1
|
Lafontaine N, Brown SJ, Perros P, Papini E, Nagy EV, Attanasio R, Hegedüs L, Walsh JP. Use of thyroid hormones in hypothyroid and euthyroid patients: A survey of members of the Endocrine Society of Australia. Clin Endocrinol (Oxf) 2024; 100:477-485. [PMID: 38462996 DOI: 10.1111/cen.15049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 02/23/2024] [Accepted: 02/27/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVE Hypothyroidism is a common endocrine condition usually managed with levothyroxine (LT4). However, controversy remains around the use of liothyronine (LT3). We aimed to investigate the practices of Australian endocrinologists when managing patients with hypothyroidism, their use of LT3 + LT4 combination therapy and use of thyroid hormones in euthyroid patients. DESIGN AND PARTICIPANTS Members of the Endocrine Society of Australia (ESA) were invited to participate in an online questionnaire. MEASUREMENTS We analysed questionnaires that had complete demographic data. RESULTS Eighty-seven questionnaires fulfilled the criteria. LT4 was used as first line treatment for hypothyroidism by all respondents. Only 45% reported that their patients were dispensed the brand of LT4 that they recommend. LT3 (alone or in combination) was prescribed by 44% in their clinical practice. Although 49% of respondents would consider LT3 + LT4 in patients with normal TSH who had ongoing symptoms of hypothyroidism, the inability of LT4 to restore normal physiology was ranked the least likely explanation for persistent symptoms and only 32% would consider it for themselves if they were diagnosed with hypothyroidism. The majority (55%), in accordance with evidence, would not prescribe thyroid hormone to euthyroid individuals but 39% would consider use in euthyroid female infertility with high levels of thyroid antibodies and 11% in euthyroid patients with a simple goitre growing over time. LT4 use in pregnancy was variable among members. CONCLUSIONS Australian endocrinologists mostly follow international guidelines when prescribing thyroid hormone therapy and many prescribe combination LT3 and LT4 therapy, particularly for patients who remain symptomatic on LT4 monotherapy. Prescribing practices are largely similar to other countries who have completed similar questionnaires.
Collapse
Affiliation(s)
- Nicole Lafontaine
- Medical School, University of Western Australia, Perth, Australia
- Department of Endocrinology & Diabetes, Sir Charles Gairdner Hospital, Perth, Australia
| | - Suzanne J Brown
- Department of Endocrinology & Diabetes, Sir Charles Gairdner Hospital, Perth, Australia
| | - Petros Perros
- Institute of Translational and Clinical Research, Newcastle University, Newcastle upon Tyne, UK
| | - Enrico Papini
- Department of Endocrinology and Metabolism, Ospedale Regina Apostolorum, Rome, Italy
| | - Endre V Nagy
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Roberto Attanasio
- Italian Association of Clinical Endocrinologists Scientific Committee, Milan, Italy
| | - Laszlo Hegedüs
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
| | - John P Walsh
- Medical School, University of Western Australia, Perth, Australia
- Department of Endocrinology & Diabetes, Sir Charles Gairdner Hospital, Perth, Australia
| |
Collapse
|
2
|
Khee GY, Lim PS, Chan YL, Lee PC. Collaborative Prescribing Practice in Managing Patients Post-Bariatric Surgery in a Tertiary Centre in Singapore. Pharmacy (Basel) 2024; 12:31. [PMID: 38392938 PMCID: PMC10893196 DOI: 10.3390/pharmacy12010031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/29/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024] Open
Abstract
Background: A collaborative prescribing (CP) practice model, established by the endocrinologists, pharmacists, and advanced practice nurses, aims to provide for the postoperative monitoring and medical and nutritional management of stable patients after bariatric surgery. Method: Under the CP agreement, endocrinologists refer patients who have undergone bariatric surgery with stable medical conditions to CP practitioners, comprising senior pharmacists and advanced practice nurses. CP practitioners review the patient's weight loss progress, blood test results and vitals, the sufficiency of micronutrient repletion, adherence to supplements and medications, and chronic disease control. CP practitioners can prescribe and adjust the medications and supplements, in accordance with a clinical evaluation and standard guidance. Patients who require immediate attention due to complications or red flags are referred to the primary endocrinologist for further management. Results: From 5 May 2020 to 30 September 2023, CP practitioners provided 672 consultations. At least 68% and 80% of patients achieved appropriate weight loss post-surgery during the acute and maintenance phases, respectively. Less than 10% of the patients presented with anaemia and iron deficiency, and vitamin B12, folate and vitamin D deficiency. More than 80% of patients achieved a HbA1c of less than 7%. Conclusions: The CP practice framework provides a sustainable and viable model to facilitate optimal outcomes after bariatric surgery.
Collapse
Affiliation(s)
- Giat Yeng Khee
- Department of Pharmacy, Singapore General Hospital, Singapore 169608, Singapore;
| | - Paik Shia Lim
- Department of Pharmacy, Singapore General Hospital, Singapore 169608, Singapore;
| | - Yoke Ling Chan
- Department of Speciality Nursing, Singapore General Hospital, Singapore 169608, Singapore;
| | - Phong Ching Lee
- Department of Endocrinology, Singapore General Hospital, Singapore 169608, Singapore;
| |
Collapse
|
3
|
Tong T, Zhong LY. Intracranial germ cell tumors: a view of the endocrinologist. J Pediatr Endocrinol Metab 2023; 36:1115-1127. [PMID: 37899276 DOI: 10.1515/jpem-2023-0368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 10/13/2023] [Indexed: 10/31/2023]
Abstract
Intracranial germ cell tumors (iGCTs) are rare malignant neoplasms that mainly affect children and adolescents. The incidence, clinical presentation, and prognosis of iGCTs exhibit high heterogeneity. Previous studies have primarily focused on eliminating tumors, reducing tumor recurrence, and improving survival rates, while neglecting the impact of the tumors and their treatment on neuroendocrine function. Throughout the entire course of the disease, neuroendocrine dysfunction may occur and is frequently overlooked by oncologists, neurosurgeons, and radiologists. Endocrinologists, however, are more interested in this issue and have varying priorities at different stages of the disease. From onset to the diagnostic phase, most patients with iGCTs may present with symptoms related to impaired neuroendocrine function, or even experience these symptoms as their first indication of the condition. Particularly, a minority of patients with sellar/suprasellar lesions may exhibit typical imaging features and elevated tumor markers long after the onset of initial symptoms. This can further complicate the diagnosis process. During the peritumor treatment phase, the neuroendocrine function shows dynamic changes and needs to be evaluated dynamically. Once diabetes insipidus and dysfunction of the hypothalamic-pituitary-adrenal and hypothalamic-pituitary-thyroid axes occur, hormone replacement therapy should be administered promptly to ensure successful tumor treatment for the patient. Subsequently, during the long-term management phase after the completion of tumor treatment, the evaluation of growth and development as well as corresponding hormone replacement therapy are the most concerning and complex issues. Thus, this paper reviews the interest of endocrinologists in iGCTs at different stages.
Collapse
Affiliation(s)
- Tao Tong
- Department of Endocrinology, Beijing Tiantan Hospital, Capital Medical University, Beijing, P.R. China
| | - Li-Yong Zhong
- Department of Endocrinology, Beijing Tiantan Hospital, Capital Medical University, Beijing, P.R. China
| |
Collapse
|
4
|
James KA, Stromin JI, Steenkamp N, Combrinck MI. Understanding the relationships between physiological and psychosocial stress, cortisol and cognition. Front Endocrinol (Lausanne) 2023; 14:1085950. [PMID: 36950689 PMCID: PMC10025564 DOI: 10.3389/fendo.2023.1085950] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/14/2023] [Indexed: 03/08/2023] Open
Abstract
Stress is viewed as a state of real or perceived threat to homeostasis, the management of which involves the endocrine, nervous, and immune systems. These systems work independently and interactively as part of the stress response. The scientific stress literature, which spans both animal and human studies, contains heterogeneous findings about the effects of stress on the brain and the body. This review seeks to summarise and integrate literature on the relationships between these systems, examining particularly the roles of physiological and psychosocial stress, the stress hormone cortisol, as controlled by the hypothalamic-pituitary-adrenal (HPA) axis, and the effects of stress on cognitive functioning. Health conditions related to impaired HPA axis functioning and their associated neuropsychiatric symptoms will also be considered. Lastly, this review will provide suggestions of clinical applicability for endocrinologists who are uniquely placed to measure outcomes related to endocrine, nervous and immune system functioning and identify areas of intervention.
Collapse
Affiliation(s)
- Katharine Ann James
- Applied Cognitive Science and Experimental Neuropsychology Team (ACSENT) Laboratory, Department of Psychology, University of Cape Town, Cape Town, South Africa
- Division of Geriatric Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Juliet Ilena Stromin
- Applied Cognitive Science and Experimental Neuropsychology Team (ACSENT) Laboratory, Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Nina Steenkamp
- Applied Cognitive Science and Experimental Neuropsychology Team (ACSENT) Laboratory, Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Marc Irwin Combrinck
- Division of Geriatric Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
5
|
Zarora R, Simmons D. Effectiveness of Diabetes Case Conferencing Program on Diabetes Management. Int J Integr Care 2023; 23:2. [PMID: 36741969 DOI: 10.5334/ijic.6545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 12/23/2022] [Indexed: 01/27/2023] Open
Abstract
Aims Diabetes case conferencing is where an endocrinologist visits a general practitioner (GP) to advise on the care of patients with diabetes. Past case conferencing studies have reported improved diabetes management and clinical outcomes in primary care. This study investigated the effectiveness of a diabetes case conferencing program in South Western Sydney, Australia. Methods Complex diabetes cases were referred by general practitioners to a visiting endocrinologist for review after obtaining patient consent. The patient was not usually present. After the case discussion, a diabetes management plan was developed jointly by the general practice/specialist team. Clinical data were compared at baseline and each year up to three years (2017-2020) after the consultation using paired t-test. The primary outcome was HbA1c. Results Clinical data were collected for 645/775 patients (mean age 64 ± 15(SD) years; 351 (54.4%) males from 40/43 general practices; 96.4% had type 2 diabetes; 6.5% were insulin treated, 54.3% non-insulin treated, 31.5% both insulin and non-insulin treated and 3.4% diet only. There were reductions in HbA1c by 1.0 ± 1.7% (11 ± 19 mmol/mol) (p < 0.001), systolic blood pressure 8.2 ± 18.1 mmHg (p < 0.001), diastolic blood pressure 2.7 ± 11.6 mmHg (p < 0.001), total cholesterol 0.2 ± 1.7 mmol/l (p = 0.007), low-density lipoprotein 0.2 ± 1.0 mmol/l (p < 0.001), weight 3.3 ± 10.1 kg (p < 0.001) and body mass index (BMI) 1.3 ± 3.5 kg/m2 (p < 0.001). Conclusions Glycaemia, weight and cardiovascular risk factors improved following case conferencing consultations in a primary care setting.
Collapse
|
6
|
McDow AD, Lanzotti N, Zahnd WE, MacKinney EC, Angelos P, Mellinger JD, Ganai S. Impact of Endocrinologist and Surgeon Density on Well-Differentiated Thyroid Cancer Survival. Am Surg 2022; 88:2626-2632. [PMID: 35591793 DOI: 10.1177/00031348221091958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The influence of provider density and access on well-differentiated thyroid cancer (DTC) survival is uncertain. METHODS We used the SEER18 database to study DTC patients undergoing surgery from 2000-2012. County-level endocrinologist and surgeon density were calculated. We evaluated the relationship between provider density and cause-specific survival controlling for demographic, socioeconomic, and treatment characteristics. RESULTS Median endocrinologist density was 1.4/100 000 residents, with 15.5% of patients living in a county with no endocrinologist. Survival increased by 11% for each endocrinologist/100,000 people (P = .007). Median surgeon density was 14.8/100 000 residents, with only 1.7% of patients living in a county with no general surgeon or otolaryngologist. No significant association between surgeon density and survival was identified (P = .06). Rural residence was independently associated with lower survival (P = .009). CONCLUSIONS County-level endocrinologist density is associated with improved DTC survival. Results may reflect endocrinologist expertise, earlier diagnosis, or represent surrogacy for higher county-level access to specialized care.
Collapse
Affiliation(s)
- Alexandria D McDow
- Division of Surgical Oncology, Department of Surgery, 12250Indiana University School of Medicine, Indianapolis, IN, USA
| | - Nicholas Lanzotti
- Stritch, School of Medicine, Department of Urology, 2456Loyola University Chicago, Maywood, IL, USA
| | - Whitney E Zahnd
- South Carolina Rural and Minority Health Research Center, Arnold School of Public Health, 49112University of South Carolina, Columbia, SC, USA
| | - Erin C MacKinney
- Department of Surgery, 5232University of Wisconsin Swedish American Health System, Rockford, IL, USA
| | - Peter Angelos
- Department of Surgery and MacLean Center for Clinical Medical Ethics, 12246University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - John D Mellinger
- Department of Surgery, 12249Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Sabha Ganai
- Department of Surgery, 12281University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
| |
Collapse
|
7
|
Abstract
CONTEXT Diabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent and reduce the risk of long-term complications. It requires an array of investigations to provide an accurate picture of the condition and its management accordingly by a qualified doctor. AIMS This study was conducted to understand the treatment received by type 2 diabetes (T2DM) patients from various categories of health care professionals and awareness about diabetes reversal by lifestyle modification and prevention of complications. SETTINGS AND DESIGN This was a community-based cross-sectional study. SUBJECTS AND METHODS The link of the semi-structured questionnaire in Google form with e-consent was sent to all members in the selected groups of "World free of obesity and diabetes" campaign on their personal WhatsApp account. STATISTICAL ANALYSIS USED A total of 3082 participants were included, and the data obtained were analyzed using SPSS v26. RESULTS The mean age of the participants was 50.26 ± 9.78 years ranging from 18 to 81 years. A total of 35.8% of the study population was diabetic for 1-5 years. A total of 54.9% were started with antidiabetic medication on the same day of diagnosis. Only 1.5% of the patients had complete investigation profile for T2DM, 50.2% of the patients were briefed about hypoglycemia, and only 15.8% of the patients were checked for retinopathy. CONCLUSIONS Most doctors, qualified as well as nonqualified, did not follow the standard guidelines for diagnosis, treatment, and patient education regarding T2DM; therefore, it is necessary to train all medical practitioners regarding these guidelines. Diabetes reversal by lifestyle modification must be prescribed as the first line of treatment in patients with T2DM.
Collapse
Affiliation(s)
- Jagannath V. Dixit
- Department of Community Medicine, Government Medical College, Maharashtra, India
| | - Rashmi S. Kulkarni
- Department of Community Medicine, Government Medical College, Maharashtra, India
| | - Shraddha Y. Badgujar
- Department of Community Medicine, Government Medical College, Maharashtra, India
| |
Collapse
|
8
|
Abstract
OBJECTIVES While growth charts depicting 7 percentile lines for height and weight are useful for healthcare workers and pediatricians, endocrinologists need indication-specific z score cutoffs to plan investigations and treatment. The current Indian charts do not offer lower percentile/z scores (-2.25, -2.5, and -3 z score) lines. Also, increasing prevalence of childhood overweight and obesity necessitates a quick screening of nutritional status without calculations while using the same growth chart. Our objectives were to produce extended and user-friendly growth charts for 0-18-year-old Indian children that depict -2.25, -2.5, and -3 z score height lines in addition to the standard 7 lines and to add a quick BMI assessment tool as an inset. METHODS LMS values from IAP 2015 growth charts (5-18 years) and WHO 2006 MGRS charts (<5 years) were used to generate -2.25, -2.5, and -3 z score height lines (1.2, 0.6, and 0.1 percentiles, respectively) from 0-18 year for boys and girls. These newly generated lines were added to standard 7 (3, 10, 25, 50, 75, 90, 97) percentile lines for height charts. In addition, modified BMI quick screening tool was incorporated as an inset. RESULTS The extended height charts (with 10 lines), standard (7 lines) weight charts, and quick BMI assessment tool are presented in a single unified chart for use by endocrinologists. CONCLUSIONS These charts will help in defining specific height z score cutoffs as well as screen for overweight and obesity without any calculations in Asian Indian children.
Collapse
Affiliation(s)
- Vaman Khadikar
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, India
| | - Anuradha V Khadilkar
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, India
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32 Sassoon Road, 411 001, Pune, India
| | - Nikhil N Lohiya
- Pediatrics, Dr. D Y Patil Medical College Hospital and Research Centre, Pune, Maharashtra, India
| | - Madhura B Karguppikar
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| |
Collapse
|
9
|
Pinardo H, Rubin SJ, Hashemi S, DePietro J, Pearce EN, Ananthakrishnan S, Alexanian SM, Steenkamp DW, Noordzij JP. The use of vitamin D in preventing post-thyroidectomy hypocalcemia: An endocrinologist survey study. Clin Endocrinol (Oxf) 2020; 93:598-604. [PMID: 32469425 DOI: 10.1111/cen.14259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/06/2020] [Accepted: 05/08/2020] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To evaluate the use of preoperative vitamin D levels and postoperative vitamin D supplementation among endocrinologists for the prevention of post-thyroidectomy hypocalcaemia. METHODS Endocrinologist members of the American Thyroid Association (ATA) were contacted via email to complete a 21-question survey, which included both questions about demographic information, and preventing and managing postoperative hypocalcaemia after thyroidectomy. Univariate and multivariate analysis was performed to determine the respondents' use of preoperative vitamin D levels, dose and duration of preoperative vitamin D repletion, decision to delay surgery for low vitamin D levels in the case of a benign or malignant disease, and routine prescription of postoperative calcium or vitamin D supplementation. RESULTS 225 endocrinologists who were ATA members responded to the questionnaire. When compared to endocrinologists practicing in other countries, those that practice in the United States were 2.5 times more likely to check preoperative vitamin D levels (95% CI[1.404, 4.535], P = .002), significantly more likely to replete vitamin D deficient patients with high-dose vitamin D (ie ≥50K IU/week), 4.458 times more likely to prescribe prophylactic supplemental calcium (95% CI[2.446, 8.126]; P < .0001) and 3.48 more likely to prescribe supplemental vitamin D (95% CI [1.906, 6.355]; P < .0001). Endocrinologists who have been in practice for >10 years were also 1.915 times more likely to prescribe supplemental vitamin D (95% CI (1.080, 3.395); P = .0263). Physicians that treat >50 thyroidectomy cases/year were 2.083 more likely to recommend a vitamin D repletion duration of >1 month than those that treat ≤50 cases/year ([1.036, 4.190], P = .0395). Lastly, if the patient has low preoperative vitamin D levels, 47.05% of respondents chose to delay surgery in a benign disease, while only 11.61% of respondents would do so in a case of malignant disease. CONCLUSIONS Approximately one-half of surveyed endocrinologists reported using preoperative vitamin D levels to assess a patient's risk for post-thyroidectomy hypocalcaemia. Endocrinologists practicing in the United States, compared to those practicing in other countries, were more likely to both test for preoperative vitamin D levels and to recommend prophylactic post-thyroidectomy calcium and vitamin D supplementation.
Collapse
Affiliation(s)
- Heinrich Pinardo
- Department of Otolaryngology-Head & Neck Surgery, Boston Medical Center, Boston, MA, USA
| | - Samuel J Rubin
- Department of Otolaryngology-Head & Neck Surgery, Boston Medical Center, Boston, MA, USA
| | - Sean Hashemi
- Department of Otolaryngology-Head & Neck Surgery, Boston Medical Center, Boston, MA, USA
| | - Joseph DePietro
- Department of Otolaryngology-Head & Neck Surgery, Boston Medical Center, Boston, MA, USA
| | - Elizabeth N Pearce
- Department of Medicine, Section of Endocrinology, Diabetes, Nutrition & Weight Management, Boston Medical Center, Boston, MA, USA
| | - Sonia Ananthakrishnan
- Department of Medicine, Section of Endocrinology, Diabetes, Nutrition & Weight Management, Boston Medical Center, Boston, MA, USA
| | - Sara M Alexanian
- Department of Medicine, Section of Endocrinology, Diabetes, Nutrition & Weight Management, Boston Medical Center, Boston, MA, USA
| | - Devin W Steenkamp
- Department of Medicine, Section of Endocrinology, Diabetes, Nutrition & Weight Management, Boston Medical Center, Boston, MA, USA
| | - Jacob Pieter Noordzij
- Department of Otolaryngology-Head & Neck Surgery, Boston Medical Center, Boston, MA, USA
| |
Collapse
|
10
|
Abstract
CONTEXT Physician burnout is a national problem that has gained increasing attention among the medical community. Many organizations like the American Medical Association, American College of Physicians, and the National Academy of Medicine are taking action. EVIDENCE ACQUISITION Endocrinologists and other members of the endocrine community are not immune to burnout. Approximately 47% of endocrinologists report feeling burnt out or have experienced symptoms of burnout, and this number is rising. EVIDENCE SYNTHESIS The consequences of burnout include personal factors such as stress, depression, and risk of suicide as well as organizational impacts like decreased quality of care, increased clinical errors, reduced empathy for patients, decreased patient satisfaction, and higher turnover rates, with some physicians leaving practice altogether. Burnout has substantial economic impacts at an organizational level, and high costs are associated with replacing, recruiting, and retraining endocrinologists. Endocrinologists identified feeling a lack of respect from administration, excessive bureaucratic tasks, increased computerization, emphasis on profit that has contributed to loss of control over schedules, and insufficient compensation as top contributors to burnout. One strategy to address burnout is to focus on the promotion of joy in work. Joy in work is guided by 4 key themes: meaning, camaraderie, choice, and equity. Each of these themes can be implemented through cocreating solutions. We discuss how each theme can be addressed among endocrine practices. CONCLUSION Ultimately, initiatives need to be implemented across the endocrinology community to cultivate joy and reduce burnout.
Collapse
|
11
|
Gunawan F, Nassif ME, Partridge C, Ahmad T, Kosiborod M, Inzucchi SE. Relative frequency of cardiology vs. endocrinology visits by type 2 diabetes patients with cardiovascular disease in the USA: implications for implementing evidence-based use of glucose-lowering medications. Cardiovasc Endocrinol Metab 2020; 9:56-9. [PMID: 32537566 DOI: 10.1097/XCE.0000000000000195] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 01/22/2020] [Indexed: 01/14/2023]
Abstract
Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in type 2 diabetes (T2D) patients. Recent cardiovascular outcome trials demonstrated clear cardiovascular benefits of novel classes of glucose-lowering agents. We performed retrospective electronic health record review at two major healthcare systems in the USA to determine the relative frequencies of outpatient encounters (hence prescribing opportunities) that a patient with T2D and CVD had with a cardiologist vs. an endocrinologist over one-year period. Of 109 747 T2D patients, 42.6% had established CVD. The ratio of cardiology-to-endocrinology outpatient encounters was 2.0:1 for all T2D patients, and 4.1:1 for those with T2D and CVD. Because each outpatient encounter provides an opportunity to discuss glucose-lowering medications with cardiovascular benefits, the much greater frequency of cardiology encounters highlights the emerging potential for cardiovascular specialists to influence or even implement evidence-based glucose-lowering therapies, thereby improving cardiovascular outcomes in their T2D patients.
Collapse
|
12
|
Bretherton I, Grossmann M, Leemaqz SY, Zajac JD, Cheung AS. Australian endocrinologists need more training in transgender health: A national survey. Clin Endocrinol (Oxf) 2020; 92:247-257. [PMID: 31845345 DOI: 10.1111/cen.14143] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 12/09/2019] [Accepted: 12/11/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE An increasing number of trans and gender diverse (TGD) individuals are seeking gender-affirming hormone therapy for gender transition. Little is known about the levels of training, experience and confidence of endocrinologists in providing care and lack of training and experience is a potential barrier to individuals seeking appropriate and timely health care. We aimed to assess the level of training and confidence of Australian endocrinologists and trainees in the endocrine management of trans and gender diverse individuals in a representative sample. DESIGN Endocrinologist and trainee members of the Endocrine Society of Australia were invited to participate in an anonymous 14-item survey. Of the 545 members, 147 clinicians (95 adult endocrinologists, 2 paediatric endocrinologists and 50 endocrinology trainees) responded. RESULTS When presented with a scenario regarding commencement of gender-affirming hormone therapy, only 19% felt confident providing clinical care to TGD individuals. Compared to other areas of endocrinology, 75% felt less or not at all confident in commencing hormone therapy in a TGD patient. No training in transgender medicine during medical school or during their endocrinology training was reported by 96% and 60%, respectively. There were significantly higher levels of confidence in all aspects including performing a consultation in those who had previously seen a TGD patient. The desire for more training was high (91%). CONCLUSIONS These results highlight the shortfall in training in TGD health care amongst endocrinologists and show that prior clinical experience is associated with higher levels of confidence. Medical schools and endocrinology fellowship training programmes will need to adapt to meet the increasing demand for quality TGD health services.
Collapse
Affiliation(s)
- Ingrid Bretherton
- Department of Endocrinology, Austin Health, Heidelberg, Vic., Australia
- Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Vic., Australia
| | - Mathis Grossmann
- Department of Endocrinology, Austin Health, Heidelberg, Vic., Australia
- Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Vic., Australia
| | - Shalem Y Leemaqz
- Robinson Research Institute, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Jeffrey D Zajac
- Department of Endocrinology, Austin Health, Heidelberg, Vic., Australia
- Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Vic., Australia
| | - Ada S Cheung
- Department of Endocrinology, Austin Health, Heidelberg, Vic., Australia
- Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Vic., Australia
| |
Collapse
|
13
|
Abstract
Objective To assess the current management of prolactinoma among endocrinologists in China. Methods An online survey of a large sample of endocrinologists was conducted in China. The questionnaire included 21 questions related to controversial issues about the management of prolactinomas. Doctors in the endocrinology department of a university-affiliated hospital or a comprehensive secondary hospital in 12 cities from East, West, South, North and Middle China were surveyed. Results A total of 290 valid questionnaires were collected, and the response rate was 40%. When hyperprolactinemia occurred, 97% of the respondents would test thyroid-stimulating hormone routinely. 22% of the respondents considered that prolactin levels <100 ng/mL exclude the presence of a prolactinoma. Only 9% of the respondents believed that prolactin >250 ng/mL could occur in all the following situations as macroprolactinoma, mircoprolactinoma, macroprolactinemia and drug-induced hyperprolactinemia. Surgery was not recommended by 272 (94%) endocrinologists as the first choice for treating microprolactinomas. 58% and 92% of endocrinologists would start drug treatment for microprolactinomas and macroprolactinomas at diagnosis. 70% and 40% chose to withdraw treatment after 2-3 years of prolactin normalization in microprolactinomas and macroprolactinomas. In case of pregnancy, 57% of the respondents considered bromocriptine as choice for women patients. Drug discontinuation after pregnancy was advocated in 63% and 27% for microprolactinoma and macroprolactinoma. Moreover, 44% of endocrinologists believed that breastfeeding was allowable in both micro- and macroprolactinoma. Conclusion This is the first study to investigate the management of prolactinomas among endocrinologists in China. We found that the current clinical treatment was not uniform. Therefore, it is necessary to strengthen the training of endocrinologists to improve clinical diagnosis and treatment practices.
Collapse
Affiliation(s)
- Lijin Ji
- Division of Endocrinology and MetabolismHuashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Na Yi
- Division of Endocrinology and MetabolismHuashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qi Zhang
- Division of Endocrinology and MetabolismHuashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Shuo Zhang
- Division of Endocrinology and MetabolismHuashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiaoxia Liu
- Division of Endocrinology and MetabolismHuashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hongli Shi
- Division of Endocrinology and MetabolismHuashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Correspondence should be addressed to H Shi or B Lu: or
| | - Bin Lu
- Division of Endocrinology and MetabolismHuashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Correspondence should be addressed to H Shi or B Lu: or
| |
Collapse
|
14
|
Abstract
AIMS To analyze the association between provider, healthcare costs, and glycemic control for patients with diabetes mellitus (DM). MATERIALS AND METHODS This cross-sectional study identified adults with type 1 or 2 DM (T1D, T2D) in the Optum database. The main independent variable was provider (endocrinologist or primary care). Regression analysis compared total medical and pharmacy costs, adjusting for health status and other patient differences, by provider. RESULTS For all patients, HbA1C improvement was greater, and medical costs significantly lower with an endocrinologist rather than a primary care provider. The largest HbA1C improvement (4%) occurred for insulin-dependent patients seen by endocrinologists. Significant medical savings with endocrinologist management occurred within the Medicare Advantage population in every sub-group of patients, with 14% lower costs ($4,767) for patients with T1D, 11% lower costs ($3,160) for patients with macro- and microvascular complications, and 10% lower costs ($2,237) for insulin-dependent patients. Within the commercial insurance population, medical costs were reduced by ≥9% in every sub-group of patients, with a 20% reduction ($8,450) for patients with micro- and macrovascular complications. Overall total costs (medical and pharmacy) were 8% ($1,541) higher for patients receiving endocrinologist rather than primary care, although endocrinologist care resulted in a 9% reduction (-$3,710) in costs for Medicare Advantage patients with T1D. Total medical costs (excluding pharmacy costs) may be a more accurate indicator of costs associated with patients in various stages of DM. LIMITATIONS There was insufficient data to develop risk-adjustment payments for pharmacy costs based on disease severity. The cross-sectional design identifies associations and not cause-effect relationships. CONCLUSION DM management by an endocrinologist was associated with greater HbA1C improvement and significantly lower medical costs. Total costs were higher with an endocrinologist, but for patients with T1D lower costs were seen, ranging from 2-9% regardless of insurance type.
Collapse
Affiliation(s)
- Max Gill
- a Medtronic - Diabetes , Northridge , CA , USA
| | | | - Mona Shah
- a Medtronic - Diabetes , Northridge , CA , USA
| | - Cyrus Zhu
- a Medtronic - Diabetes , Northridge , CA , USA
| | - Howard Lando
- b Medical Specs of Northern VA , Alexandria , VA , USA
| | | |
Collapse
|