook University Hospital
1510 – 1530 Diabetes in care homes across Tyne and Wear: Using audit to motivate health improvement: T Aspray, K Nesbit, M Bowler, G Hawthorne. Newcastle Diabetes Centre
1530 – 1550 Management of acute hyperglycaemia in the hospital away from ITU or CCU care: P Peter. Bishop Auckland District General Hospital
1550 – 1600 Coffee/Tea break
1600 – 1620 Insulin starts in people with type 2 diabetes: An interface audit between primary and secondary care in Gateshead: R Thomas, L Topping, M Kerrison, C Oxynos, K R Narayanan
Gateshead PCT and Queen Elizabeth Hospital, Gateshead
1620 – 1640 Audit on the use of Insulin Detemir in North Tees and Hartlepool University Hospitals: P E Carey, J Macleod. North Tees and Hartlepool University Hospitals
1640 – 1700 Charcot’s arthropathy: the diagnostic dilemma: E L Lim, C M Lee, J B Wilsdon,
N Leech. Newcastle Diabetes Centre

Contact: Dr K Narayanan

JRCPTB Recognition of Research/ Overseas Training

2007-05-03T18:37:00.000+01:00

Dear Specialist Registrar,

I am bringing to your urgent attention a change in the regulations for recognising research & overseas training retrospectively. (This includes past, completed research & research currently being undertaken, but approval not yet applied for).

The Postgraduate Medical Education & Training Board (PMETB) have informed us that with effect from 31st July 2007 it will no longer be possible for JRCPTB (formerly JCHMT) to retrospectively recognise any research or overseas training as counting towards a CCT. Therefore if you, or any of your Specialist Registrar colleagues, wish to have research or overseas training counted which is in accordance with JCHMT/JRCPTB policy - you should make application to JRCPTB IMMEDIATELY - using the Research Application Form or the Overseas Clinical Application Form, together with a copy of your up to date CV. The forms can be downloaded from the JRCPTB website by going to Forms & Guidance and then scrolling down to Research Application Form or Overseas Application Form.

(Contact details of Specialty Managers are on the JRCPTB website if you have any queries. If you are unsure of the JRCPTB policy concerning research and overseas training, they can be found in the JCHMT Handbook inside your Training Record, or seek advice from the relevant Specialty Manager).

In thinking about whether to apply for recognition (or not) - you need to be aware that once approved by JRCPTB, you will not be able to change your mind. The CCT date cannot be changed/amended.

In order for JRCPTB and its SACs to approve applications by the 31st July, 2007, we need to receive all requests by 1st June 2007. This is to allow for checking and queries of applications, despatch to SACs and return to JRCPTB for database amendment and confirmatory letters/emails, and taking place against a background of examinations and annual leave.

PLEASE NOTE: All prospective applications for research and overseas training (or anything else that would require an Out of Programme Experience) will need to be prospectively approved by the Deanery, JRCPTB and the PMETB - further advice about the process for these applications will be available shortly.

Best wishes

Lesley Hagger
Deputy Manager, Specialties, JRCPTB