Barnsley Hospital NHS Foundation Trust

Barnsley, United Kingdom

Barnsley Hospital NHS Foundation Trust

Barnsley, United Kingdom
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Jones T.H.,University of Sheffield | Jones T.H.,Barnsley Hospital NHS Foundation Trust
Journal of Diabetes | Year: 2010

Observations from clinical studies suggest that low serum levels of testosterone in men are often associated with obesity, insulin resistance, and metabolic compromise. Indeed, the clinical symptoms of late-onset hypogonadism are markedly similar to those of Type 2 diabetes mellitus (T2DM) and metabolic syndrome, and may share a similar pathophysiology. Observational and experimental data suggest that testosterone treatment improves a number of hallmark features of T2DM and metabolic syndrome, namely insulin resistance, obesity, dyslipidemia, and sexual dysfunction. Consequently, clinical studies have been undertaken to assess the impact of testosterone-replacement therapy in this patient group. The present article reviews the observational clinical data suggesting an association between low serum testosterone and metabolic impairment, the clinical data relating to the effects of testosterone treatment on components of the metabolic syndrome, and the randomized clinical trails that have formally investigated whether testosterone-replacement therapy provides clinical benefit to hypogonadal men with T2DM andor metabolic syndrome. © 2010 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Blackwell Publishing Asia Pty Ltd.


Bennett A.,Barnsley Hospital NHS Foundation Trust
Nursing standard (Royal College of Nursing (Great Britain) : 1987) | Year: 2013

Lung cancer is the most common cancer worldwide and is associated with significant morbidity and mortality. In recent years, there have been important developments in the techniques used to diagnose lung cancer and in the treatment options available, allowing more people to be given anti-cancer treatment with the aim of increasing survival rates. This article provides an overview of lung cancer, including epidemiology, risk factors, diagnosis and treatment. It aims to provide healthcare professionals with information to improve care delivery and patients' quality of life.


Kelly D.M.,University of Sheffield | Jones T.H.,University of Sheffield | Jones T.H.,Barnsley Hospital NHS Foundation Trust
Journal of Endocrinology | Year: 2013

Coronary heart disease is a leading cause of premature death in men. Epidemiological studies have shown a high prevalence of low serum testosterone levels in men with cardiovascular disease (CVD). Furthermore, a low testosterone level is associated in some but not in all observational studies with an increase in cardiovascular events and mortality. Testosterone has beneficial effects on several cardiovascular risk factors, which include cholesterol, endothelial dysfunction and inflammation: key mediators of atherosclerosis. A bidirectional relationship between low endogenous testosterone levels and concurrent illness complicates attempts to validate causality in this association and potential mechanistic actions are complex. Testosterone is a vasoactive hormone that predominantly has vasodilatory actions on several vascular beds, although some studies have reported conflicting effects. In clinical studies, acute and chronic testosterone administration increases coronary artery diameter and flow, improves cardiac ischaemia and symptoms in men with chronic stable angina and reduces peripheral vascular resistance in chronic heart failure. Although the mechanism of the action of testosterone on vascular tone in vivo is not understood, laboratory research has found that testosterone is an L-calcium channel blocker and induces potassium channel activation in vascular smooth muscle cells. Animal studies have consistently demonstrated that testosterone is atheroprotective, whereas testosterone deficiency promotes the early stages of atherogenesis. The translational effects of testosterone between in vitro animal and human studies, some of which have conflicting effects, will be discussed in this review. We review the evidence for a role of testosterone in vascular health, its therapeutic potential and safety in hypogonadal men with CVD, and some of the possible underlying mechanisms. © 2013 Society for Endocrinology.


Kelly D.M.,University of Sheffield | Jones T.H.,University of Sheffield | Jones T.H.,Barnsley Hospital NHS Foundation Trust
Obesity Reviews | Year: 2015

Testosterone is a key hormone in the pathology of metabolic diseases such as obesity. Low testosterone levels are associated with increased fat mass (particularly central adiposity) and reduced lean mass in males. These morphological features are linked to metabolic dysfunction, and testosterone deficiency is associated with energy imbalance, impaired glucose control, reduced insulin sensitivity and dyslipidaemia. A bidirectional relationship between testosterone and obesity underpins this association indicated by the hypogonadal-obesity cycle and evidence weight loss can lead to increased testosterone levels. Androgenic effects on enzymatic pathways of fatty acid metabolism, glucose control and energy utilization are apparent and often tissue specific with differential effects noted in different regional fat depots, muscle and liver to potentially explain the mechanisms of testosterone action. Testosterone replacement therapy demonstrates beneficial effects on measures of obesity that are partially explained by both direct metabolic actions on adipose and muscle and also potentially by increasing motivation, vigour and energy allowing obese individuals to engage in more active lifestyles. The degree of these beneficial effects may be dependent on the treatment modality with longer term administration often achieving greater improvements. Testosterone replacement may therefore potentially be an effective adjunctive treatment for weight management in obese men with concomitant hypogonadism. © 2015 World Obesity.


Sabroe R.A.,Barnsley Hospital NHS Foundation Trust
Clinical and Experimental Dermatology | Year: 2010

Cholinergic urticaria is one of the more common physical urticarias. Although it is often fairly mild, severe treatment-resistant disease may occur, with significant associated disability. Omalizumab, a monoclonal IgG anti-IgE antibody licensed for use in severe asthma, has recently been used successfully in several types of urticaria, including in one case of cholinergic urticaria. This paper reports a patient with severe cholinergic urticaria, unresponsive to antihistamines and multiple other treatments, whose disease was also unresponsive to omalizumab. © 2009 British Association of Dermatologists.


Judge S.,Barnsley Hospital NHS Foundation Trust | Judge S.,University of Sheffield | Townend G.,Speech Kingdom
International Journal of Language and Communication Disorders | Year: 2013

Background Voice output communication aids (VOCAs) are a key form of aided communication within the field of augmentative and alternative communication (AAC). In recent years, rapid developments in technology have resulted in an explosion of devices available commercially, yet little research has been conducted into what people who use VOCAs think about them. Aims The aim of this research was to explore the perceptions of communication aid design from the perspective of end users and AAC professionals, with the objective being to inform and influence the design of future devices. Methods & Procedures A two-part study was conducted: interviews were undertaken with people who use VOCAs, and questionnaires were distributed to those who use aided communication and to AAC professionals. Analysis of the interview data was carried out using a qualitative method based on framework analysis, whilst descriptive statistics were generated from the questionnaire data. Interview participants were an opportunity sample of VOCA users within a defined region of the UK. Those recruited were over the age of 12 years and able to engage in the interview process; they were identified through the caseloads of local Speech and Language Therapists specializing in AAC. The questionnaire was marketed to the AAC community throughout the UK. Respondents were self-selecting as those using aided communication, their carers and AAC professionals. Outcomes & Results Eighteen people participated in the interviews. Questionnaires were completed by 43 people who use aided communication and 68 AAC professionals. The data suggest that current devices are considered to be neither reliable nor durable by users and professionals. Although features given a higher importance ranking are more likely to be perceived as available, a number of important design deficits are identified by users and/or professionals. Simplicity of design (and use) and the desire for devices which support communication that is as fast and spontaneous as possible also emerge as key requirements. Synthesis of the data produced a framework with three main themes covering the range of issues which influence the successful use of a VOCA: specific aspects of the design of a device; the consideration of the wider picture around the person; and the personal context in which someone uses their device. Conclusions & Implications Although the original aim of the project was to establish the user requirements of VOCA design, the data indicate that the characteristics of the device cannot be considered in isolation. Those factors uncovered highlight questions about whether the design of communication aids is truly effective in meeting the needs of the people who use them. Based on these data, an initial specification for future device design is proposed. © 2013 Royal College of Speech and Language Therapists.


Gray T.,Sheffield Teaching Hospitals NHS Foundation Trust | Dass M.,Barnsley Hospital NHS Foundation Trust
British Journal of Hospital Medicine | Year: 2012

Ketamine abuse is increasingly common in the UK. Ketamine-induced cystitis can cause serious damage to the urinary tract. This emerging problem presents a new diagnostic challenge and is very likely to increase in incidence over the coming years.


Kelly D.M.,University of Sheffield | Jones T.H.,University of Sheffield | Jones T.H.,Barnsley Hospital NHS Foundation Trust
Journal of Endocrinology | Year: 2013

Testosterone is a hormone that plays a key role in carbohydrate, fat and protein metabolism. It has been known for some time that testosterone has a major influence on body fat composition and muscle mass in the male. Testosterone deficiency is associated with an increased fat mass (in particular central adiposity), reduced insulin sensitivity, impaired glucose tolerance, elevated triglycerides and cholesterol and low HDL-cholesterol. All these factors are found in the metabolic syndrome (MetS) and type 2 diabetes, contributing to cardiovascular risk. Clinical trials demonstrate that testosterone replacement therapy improves the insulin resistance found in these conditions as well as glycaemic control and also reduces body fat mass, in particular truncal adiposity, cholesterol and triglycerides. The mechanisms by which testosterone acts on pathways to control metabolism are not fully clear. There is, however, an increasing body of evidence from animal, cell and clinical studies that testosterone at the molecular level controls the expression of important regulatory proteins involved in glycolysis, glycogen synthesis and lipid and cholesterol metabolism. The effects of testosterone differ in the major tissues involved in insulin action, which include liver, muscle and fat, suggesting a complex regulatory influence on metabolism. The cumulative effects of testosterone on these biochemical pathways would account for the overall benefit on insulin sensitivity observed in clinical trials.This review discusses the current knowledge of the metabolic actions of testosterone and how testosterone deficiency contributes to the clinical disease states of obesity, MetS and type 2 diabetes and the role of testosterone replacement. © 2013 Society for Endocrinology Printed in Great Britain.


Jones T.H.,Barnsley Hospital NHS Foundation Trust | Jones T.H.,University of Sheffield
Trends in Endocrinology and Metabolism | Year: 2010

Male gender is a major risk factor for premature cardiovascular death, a relationship not yet explained. Low testosterone in men is a risk factor for the metabolic syndrome and type 2 diabetes and is associated independently with individual components of the metabolic syndrome - visceral obesity, insulin resistance, hyperglycemia, hypertension and dyslipidemia. Epidemiological studies report increased mortality in men with low testosterone. Testosterone replacement in the short-term reduces waist circumference, cholesterol and circulating pro-inflammatory cytokines and improves insulin sensitivity and glycemic control in diabetics. Testosterone also has beneficial effects on cardiac ischemia, angina and chronic heart failure. This manuscript reviews the current evidence supporting a link between low testosterone and cardiovascular disease, highlighting the need for larger, longer-term studies. © 2010 Elsevier Ltd.


Griffiths J.R.,Barnsley Hospital NHS Foundation Trust | Kidney E.M.,Barnsley Hospital NHS Foundation Trust
Emergency Medicine Journal | Year: 2012

Background: There is recent evidence that the modified early warning scoring systems (MEWS) in the emergency department (ED) can identify patients at risk of deterioration. However, concerns remain that they are not sensitive enough to use as a risk assessment tool. Objective: To assess use of MEWS in UK EDs. Methods: A postal survey was undertaken of 254 adult EDs within the UK. Questionnaires were sent to the clinical lead at each department about their use of early warning scoring systems. Results: Responses were received from 145 departments giving a response rate of 57%. 87% of respondents are currently using early warning scores (EWS). Of those, 80% are using MEWS. In 71% high EWS results in senior ED review, however in 25% it does not. Less than half of departments use high MEWS to trigger critical care input. 93% of respondents support using EWS in the ED. Conclusion: Despite the lack of strong evidence, the majority of UK EDs are using EWS in some form. MEWS is the most commonly used but departments vary on their use of EWS for senior ED and/or critical care review. Over 90% of respondents in this survey support EWS in the ED.

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