Barnsley Hospital

Barnsley, United Kingdom

Barnsley Hospital

Barnsley, United Kingdom

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Jones T.H.,Barnsley Hospital | Jones T.H.,University of Sheffield | Arver S.,Karolinska University Hospital | Behre H.M.,Martin Luther University of Halle Wittenberg | And 8 more authors.
Diabetes Care | Year: 2011

OBJECTIVE - This study evaluated the effects of testosterone replacement therapy (TRT) on insulin resistance, cardiovascular risk factors, and symptoms in hypogonadal men with type 2 diabetes and/or metabolic syndrome (MetS). RESEARCH DESIGN AND METHODS - The efficacy, safety, and tolerability of a novel transdermal 2% testosterone gel was evaluated over 12 months in 220 hypogonadal men with type 2 diabetes and/or MetS in a multicenter, prospective, randomized, double-blind, placebo-controlled study. The primary outcome was mean change from baseline in homeostasis model assessment of insulin resistance (HOMA-IR). Secondary outcomes were measures of body composition, glycemic control, lipids, and sexual function. Efficacy results focused primarily on months 0-6 (phase 1; no changes in medication allowed). Medication changes were allowed in phase 2 (months 6-12). RESULTS - TRT reduced HOMA-IR in the overall population by 15.2% at 6 months (P = 0.018) and 16.4% at 12 months (P = 0.006). In type 2 diabetic patients, glycemic control was significantly better in the TRT group than the placebo group at month 9 (HbA1c: treatment difference, -0.446%; P = 0.035). Improvements in total and LDL cholesterol, lipoprotein a (Lpa), body composition, libido, and sexual function occurred in selected patient groups. There were no significant differences between groups in the frequencies of adverse events (AEs) or serious AEs. The majority of AEs (>95%) were mild or moderate. CONCLUSIONS - Over a 6-month period, transdermal TRT was associated with beneficial effects on insulin resistance, total and LDL-cholesterol, Lpa, and sexual health in hypogonadal men with type 2 diabetes and/or MetS. © 2011 by the American Diabetes Association.


PubMed | Brunel University, Bangor University, Barnsley Hospital, Dalarna University and Northumbria University
Type: | Journal: Health & social care in the community | Year: 2016

The prevalence of urinary incontinence (UI) increases with age and can negatively affect quality of life. However, relatively few older people with UI seek treatment. The aim of this study was to explore the views of older people with UI on the process of seeking help. Older people with UI were recruited to the study from three continence services in the north of England: a geriatrician-led hospital outpatient clinic (n=18), a community-based nurse-led service (n=22) and a consultant gynaecologist-led service specialising in surgical treatment (n=10). Participants took part in semi-structured interviews, which were transcribed and underwent thematic content analysis. Three main themes emerged: Being brushed aside, in which participants expressed the feeling that general practitioners did not prioritise or recognise their concerns; Putting up with it, in which participants delayed seeking help for their UI due to various reasons including embarrassment, the development of coping mechanisms, perceiving UI as a normal part of the ageing process, or being unaware that help was available; and Something has to be done, in which help-seeking was prompted by the recognition that their UI was a serious problem, whether as a result of experiencing UI in public, the remark of a relative, the belief that they had a serious illness or the detection of UI during comprehensive geriatric assessment. Greater awareness that UI is a treatable condition and not a normal part of ageing is needed in the population and among health professionals. Comprehensive geriatric assessment appeared an important trigger for referral and treatment in our participants. Screening questions by healthcare professionals could be a means to identify, assess and treat older people with UI.


Smith C.M.,Barnsley Hospital | Wright N.P.,Sheffield Childrens Hospital | Wales J.K.H.,Sheffield Childrens Hospital | MacKenzie C.,Sheffield Childrens Hospital | And 3 more authors.
Clinical Endocrinology | Year: 2011

Context Increasing numbers of very low birth weight (VLBW) infants are surviving into adulthood because of improvements in neonatal intensive care. Adverse events in early life can have long-term effects through reprogramming of metabolic systems. Objective To determine whether young adult VLBW survivors have abnormalities of skeletal development or endocrine function. Design Cross-sectional, observational, case-control study. Participants Thirty-seven VLBW subjects and 27 healthy controls at peak bone mass (mean age 23). Measurements Differences between cases and controls in body size, body composition, bone mass and bone geometry [assessed by dual-energy X-ray absorptiometry (DXA), hip structure analysis and peripheral quantitative computed tomography (pQCT)], bone turnover [urine N-terminal telopeptide of type I collagen (NTX), serum C-terminal telopeptide of type I collagen (CTX)], aminoterminal propeptide of type I procollagen (PINP) and bone alkaline phosphatase), hormones (sex steroids, IGF-1, PTH and 25-OH vitamin D) and insulin sensitivity (HOMA-IR and oral glucose tolerance testing). Results VLBW subjects had lower bone density at the lumbar spine (5.7%) and femoral neck (8.6%), which persisted after correction for bone size by the estimation of volumetric density (bone mineral apparent density). Urine NTX was higher in VLBW subjects than in controls, but there were no significant differences in other bone turnover markers. VLBW survivors had lower insulin sensitivity (mean INS-30 controls = 57.0, VLBW subjects = 94.3, P < 0.01), but there were no differences in whole body fat mass or truncal fat mass between VLBW subjects and controls. Conclusions Young adult VLBW survivors have reduced bone density for their bone size and reduced insulin sensitivity, which may have significant implications for their risk of fracture and diabetes in later life. © 2011 Blackwell Publishing Ltd.


Stanworth R.D.,Barnsley Hospital | Stanworth R.D.,University of Sheffield | Kapoor D.,Barnsley Hospital | Kapoor D.,University of Sheffield | And 4 more authors.
Clinical Endocrinology | Year: 2011

Summary Objective There is a high prevalence of low testosterone and dyslipidaemia in men with type 2 diabetes. The androgen receptor CAG repeat polymorphism (AR CAG) affects receptor transcriptional activity (the shorter repeats the more sensitive AR) and is associated with androgenic parameters and obesity. This study describes the relationships between testosterone, AR CAG and serum lipids in men with type 2 diabetes. Design and Patients Cross-sectional study of men with type 2 diabetes in a District General Hospital Diabetes Centre. Measurements Correlation between testosterone, AR CAG and serum lipids. Results HDL cholesterol (HDL-C) correlated with total testosterone (TT) (r = 0·251, P < 0·001), bioavailable testosterone (BT) (r = 0·19, P = 0·001), free testosterone (FT) (r = 0·165, P = 0·005) and sex hormone-binding globulin (SHBG) (r = 0·147, P = 0·014). HDL-C did not correlate with oestradiol, but men with the lowest quartile of oestradiol had lower HDL-C compared to highest quartile (P = 0·046). Triglycerides correlated negatively with TT (r = -0·195, P = 0·001), BT (r = -0·148, P = 0·013) and SHBG (-0·14, P = 0·019) but not with FT or oestradiol. Total and LDL cholesterol (LDL-C) correlated negatively with oestradiol (r = -0·121, P = 0·05) but not with testosterone or SHBG. One-way anova testing across four quartiles of AR CAG showed a trend to alteration in HDL-C across groups of AR CAG (P = 0·08). HDL-C was significantly higher in men with the longest AR CAG compared with the shortest (1·19 vs 1·08 mmol/l, P = 0·02). Conclusions Lower testosterone and oestradiol levels in men with diabetes are associated with an adverse lipid profile. Shorter AR CAG is associated with low HDL-C and testosterone. The paradox that HDL-C is associated with low testosterone levels and a more active AR may suggest divergent effect of testosterone on HDL-C via genomic vs nongenomic mechanisms. © 2011 Blackwell Publishing Ltd.


Muraleedharan V.,Barnsley Hospital | Muraleedharan V.,University of Sheffield | Jones T.H.,Barnsley Hospital | Jones T.H.,University of Sheffield | Jones T.H.,Kings Mill Hospital
Clinical Endocrinology | Year: 2014

Epidemiological studies have found that men with low or low normal endogenous testosterone are at an increased risk of mortality than those with higher levels. Cardiovascular disease accounts for the greater proportion of deaths in those with low testosterone. Cancer and respiratory deaths in some of the studies are also significantly more prevalent. Disease-specific studies have identified that there are higher mortality rates in men with cardiovascular, respiratory and renal diseases, type 2 diabetes and cancer with low testosterone. Obesity, metabolic syndrome, type 2 diabetes, cardiovascular disease and inflammatory disorders are all associated with an increased prevalence of testosterone deficiency. Two major questions that arise from these findings are (1) is testosterone deficiency directly involved in the pathogenesis of these conditions and/or a contributory factor impairing the body's natural defences or is it merely a biomarker of ill health and the severity of underlying disease process? (2) Does testosterone replacement therapy retard disease progression and ultimately enhance the clinical prognosis and survival? This review will discuss the current state of knowledge and discuss whether or not there are any answers to either of these questions. There is convincing evidence that low testosterone is a biomarker for disease severity and mortality. Testosterone deficiency is associated with adverse effects on certain cardiovascular risk factors that when combined could potentially promote atherosclerosis. The issue of whether or not testosterone replacement therapy improves outcomes is controversial. Two retrospective studies in men with diagnosed hypogonadism with or without type 2 diabetes have reported significantly improved survival. © 2014 John Wiley & Sons Ltd.


Malkin C.J.,Royal Hallamshire Hospital | Pugh P.J.,Royal Hallamshire Hospital | Morris P.D.,Royal Hallamshire Hospital | Asif S.,Royal Hallamshire Hospital | And 3 more authors.
Heart | Year: 2010

Background: To examine the effect of serum testosterone levels on survival in a consecutive series of men with confirmed coronary disease and calculate the prevalence of testosterone deficiency. Design: Longitudinal follow-up study. Setting: Tertiary referral cardiothoracic centre. Patients: 930 consecutive men with coronary disease referred for diagnostic angiography recruited between June 2000 and June 2002 and followed up for a mean of 6.9±2.1 years. Outcome: All-cause mortality and vascular mortality. Prevalence of testosterone deficiency. Results: The overall prevalence of biochemical testosterone deficiency in the coronary disease cohort using bio-available testosterone (bio-T) <2.6 nmol/l was 20.9%, using total testosterone <8.1 nmol/l was 16.9% and using either was 24%. Excess mortality was noted in the androgen-deficient group compared with normal (41 (21%) vs 88 (12%), p=0.002). The only parameters found to influence time to all-cause and vascular mortality (HR < 95% CI) in multivariate analyses were the presence of left ventricular dysfunction (3.85; 1.72 to 8.33), aspirin therapy (0.63; 0.38 to 1.0), β-blocker therapy (0.45; 0.31 to 0.67) and low serum bio-T (2.27; 1.45 to 3.6). Conclusions: In patients with coronary disease testosterone deficiency is common and impacts significantly negatively on survival. Prospective trials of testosterone replacement are needed to assess the effect of treatment on survival.


Kelly D.M.,University of Sheffield | Jones T.H.,University of Sheffield | Jones T.H.,Barnsley Hospital
Frontiers of Hormone Research | Year: 2014

Testosterone deficiency is highly prevalent in men with cardiovascular disease (CVD) and is associated with an increased mortality. Low testosterone also has an adverse effect on several cardiovascular risk factors, which include insulin resistance, diabetes, dyslipidaemia, central adiposity and endothelial dysfunction. Male gender is a well-recognised risk factor for premature CVD and mortality. The question of whether or not testosterone deficiency is a contributory factor to atherogenesis or merely a biomarker of ill health arises. Animal studies and experiments on isolated cells indicate that many of the mechanisms intimate to the atherosclerotic process are beneficially modulated by testosterone. Epidemiological studies have shown that men with endogenous testosterone levels in the mid-upper normal range have reduced cardiovascular events and mortality compared to those with low or lower range, and with high range testosterone. Testosterone replacement in men diagnosed with hypogonadism where mid-normal range levels are achieved have shown a beneficial effect on several cardiovascular risk factors, cardiac ischaemia, functional exercise capacity and improved mortality. Yet studies where patients were either undertreated or given high-dose testosterone have been associated with an increased risk of cardiovascular-related events. Clinical monitoring and titration of testosterone dose is therefore of paramount importance. © 2014 S. Karger AG, Basel.


Muraleedharan V.,University of Sheffield | Jones T.H.,Barnsley Hospital | Jones T.H.,University of Sheffield
Therapeutic Advances in Endocrinology and Metabolism | Year: 2010

Metabolic syndrome and testosterone deficiency in men are closely linked. Epidemiological studies have shown that low testosterone levels are associated with obesity, insulin resistance and an adverse lipid profile in men. Conversely in men with metabolic syndrome and type 2 diabetes have a high prevalence of hypogonadism. Metabolic syndrome and low testosterone status are both independently associated with increased all-cause and cardiovascular mortality. Observational and experimental data suggest that physiological replacement of testosterone produces improvement in insulin resistance, obesity, dyslipidaemia and sexual dysfunction along with improved quality of life. However, there are no longterm interventional studies to assess the effect of testosterone replacement on mortality in men with low testosterone levels. This article reviews the observational and interventional clinical data in relation to testosterone and metabolic syndrome. © The Author(s), 2010.


Judge S.,Barnsley Hospital | Friday M.,Barnsley Hospital
Journal of Assistive Technologies | Year: 2011

Purpose: "Ambiguous keyboards" and "disambiguation processes" are becoming universally recognised through the popularisation of "predictive text messaging" on mobile phones. As this paper shows, although originating in the AT and AAC fields, these terms and techniques no longer appear to be widely understood or adopted by practitioners or users. The purpose of this paper is to introduce these techniques, discussing the research and theory around them, and to suggest them as AT and AAC strategies to be considered by practitioners and users. Design/methodology/approach: This is a conceptual paper that describes the use of ambiguous keyboards and disambiguation. The hypothesis of the paper is that ambiguous keyboards and disambiguation processes offer potential to increase the efficiency and effectiveness of AAC and should thus be considered further in research and practice. Findings: The two broad methods for removing the ambiguity from the output of an ambiguous keyboard are presented. A summary of the literature around the use of disambiguation processes provided and the use of disambiguation processes for AAC discussed. Originality/value: This paper suggests that ambiguity should be adopted as a characteristic of an AAC keyboard as should the method of removing ambiguity - namely either coding or a disambiguation process. © Emerald Group Publishing Limited.


Hemaya S.A.K.,Barnsley Hospital | Locker T.E.,Barnsley Hospital
Emergency Medicine Journal | Year: 2012

Background Information regarding waiting times has been shown to be a key determinant of patient satisfaction. This study aimed to examine the potential accuracy of predicted waiting times determined on the patient's arrival in the Emergency Department (ED). Methods A retrospective study of 50 000 consecutive patients attending a single ED was undertaken. A linear regression model was developed to predict waiting times, assessing a number of different measures derived from the waiting times of patients seen immediately prior to an individual patient's time of arrival. To assess the fit of the model, the mean absolute difference between the patient's actual and predicted waiting times was determined. Results 6726 patients had incomplete data and were excluded from the analysis. The mean waiting time across all streams was 64.6 (SD 43.7) min. The best performing linear regression model used two variables to predict a patient's waiting time, calculated across the entire sample of patients. This model predicted 27% of the variability in waiting time. The mean absolute difference between actual and predicted waiting times across all streams was 29.0 (SD 23.5) min. The mean absolute difference in waiting times was similar across the streams. Conclusions There is a considerable difference between predicted and actual waiting times using this method. Further investigation is required to determine whether such a degree of inaccuracy is acceptable to patients and improves satisfaction more than the provision of no information regarding waiting times.

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