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Julian H. Barth - One of the best experts on this subject based on the ideXlab platform.
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An evidence-base for Laboratory Endocrinology?
The Clinical biochemist. Reviews, 2008Co-Authors: Julian H. BarthAbstract:“Deficiencies in how research studies are reported are both well-documented and widespread across all medical specialties and study designs. Although randomised trials have received the most attention in this regard, similar concerns have been expressed about reporting of other types of research including diagnostic and epidemiological studies.”1 The use of evidence-based methods in clinical medicine has permitted considerable clarity in clinical studies and, despite the detractors of Evidence-Based Medicine (EBM), it is now possible to read research papers and decide whether, or not, they are applicable to a particular clinical scenario. A typical design might be a series of patients with a particular symptom complex who are randomised to receive different therapies; and assuming the study is sufficiently powered then the therapies can be compared. The intervention in question could be a diagnostic test and study designs have been created which allow for comparison of different diagnostic tests and strategies.2 Unfortunately their application in Endocrinology has not been widely used. Critical analysis of diagnostic procedures should be part of Laboratory Endocrinology since the diagnosis and management of patients with endocrine disorders is underpinned by Laboratory testing. However, whilst endocrine therapies are subjected to the full panoply of clinical trial methodology followed by intensive interrogation with meta-analyses, Laboratory testing is lagging behind and is accepted on a largely observational basis on selected subjects. Regrettably, there is even a move to lower the diagnostic standards in the clinical arena by attempts to simplify Laboratory investigation. Examples include the preference for glycated haemoglobin rather than an oral glucose tolerance test to diagnose diabetes3 and IGF1 rather than stimulation tests for growth hormone deficiency. These proposals are controversial and have been made despite some indication that they deliver lesser diagnostic performance. A further more demanding problem facing the development of evidence-based endocrine diagnostics is the relative rarity of some disorders e.g. Cushing’s, acromegaly, as well as the lack of clearly defined clinical “gold standards” e.g. Cushing’s, growth hormone deficiency and polycystic ovary syndrome (PCOS) which are discussed below. The problems behind an evidence-based approach to Laboratory diagnostics can be clearly illustrated by the components of a typical dynamic test used to diagnose growth hormone deficiency. These consist of 1) a variety of protocols and 2) secretagogues, 3) a variable biological response to stimulation, 4) a multiplicity of assays which differ in antibody specificity and standards and 5) finally the variability in clinical interpretation. The uncertainty produced by a combination of these factors has led to a lack of confidence in growth hormone testing that has induced a group of leading Paediatric Endocrinologists to resort to measurement of growth velocity (auxology) rather than provocative testing!4 However, prior to considering the design of investigative protocols, it is appropriate to consider the variables relevant to the analytical process. These include a number of pre- and post-analytical as well as analytical issues. Many of these aspects of the diagnostic process are fundamental and without a solution may destroy the evidence-base for Laboratory Endocrinology.
Nikhil Tandon - One of the best experts on this subject based on the ideXlab platform.
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Perceptions about Training during Endocrinology Residency Programs in India over the Years: A Cross-sectional Study (PEER India Study).
Indian Journal of Endocrinology and Metabolism, 2017Co-Authors: Deepak Khandelwal, Deep Dutta, Rajiv Singla, Vineet Surana, Sameer Aggarwal, Yashdeep Gupta, Sanjay Kalra, Rajesh Khadgawat, Nikhil TandonAbstract:Background: Residents' perception on quality of Endocrinology training in India is not known. This study aimed to evaluate the perceptions about Endocrinology residency programs in India among current trainees as compared to practicing endocrinologists. Methods: Trainees attending a preconference workshop at the annual conference of Endocrine Society of India (ESI) were given a questionnaire designed to evaluate their perceptions on their training. These evaluated the reasons for choosing Endocrinology, their experiences during residency, and career plans. Practicing endocrinologists attending ESICON with at least 5-year experience were evaluated as controls. Results: Questionnaires from 63 endocrine trainees and 78 practicing endocrinologists were analyzed. Endocrinology is perceived to be the super-specialty with the best quality of life (QOL) but fair with regard to financial remuneration. Among current trainees, 61.89%, 31.74%, and 34.91% are satisfied with training in clinical Endocrinology, Laboratory Endocrinology, and clinical/translational research, respectively. The corresponding figures for practicing endocrinologists are 71.78%, 25.63%, and 30.75%, respectively. Exposure to national Endocrinology conferences during their Endocrinology residency was adequate. However, exposure to international Endocrinology conferences, research publications, project writing, and grant application are limited. Laboratory Endocrinology is rated as the most neglected aspect during endocrine residency. Most of the trainees want to establish their own clinical practice in the long run. Very few trainees (17.46%) wish to join the medical education services. Conclusion: There is a good perception of QOL in Endocrinology in spite of average financial remuneration. There is dissatisfaction with the quality of training in Laboratory Endocrinology and clinical research. Very few endocrine trainees consider academics as a long-term career option in India.
Deepak Khandelwal - One of the best experts on this subject based on the ideXlab platform.
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Perceptions about Training during Endocrinology Residency Programs in India over the Years: A Cross-sectional Study (PEER India Study).
Indian Journal of Endocrinology and Metabolism, 2017Co-Authors: Deepak Khandelwal, Deep Dutta, Rajiv Singla, Vineet Surana, Sameer Aggarwal, Yashdeep Gupta, Sanjay Kalra, Rajesh Khadgawat, Nikhil TandonAbstract:Background: Residents' perception on quality of Endocrinology training in India is not known. This study aimed to evaluate the perceptions about Endocrinology residency programs in India among current trainees as compared to practicing endocrinologists. Methods: Trainees attending a preconference workshop at the annual conference of Endocrine Society of India (ESI) were given a questionnaire designed to evaluate their perceptions on their training. These evaluated the reasons for choosing Endocrinology, their experiences during residency, and career plans. Practicing endocrinologists attending ESICON with at least 5-year experience were evaluated as controls. Results: Questionnaires from 63 endocrine trainees and 78 practicing endocrinologists were analyzed. Endocrinology is perceived to be the super-specialty with the best quality of life (QOL) but fair with regard to financial remuneration. Among current trainees, 61.89%, 31.74%, and 34.91% are satisfied with training in clinical Endocrinology, Laboratory Endocrinology, and clinical/translational research, respectively. The corresponding figures for practicing endocrinologists are 71.78%, 25.63%, and 30.75%, respectively. Exposure to national Endocrinology conferences during their Endocrinology residency was adequate. However, exposure to international Endocrinology conferences, research publications, project writing, and grant application are limited. Laboratory Endocrinology is rated as the most neglected aspect during endocrine residency. Most of the trainees want to establish their own clinical practice in the long run. Very few trainees (17.46%) wish to join the medical education services. Conclusion: There is a good perception of QOL in Endocrinology in spite of average financial remuneration. There is dissatisfaction with the quality of training in Laboratory Endocrinology and clinical research. Very few endocrine trainees consider academics as a long-term career option in India.
Sameer Aggarwal - One of the best experts on this subject based on the ideXlab platform.
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Perceptions about Training during Endocrinology Residency Programs in India over the Years: A Cross-sectional Study (PEER India Study).
Indian Journal of Endocrinology and Metabolism, 2017Co-Authors: Deepak Khandelwal, Deep Dutta, Rajiv Singla, Vineet Surana, Sameer Aggarwal, Yashdeep Gupta, Sanjay Kalra, Rajesh Khadgawat, Nikhil TandonAbstract:Background: Residents' perception on quality of Endocrinology training in India is not known. This study aimed to evaluate the perceptions about Endocrinology residency programs in India among current trainees as compared to practicing endocrinologists. Methods: Trainees attending a preconference workshop at the annual conference of Endocrine Society of India (ESI) were given a questionnaire designed to evaluate their perceptions on their training. These evaluated the reasons for choosing Endocrinology, their experiences during residency, and career plans. Practicing endocrinologists attending ESICON with at least 5-year experience were evaluated as controls. Results: Questionnaires from 63 endocrine trainees and 78 practicing endocrinologists were analyzed. Endocrinology is perceived to be the super-specialty with the best quality of life (QOL) but fair with regard to financial remuneration. Among current trainees, 61.89%, 31.74%, and 34.91% are satisfied with training in clinical Endocrinology, Laboratory Endocrinology, and clinical/translational research, respectively. The corresponding figures for practicing endocrinologists are 71.78%, 25.63%, and 30.75%, respectively. Exposure to national Endocrinology conferences during their Endocrinology residency was adequate. However, exposure to international Endocrinology conferences, research publications, project writing, and grant application are limited. Laboratory Endocrinology is rated as the most neglected aspect during endocrine residency. Most of the trainees want to establish their own clinical practice in the long run. Very few trainees (17.46%) wish to join the medical education services. Conclusion: There is a good perception of QOL in Endocrinology in spite of average financial remuneration. There is dissatisfaction with the quality of training in Laboratory Endocrinology and clinical research. Very few endocrine trainees consider academics as a long-term career option in India.
Rajesh Khadgawat - One of the best experts on this subject based on the ideXlab platform.
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Perceptions about Training during Endocrinology Residency Programs in India over the Years: A Cross-sectional Study (PEER India Study).
Indian Journal of Endocrinology and Metabolism, 2017Co-Authors: Deepak Khandelwal, Deep Dutta, Rajiv Singla, Vineet Surana, Sameer Aggarwal, Yashdeep Gupta, Sanjay Kalra, Rajesh Khadgawat, Nikhil TandonAbstract:Background: Residents' perception on quality of Endocrinology training in India is not known. This study aimed to evaluate the perceptions about Endocrinology residency programs in India among current trainees as compared to practicing endocrinologists. Methods: Trainees attending a preconference workshop at the annual conference of Endocrine Society of India (ESI) were given a questionnaire designed to evaluate their perceptions on their training. These evaluated the reasons for choosing Endocrinology, their experiences during residency, and career plans. Practicing endocrinologists attending ESICON with at least 5-year experience were evaluated as controls. Results: Questionnaires from 63 endocrine trainees and 78 practicing endocrinologists were analyzed. Endocrinology is perceived to be the super-specialty with the best quality of life (QOL) but fair with regard to financial remuneration. Among current trainees, 61.89%, 31.74%, and 34.91% are satisfied with training in clinical Endocrinology, Laboratory Endocrinology, and clinical/translational research, respectively. The corresponding figures for practicing endocrinologists are 71.78%, 25.63%, and 30.75%, respectively. Exposure to national Endocrinology conferences during their Endocrinology residency was adequate. However, exposure to international Endocrinology conferences, research publications, project writing, and grant application are limited. Laboratory Endocrinology is rated as the most neglected aspect during endocrine residency. Most of the trainees want to establish their own clinical practice in the long run. Very few trainees (17.46%) wish to join the medical education services. Conclusion: There is a good perception of QOL in Endocrinology in spite of average financial remuneration. There is dissatisfaction with the quality of training in Laboratory Endocrinology and clinical research. Very few endocrine trainees consider academics as a long-term career option in India.
