From small seeds grow mighty oaks: how the Endocrine Nurse community is growing together to share knowledge

Lisa Shepherd, an Endocrinology Advanced Nurse Practitioner at Heart of England NHS Foundation Trust and Chair of the Society for Endocrinology Nurse Committee, discusses continuing education opportunities and the value of networking for endocrine nurses.

Endocrinology is a fascinating but complex area and nurses often work in isolation, so opportunities to develop and update their knowledge, benchmark their practice and network with other nurses are invaluable. The Society for Endocrinology Nurse Committee supports a number of strategies that promote networking amongst the Endocrine Nurse community.

Social media is increasingly used to build professional networks, so the Nurse Committee have set up an invite-only group on Facebook for endocrine nurses, which is a fast and easy way for the community to share protocols and information. Nurse Members of the Society also have a Twitter feed where training opportunities, research and nursing practice can be promoted to the wider community.

Face-to-face networking remains an effective means of sharing experience and learning from others, so a ‘nurses lounge’ was recently introduced at the SfE BES conference, to give nurses a dedicated space to meet each other in person. As many nurses are working in isolation it is valuable to provide a variety of opportunities, across different media that encourages endocrine nurses to support and learn from each other.

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Endocrine Nurse Update (ENU) is coming up soon. This yearly update is designed by nurses for nurses and offers a varied and active programme of endocrinology topics. I am very excited that this year’s ENU will feature the inaugural Endocrine Nurse Award lecture by winner, Nikki Kieffer. This award was introduced to recognise excellent nursing practice that can be shared to advance knowledge and understanding in the discipline. Nikki is an endocrine nurse specialist at Leicester Royal Infirmary and led the project that developed the Competency Framework for Adult Endocrine Nursing. This project is a great example of nurses working together to share best practice and Nikki will deliver the prize lecture at ENU 2017 in March.

There are also great benefits to networking with other closely related communities and this year, for the first time, ENU will include a workshop run collaboratively between clinician and nurse colleagues, Dr Richard Quinton, Dr Channa Jayasena and Dr Andrew Dwyer. Whether you are a nurse new to endocrinology or a nurse with many years of experience, the ENU programme, in combination with Clinical Update has something to offer all. I hope you can join us at the meeting or follow us online, to learn from your colleagues and share your experience.

Nominations for the 2018 Endocrine Nurse Award are open until 16 June 2017, find out more.

Travel grants are available for ENU 2017, apply before 15 March.

View the ENU 2017 programme.

 

Should prednisolone be the first line for glucocorticoid replacement in adrenal insufficiency?

At 18.30 on Monday 7 November Professor Jeremy Tomlinson is chairing a debate on the treatment of adrenal insufficiency at SfE BES 2016. Ahead of the debate, we asked Professors Stafford Lightman and Karim Meeran to give you a little taste of their stance on this hot topic in endocrinology.

 

Professor Jeremy Tomlinson, University of Oxford – Chair

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The optimal strategy for glucocorticoid replacement in patients with adrenal insufficiency remains a contentious issue. In the majority of cases, hydrocortisone is used, but there are issues relating to the need for three times a day administration alongside the high costs of treatment. Are there alternatives?

Prednisolone is significantly cheaper, has a longer duration of action and therefore can be administered twice daily. However, it is a synthetic glucocorticoid that does not act in an identical way to hydrocortisone.

Head-to-head comparisons with meaningful clinical end points are lacking, and in the modern NHS, treatment costs play an increasingly important role.

Let the debate begin!

 

Professor Stafford Lightman, University of Bristol – AGAINST

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The evolution of Homo sapiens from early mammals has taken about 200,000,000 years. During this time we have developed many highly specialised physiological systems –including the key homeostatic system we call the Hypothalamo-Pituitary-Adrenal axis. This system maintains key cognitive, metabolic and immunological systems in optimal state and is also a rapid response system to protect us against stress. The hormone that has evolved to do this is cortisol.

In the absence of endogenous cortisol no-one would disagree that the gold standard therapeutic hormone replacement should be the closest we can get to normal physiology, so if we have to go second-best and provide a different steroid or pattern of plasma steroids it is incumbent on us to prove that this alternative treatment is as good as the best possible therapy available with the native compound.

Prednisolone differs from cortisol in many ways. Not only does it have different characteristics of glucocorticoid mediated gene transcription with no simple dose response comparison to cortisol, but its plasma half-life and metabolism are also unphysiological.

During the debate, I shall demonstrate why these aspects of prednisolone replacement are potentially disadvantageous at cognitive, metabolic and immunological levels. I will explain why I feel it would be dangerous to submit patients to such long duration therapy unless appropriate long term studies are able to show non-inferiority of this regime.

 

Professor Karim Meeran, Imperial College London – For

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Patients with endocrine deficiency need replacement therapy.

We are getting better at making new analogues of replacement hormones that are more patient friendly and improve compliance by lasting longer. Thus for insulin, we have moved away from normal human insulin to analogues of insulin that have variable half-lives, but are a totally different molecule. There is no evidence that the new analogues are any better than native insulin, but production of some preparations of native human insulins have ceased and many of us use these new insulin analogues. Vasopressin is replaced with a modified molecule, 1-desamino-8-D-arginine vasopressin; the D-enantiomer is used (which never occurs in nature) because it lasts longer. The argument in some quarters that “natural” cortisol would be better thus has no basis.

Similarly, rather than give hydrocortisone several times a day, we need to modify the molecule slightly by inserting a double bond, which increases its half-life and potency, and enables once daily administration. A slow release preparation has been developed and costs £400 per month, but it is far better to use a drug that has an appropriate half-life.

We don’t need to develop one because, remarkably, prednisolone has a half-life that is perfect for a once-daily administration. It happens to be extremely cheap, but that should not deter us from using it!

We now have an assay available for prednisolone, and present data at a number of posters at the BES in November confirming that a once-daily dose of prednisolone 3mg is equivalent to hydrocortisone 10mg plus 5mg plus 5mg. I have converted several patients, who regularly report how well they feel on prednisolone 3mg, and how much easier it is to take.

The main reason that patients should take once-daily prednisolone is its convenience. Added benefits for those in the UK are the low price of prednisolone compared to hydrocortisone, which is substantially more expensive in the UK than in other countries because of a peculiar licensing issue, and the fact that the NHS is not allowed to import it.

We have a serious problem in the UK with the cost of hydrocortisone, and every patient who is switched to prednisolone will save over £100 per month.

 

Five reasons to be Tweeting at SfE BES

SfE BES 2015 (RGB)Love it or hate it, Twitter can really help you get more out of your conference. Here are our top five ways, from the Society for Endocrinology communications team. Happy Tweeting! (and don’t forget the hashtag #SfEBES15 !)

1. Meet fellow delegatesTWITTER

It’s networking – but online. Meet that colleague who’s active in your field, or find your next career opportunity, Twitter is a great way to introduce yourself before you meet in person. Continue reading “Five reasons to be Tweeting at SfE BES”

Five tips for applying to medical school

Society member Seb Shaw is probably not your typical medical student. Currently studying for a Masters degree at Brighton and Sussex Medical School, he’s keen to dispel myths and give a little insight into the real world of medicine. Here are his five top tips for applying to med school….

Continue reading “Five tips for applying to medical school”

Women in endocrinology: hints and tips

The latest issue of The Endocrinologist explores some of the issues facing women in endocrinology. As an addendum to her article ‘Addressing the Challenges’, Anna Crown imparts her ‘hints and tips for those in the thick of it’…

Choosing a partner

When I got married, the vicar alluded to a panel on the Bayeux tapestry.  The text states that ‘the bishop comforted the troops’, whilst the illustration shows the bishop with a big pointy spear, prodding the troops out into battle.  This, he said, was a true interpretation of the term ‘comfort’ in the context of marriage; that each partner should encourage the other to take on new challenges.  This is important.  Pick a partner to ‘comfort’ you, but not one who deep down is looking for a ‘traditional wife’ (whatever their protestations). Continue reading “Women in endocrinology: hints and tips”