Professor Greet Van den Berghe is the head of the clinical department and laboratory of Intensive Care Medicine at KU Leuven University and its University Hospitals in Belgium. The Leuven Clinical Intensive Care department is a large, tertiary referral centre treating over 3,100 patients per year. She is also Professor of Medicine at KU Leuven and actively researches the endocrinology and metabolism of critical illness. Here she tells about her career, research and how important it is to break boundaries and challenge classical ideas in the pursuit of better patient care.
Tell us a little about your career path After obtaining my medical degree, I trained in anesthesiology and intensive care, then in biostatistics and later completed a PhD in endocrinology. I followed this path so that I could work at the boundaries of several disciplines, which provided an excellent opportunity to build a multidisciplinary research team and to expand on translational research in endocrinology and metabolism of critical illness, from bed to bench and back.
What inspired you into research? When I was a junior attending physician in the intensive care unit (ICU), I observed that long-stay ICU patients, both children and adults, quickly began to look much older than their chronological age. At the same time they showed endocrine and metabolic abnormalities that mimicked certain characteristic of ‘ageing’. I hypothesised that maybe this ‘accelerated ageing’ phenotype of ICU patients could in part be iatrogenic, and if so, may be preventable. These thoughts formed the basis for my PhD research, in which I demonstrated that dopamine infusion, a drug commonly used at the time for haemodynamic and renal support, was causing an iatrogenic suppression of the anterior pituitary with harmful consequences. Based on these findings the practice of infusing dopamine in the ICU was abandoned.
In my postdoctoral research, we went a step further and identified biphasic neuroendocrine and metabolic responses to acute and prolonged critical illness in both patients and animal models. This research clarified many earlier, apparent paradoxes and provided the basis for our later work that focused on the acute and long-term harmful impact of hyperglycemia, the early use of parenteral nutrition and the pathophysiology of the HPA axis response to the stress of critical illness.
What are you proudest of in your career, so far? In 2002, I inherited a very large and well organised clinical intensive care department to chair, upon which I have built research from bed to bench and back again. There was no research in the department when I started, so I had to build everything from scratch. Over the years, this growing symbiosis, between high-level patient care and research, has proved to be very successful. This also allowed me to recruit the best clinicians and scientists who now work effectively together as a very close team.
Together we have made exciting discoveries and we were able to repeatedly close the loop from an original idea triggered by patient care, to basic research in the lab and back to randomized-controlled trials in patients. That is such great fun! So, I am most proud of my team, and grateful to them for making me happy every day!
What do you enjoy most about your work? I enjoy thinking outside the box, creating new ideas by crossing boundaries between classical disciplines, and working with young, enthusiastic physicians and scientists, to generate new knowledge that forms a solid basis for better patient care.
What will you be presenting in your lecture at SfE BES 2021? In my talk, entitled “Re-thinking critical illness induced corticosteroid insufficiency”, I will present novel insights from our recent research on HPA axis changes that occur in response to acute and prolonged critical illness. I will challenge the classical paradigm of stress-induced increased ACTH-driven cortisol production as the basis for increased systemic cortisol availability in severely ill patients. I will also challenge the idea that a short ACTH stimulation test can diagnose failure of this stress response.
To say it with a metaphor: “What you see is not always what you get”.
Any words of wisdom for aspiring endocrinologists? Look further than the boundaries of your own discipline, there is much to be learnt and innovated when you go beyond them!
You can attend Professor Van den Berghe’s Medal Lecture, “Re-thinking critical illness induced corticosteroid insufficiency” on Tuesday 9 November at 18:45.
Dr Julia Prague is a clinical consultant and clinical academic at the Royal Devon and Exeter NHS Trust and University of Exeter. In our interview, she tells us about her clinical practice and research projects, as well as how she thinks endocrine practice will evolve after the COVID-19 pandemic.
Tell us a bit about your current positionand what you enjoy most
As a clinical consultant and clinical academic I split my time almost 50/50 through the week. At the moment, my clinical commitments include outpatient endocrinology, and inpatient endocrinology, diabetes and general medicine. I moved from London to Exeter last year, and one of the big reasons to move was that near 50/50 split between clinical commitments and research. It’s a great balance that gives me time and space, not only to be with the patients, but also to investigate and take forward some of the issues that they bring up in clinic. Forming new collaborations and being in a new unit with new colleagues is pretty exciting too.
Research wise, I’m particularly interested in the menopause through a number of different collaborations. I’m working with the respiratory department on a project looking at lung conditions and sex hormones. Investigating the impact of the menopause in diabetes. I’m also still involved in establishing the role of neurokinin 3 receptor (NK3R) antagonists to treat hot flushes and improve sleep during the menopause.
What got you interested in research on menopause?
Spending hours with the women in our research study of a new treatment for menopausal flushes, and from receiving hundreds of emails from menopausal women wanting to take part. My admiration for them was huge, not least because they so often described themselves as struggling to cope, yet they were the complete opposite of that, meeting endless challenges with amazing fortitude and whilst mostly suffering in silence. To then see them leave misery and suffering behind and find themselves feeling vibrant and human again was rewarding beyond measure.
Furthermore, the majority of women will have menopausal symptoms that impact on all aspects of their daily life, but many will also have co-existing medical conditions before their menopause and these can also be impacted too. Many medical conditions are influenced by the menstrual cycle and that’s an aspect that is under-investigated and I think is really interesting. Inflammatory bowel disease, for example, can fluctuate during the menstrual cycle and Crohn’s disease typically gets better in pregnancy.
Diabetes is also impacted by the menstrual cycle, and it’s the same hormones that are changing during the menopause but this hasn’t been investigated, which is why I’m now interested in this, as this is something patients often report as being a problem for them. I think it’s important to listen to what patients are telling you and then try and investigate why that is, to hopefully find an improved solution for them.
How was your work affected by the COVID-19 pandemic?
I was a Senior Registrar at King’s College Hospital at the height of the first wave, so I became involved in a lot of the management and service re-design work within the diabetes and endocrinology department, including rota management to facilitate re-deployment to general medicine but whilst maintaining a core specialist service and whilst supporting our junior trainees and particularly our international medical graduates who were isolated from their families, and ensuring our patients were supported and aware of sick day rules and had all the medications they needed. Our department was also therefore part of the frontline team. I was the medical registrar on call for the first peak weekend of King’s admissions. Then I got COVID-19 and could not get out of bed/off the sofa for 4 weeks.
I moved to Exeter towards the end of summer 2020 to take up my Consultant job. Since then I have continued to do quite a lot of frontline COVID inpatient medicine. Now we’re involved in recovery and trying to catch up. Many patients couldn’t be seen through the pandemic because resources had to be syphoned off elsewhere.
I never imagined I would interview for my consultant job on Zoom! Moving to a new city, a new department, a new consultant role and a new research role during the pandemic was definitely an interesting twist at such a significant stage of my life and career.
What are you proudest of in your career so far?
My work on menopause and NK3R antagonists – being published in The Lancet was a huge honour, and the potential that this work has to relieve suffering of women is incredible. As a doctor, all you want is to relieve suffering in your patients and this has that opportunity. It’s also given me a platform to continue working in that field and to be invited to speak at international conferences, as well as develop new collaborations.
This drug class are now in phase three studies and it looks like they’re probably going to be marketed from around 2023/2024. This research is still advancing within the pharmaceutical field, butte top-line results coming out continue to show great promise for the therapy. Seeing the NK3R antagonists come to market will be amazing. For me, to have played some part in that will be awesome and to see patients being able to go to clinicians and get that medication prescribed will be great.
There will be far fewer centres doing more complex endocrinology, and the development of this could be guided by some of what we have learnt regarding remote consultations and remote networking during the pandemic.
What do you think are the biggest challenges in endocrinology?
We have to mention COVID recovery, in what was an already overstretched system. However, somewhat linked to that, is the pull of general medicine on our time as endocrinologists. The pandemic has further highlighted this to be an important issue. Hospital inpatient medicine is busy and can’t be cancelled. However, it is essential for recruitment, training, and retention that our specialist time is more protected. The new internal medicine training (IMT) programme will change the number of specialty training years to shorten it, which could have some quite big consequences for the endocrine discipline.
COVID-19 has brought some positives though; it’s highlighted that we can achieve quite a lot remotely with patients using virtual appointments, and some patients prefer fitting their appointments in to their life rather than having to attend the hospital. How this translates going forward though could involve big changes for the specialty.
The Society has become much more inclusive, and far more diverse, with a much broader mix of people, and I think that should really be celebrated and welcomed.
What do you think will be the major changes in the future of endocrinology?
I think there will continue to be a drive for a smaller number of national centres of excellence in endocrinology. There will be far fewer centres doing more complex endocrinology, and the development of this could be guided by some of what we have learnt regarding remote consultations and remote networking during the pandemic. That will be good for patients overall but the downside could be that there will be a smaller number of centres with specialist services, which means that staff may have less involvement in specialist endocrinology. A lot of these changes will be driven by the GIRFT recommendations, which will affect how all services are delivered going forward.
What challenges do you see for your research?
Availability of funding will be critical. COVID has had an impact on available funding but so has Brexit, there’s now a lot of European grants that UK researchers will not be eligible for. Universities have less money because they’ve had fewer students and international students may think differently about studying in the UK post-Brexit and post-pandemic. Charities that fund research have also been hit as many of their fundraising activities were suspended during the COVID restrictions. The Government has a significant financial deficit to address. Availability of research funding was already challenging but it’s going to be even more difficult in the years to come. It’s usually funding that restricts research activity rather than a lack of ideas or collaborations.
How would you like to see the Society develop?
My overwhelming memory of attending my first Society meetings in 2006/2007 is of a lot of senior white men wearing tweed jackets! Now every time I come to Society meetings it’s such a stark change from that. Everything that the Society has done, and is doing, to make itself more reflective of everyone within it is really important. Recruiting the next generation is also a huge part of that, and it is great to also see more focus on this now than then too. The Society has become much more inclusive, and far more diverse, with a much broader mix of people, and I think that should really be celebrated and welcomed.
That level of change takes time and effort and over the years I’ve tried to play some part in helping to make the Society a more different place to the one that I initially knew.
As a Leadership and Development Awardee I was really looking forward to SfE BES 2020 as we were going to be paired with award lecturers, and it is also always a great opportunity to catch up with friends, previous colleagues, and previous as well as potential new collaborators. But of course, that didn’t happen. I’ve just been finding my feet as a new consultant and researcher in a new city but being an Awardee has opened up other opportunities. I’ve been involved in discussions with an external organisation exploring new collaborations and identifying our shared goals and objectives that we could achieve together. I’m sure that being an Awardee has helped me be offered these opportunities.
Who have you been most inspired by?
Prof John Wass, obviously, but I have also been very lucky to have amazing clinical and research mentors. From the literal beginning to the end of my clinical training and beyond (now over 15 years!) with Dr Simon Aylwin at King’s and Dr Roderick Clifton-Bligh in Sydney. I also learnt a lot from Prof Waljit Dhillo whilst doing my PhD at Imperial.
Why do you love endocrinology?
The balance of the acute and long-term follow up of patients, and the importance of making the right diagnosis for patients based on their history, examination and targeted investigation. Many patients with endocrine conditions go undiagnosed or misdiagnosed for a long time, so when you make the right diagnosis and instigate the right treatment, they feel and do so much better and you often see it unfold in front of you. As endocrinologists we are also part of a much wider multidisciplinary team, which is great.
Any words of wisdom for aspiring endocrinologists?
I’ve always tried to be involved with the Society in recruiting the next generation. It’s important that they get to see the ‘real’ endocrinology and diabetes because often, those rotation attachments are mostly inpatient general medicine.
My advice would be to try to get to clinic as much as possible because a lot of our patients are outpatients, and also to go and review specialty patients on the wards when they are admitted. Remember also that there’s lots of different sub-specialties within endocrinology (and diabetes) so there is a place for everyone and an opportunity to be involved in the areas that you find most interesting/rewarding.
Don’t let yourself be put off by the general medicine component or thinking that it’s all diabetic feet! I also always recommend going to SfE BES, it’s a really good platform for meeting other clinicians and scientists involved in the field, and hearing about the patients that we look after. Get involved, come along and see what the specialty really has to offer.
We are keen to reflect the diversity and breadth of our discipline by hearing from members across all backgrounds, career stages, career types and geographical locations, to get a true flavour of the range of views, needs and challenges faced by our Society members.
…The public have the right (and duty, some may say) to engage with science and medicine.
…Public engagement gives your work real-world context and a fresh perspective on what you do.
…If you are applying for funding, get ready to demonstrate your involvement with the public.
The many reasons why you should engage with the public have been listed and discussed plenty of times, so you already know what it’s about. You know it’s essential; you know it’s not just about communicating science, but about having a conversation; you know your audience has a voice and an active role to play – they’re not just spectators.
However, finding the time to dedicate to public engagement is no easy endeavour – even less so considering your already crammed schedule. Besides, interacting with school children and families at a science festival is not everybody’s cup of tea, and the risk of being forced into it can make your public engagement efforts become a ‘tick-box activity’.
But here’s the good news – public engagement comes in many more shapes than you may think. There’s a plethora of sometimes quirky, always wonderful initiatives out there to exemplify that engagement can take fascinating formats.
Even better news for those with overloaded schedules – sometimes it may be more effective to reach your audience remotely, which may allow more flexibility and make your life a little easier! In many cases your target audience won’t be the science fair type, after all, and picking the right medium to engage them is tightly related to the kind of audience they are. Ask yourself – how old are they? Where do they hang out, on- and off-line? What are their interests and motivations? What does their day-to-day life look like? Consideration of these factors is crucial before you embark on any public engagement journey!
Without further ado, here is a list of formats that showcase the many faces of public engagement…
Let your imagination be sparked!
At schools, colleges, community groups or science / family festivals. A well-known public engagement format for science and medicine, and no wonder – this can be a most gratifying way to participate. Contrary to what some think, people do want to know about your work and can be extremely engaged – you just need to find a way to tap into the curiosity of your particular audience.. Again, there is no one-size-fits-all. You could design an activity or inspire a crowd just by talking about your own journey in STEM and medicine.
At a music festival, your local mall, the pub or other unlikely places. By taking your activity to a place where people would not expect you can reach very different audiences, and can add an extra layer of fun to public engagement. Guerrilla Science managed to engage festival-goers at Glastonbury by challenging them to prove themselves smarter than a rat.
At your own workplace. Instead of taking your experience and activities elsewhere, you could invite people to take part in an immersive experience at your institution. Organise a one-off careers event or even start a sustained engagement scheme between your institution and a selection of people. This gives them a chance to see what’s going on behind the scenes and have a feel of the day-to-day life of doctors, nurses or scientists.
Through public dialogue. As defined by the Research Council UK, public dialogue is a deliberative participatory engagement where the outcomes are used to inform decision-making. An example of this may be organising a focus group with patients in order to decide what the next step of your research should be. These initiatives can go really far –patients can even become the researchers!
Through broadcast media. Whether it’s an appearance on a TV, radio show or a podcast, this can be an effective way to reach out to the public. Your audience can participate by phone or social media, or there could be an associated event to enable them to have their say. Need tips on how to do TV or to work with journalists effectively? The Society can support you and point you in the right direction for training and useful resources.
Through written word. If you are a keen writer and enjoy the creativeness of the process you can apply those skills to engage your audience by telling them about your work. Write a blog or become a contributor for a website or magazine and spark a conversation with and amongst your readers.
Through art. Art and science aren’t opposites – they are both driven by curiosity, require creativity and both aim to gain a better understanding of the world. Collaborations between science and the arts range from films, theatre and exhibitions to dance, storytelling, comics and stand-up comedy.
Creating a resource. If you have the creative drive and the crafting skills but define yourself as a ‘behind the scenes’ sort of person, why not creating materials or activities for other people to use? Board games, mobile apps, activities for science festivals – you name it!
Public engagement isn’t easy, but that doesn’t make it dreadful, inconvenient or disruptive. Rather, your challenge lies in approaching it creatively. If you have a passion for what you do, there will be a way to channel it into a public engagement activity – you just need to find the right fit for you and your public!
Aida de Heras, Society for Endocrinology Communications Executive.
The Society for Endocrinology is committed to public engagement by offering members training opportunities, public engagement resources and opportunities to get involved.
This year, I was lucky enough to attend my first parliamentary links day. The largest science event in the Houses of Parliament, this day is held to promote dialogue between parliament and the scientific community. Given the vote to leave the EU less than a week earlier, it couldn’t have been a more interesting time to attend!
The scientific community directly benefit from the EU in terms of funding, collaboration and free movement of people. It was therefore no surprise that this year’s event saw the biggest attendance in history. The event, opened by John Bercow MP (Speaker of the House of Commons), involved opening remarks from Jo Johnson (Minister for Universities and Science) and Nicola Blackwood (Chair of the Science and Technology Select Committee). Two panels then followed, and then final speeches were given by Lord O’Neill of Gately, Sir Venki Ramakrishnan, and Stephen Metcalfe MP. Bewildered scientists filled the room, all anxious about their now uncertain future, and all speakers tried their best to reassure us.
‘Nothing has changed overnight in legal terms’ said Jo Johnson. MPs agreed that we have a strong country with a resilient history, and are able to pull through. Our science in particular they say is world class, and this can be used to help in our recovery. Many speakers told of reassurance from abroad, recognising the work we do and that they want to continue collaborating. These academic networks can therefore provide an alternative to the political networks, and help to smooth waters. So the message was one of hope and determination, despite the disappointment.
All emphasised that we now need to shout loud to ensure that science is prominent in the negotiations and in particular that the government maintain our overall investment in science. MPs assured us that they will do their best to fight for these things, and they said that we also need to send out the message to connections and networks across the world, that despite this decision Britain is a willing collaborator and welcoming society. Finally, they asked us to think about what we can learn. Although leaving the EU would clearly be bad for science, half of the public still responded with the leave vote. This suggests that science is not important to them, so what can we do now to convince people that science is worth investing in?
I will always remember this day at such an important time in British history. After all the hope given I look forward to seeing what the future holds for UK science!
Amber Abernethie is in the second year of her PhD in Cardiovascular Biology. She is based at the Queens Medical Research Centre (University of Edinburgh) but is originally from Cleethorpes, England.
Following the referendum result on the UK’s membership of the European Union (EU) the Society for Endocrinology urges the UK government to ensure that free movement of students, researchers and clinicians between the UK and other EU countries and full access to, and participation in, the EU research infrastructure is preserved. We strongly believe that the free movement of labour is essential to the delivery of care within the National Health Service (NHS) and to ensure that the UK continues to be a world leader in international scientific research. The full statement is available on our website.
Next Tuesday, Liverpool John Moores University will host a public awareness day on anti-doping in sport, aimed predominantly at high school students, their teachers and practising coaches. In this post, Professor Graeme Close explains why it’s important to get an anti-doping message out to schools. The event is supported by a Society for Endocrinology public engagement grant.
Athletes who dope fall into two broad categories. Firstly, those who believe that it is not possible to be successful in their sport without using performance enhancing drugs and secondly those who accidentally take contaminated supplements or over-the-counter medication that contains prohibited substances. Without doubt, the best way to tackle both of these mistakes is by effectively educating athletes in schools before mistakes are made. In wake of recent doping scandals, this Society for Endocrinology sponsored event is not only timely but essential to promote clean sport.
We want attendees to think about why athletes do not need to dope in sport. We will cover the science of muscle mass and strength increases, which is very poorly understood. Many junior athletes believe that the only way to increase lean mass is to use sports supplements and/or take prohibited substances. In reality, this goal can be achieved through correct nutrition and optimisation of training plans. The problem is that many people do not understand how to eat and how to train to gain muscle mass and as such their training is often ineffective.
It is important to tell the truth about sports supplementation. There is currently a trend that you either have to join a “no-supplement” or “pro-supplement” team and there is no place for a balanced opinion. The reality is that there are a handful of supplements that may be beneficial if taken at the right time. If we are truthful with our education, athletes will come to qualified people for advice, such as nutritionists on the Sport and Exercise Nutrition register (SENr). In contrast, if we have a blanket no-supplement policy the danger is that athletes may take the matter into their own hands and take supplements that not only do not work but more worryingly have not been tested for contaminants.
As sport scientists, it is our moral and ethical duty to educate athletes on doping. It is crucial that respected practitioners and academics provide appropriate education with regards to anti-doping. As well as facing a potential lifetime ban from sport, there are many dangerous consequences of taking performance enhancing drugs such as cardiac damage and mental health problems. There are even fatalities following the misuse of drugs in sport.
The event we are hosting at LJMU will include highly experienced researchers and practitioners who support some of the world’s greatest athletes, as well as top level athletes themselves. In addition, the Rugby Football Union and UK Anti-Doping will be present to help us reach out to kids more effectively.
We hope that this is the first of many such educational days and that the students, teachers and coaches will leave the event feeling inspired and motivated to commit to a future of clean sport.
Public engagement grantshave been developed to help Society members and public engagement professionals (non-members) organise and deliver outreach activities, aimed at school children and/or the general public, to communicate the science of endocrinology. Find out how to apply for a public engagement grant on the Grants page of our website.
In our last public engagement post, we shared a simple How-To graphic for one of our most successful public engagement activities. Now, it’s time to see another:
Introducing: The Hormone Card Game
This is a great (and simple!) activity to use at science fairs, open days or even careers fairs.
Create a set of 10 cards – 5 of them show the name of a hormone, and the other 5 show a description of the function of each hormone. We printed ours on A4 card. When the cards have then been shuffled, participants have the task of matching each hormone to its correct function. For extra help, you can add clues to the back of the hormone cards – if the participants are unsure, they can turn over for a helpful hint.
Finally, what’s really great about this activity is that it provides an easy and engaging springboard for discussing hormones in a little more detail. Have a look below to see how it works:
Every year, an average of around 30 people in England and Wales die from adrenal crisis, undertreated or undiagnosed Addison’s Disease*.
Because of this the Addison’s Disease Self Help Group (ADSHG) teamed up with the Society for Endocrinology, which provided the kick-start funding for a how-to guide on giving an emergency hydrocortisone self-injection – an injection which could have saved some of those lives.
The aim was simple: to produce a series of short video clips which would give people with Addison’s – as well as their friends, family, school or work first-aiders – the knowledge and confidence to administer the injection correctly, using any of the available drug formulations. The charity was fortunate to have the close support and involvement of one of the UK’s leading adrenal specialists, Professor John Wass, who explains when it is necessary to give an emergency injection. You can find all videos on the ADSHG website. Below, watch when to give an emergency injection.
Above video: Adrenal crisis: when to give an emergency injection from Addisons Disease Self-Help Group video hub. Interview with Professor John Wass, Addison’s Clinical Advisory Panel Chair.
We hope that this education tool will not only save lives and reduce the length of hospital stays, but improve the confidence of those with Addison’s, helping them to maintain independence and overall quality of life. It pays to be prepared!
Patient Support Grant
Thanks to the Society for Endocrinology Patient Support Grant, funding was provided to begin the production of these life-saving videos. These grants assist small charities and patient support groups who work with endocrine-related conditions, and aim to fund projects directly benefitting patients.
The deadline for 2016 grant applications is now closed, but you can read more about the grant here, and start planning your application for 2017! We would love to hear from you in our quest to support patients.
Last week was the Big Bang Fair 2016, and we were there in force at the NEC, Birmingham with our banners and our many, many test tubes of fake blood. And the crowds? They were BIG.
The aim of the game was to do exactly what our slogan said – Let’s Talk About Hormones! Over the next few posts, we’re going to tell you exactly how we did this, starting with this simple step-by-step instruction sheet for our most popular public engagement activity.