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Steele T, Narayanan RP, James M, James J, Mazey N, Wilding JPH. Evaluation of Aintree LOSS, a community-based, multidisciplinary weight management service: outcomes and predictors of engagement. Clin Obes 2017; 7:368-376. [PMID: 28871633 DOI: 10.1111/cob.12216] [Citation(s) in RCA: 9] [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: 05/02/2017] [Revised: 06/26/2017] [Accepted: 07/19/2017] [Indexed: 11/30/2022]
Abstract
Aintree LOSS is a community-based, multidisciplinary weight management programme for patients with severe and complex obesity, focusing on a flexible and individualized service with follow-up for up to 2 years. We evaluated all 2472 patients referred to the service between October 2009 and 2013. Demographic data were recorded at baseline, with the Index of Multiple Deprivation (IMD) used to measure socioeconomic deprivation. Weight was recorded at each visit. Mean body mass index at baseline was 45.6 (standard deviation 6.8), and 58.9% of patients lived in areas in the most deprived decile nationally. Of 2315 appropriate referrals, 1249 (55.1%) attended >2 visits; mean final weight loss was 3.50 ± 8.55 kg, and 24.1% achieved ≥5% weight loss. Of the patients, 754 (33.3%) attended for over 6 months; mean final weight loss was 4.94 ± 10 kg, and 34% achieved 5% weight loss. Multivariate logistic regression analysis showed increasing age, residence in a less deprived area and sleep apnoea to be independently associated with attendance for >6 months, and there was a linear relationship between 6-month attendance and deprivation quintile. Year-on-year analyses showed improvement in engagement over time, coinciding with efforts to improve access to the service. This work shows a multidisciplinary, community-based weight loss programme prioritizing a fully flexible and individualized approach functioning effectively in real-world practice. Maintaining engagement remains a challenge in weight loss programmes, and our results suggest younger patients living in areas with greater deprivation should be a target for efforts to improve engagement.
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Affiliation(s)
- T Steele
- Obesity and Endocrinology Research, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - R P Narayanan
- Obesity and Endocrinology Research, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - M James
- Aintree Weight Management Services, Aintree University Hospital, Liverpool, UK
| | - J James
- Aintree Weight Management Services, Aintree University Hospital, Liverpool, UK
| | - N Mazey
- Brownlow Group Practice, Liverpool, UK
| | - J P H Wilding
- Obesity and Endocrinology Research, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
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Longworth H, McCallin K, Narayanan RP, Turner MA, Quenby S, Rycroft D, Charnley M, Abayomi J, Topping J, Weeks AD, Wilding JPH. Screening methods for obstructive sleep apnoea in severely obese pregnant women. Clin Obes 2017; 7:239-244. [PMID: 28557355 DOI: 10.1111/cob.12196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 12/20/2016] [Revised: 03/02/2017] [Accepted: 03/22/2017] [Indexed: 11/27/2022]
Abstract
Obstructive sleep apnoea (OSA) is an often-overlooked diagnosis, more prevalent in the obese population. Screening method accuracy, uptake and hence diagnosis is variable. There is limited data available regarding the obese pregnant population; however, many studies highlight potential risks of apnoeic episodes to mother and foetus, including hypertension, diabetes and preeclampsia. A total of 162 women with a body mass index (BMI) ≥ 35 were recruited from a tertiary referral hospital in the northwest of England. They were invited to attend three research antenatal clinics, completing an Epworth Sleepiness Scale (ESS) questionnaire at each visit. A monitor measuring the apnoea hypopnoea index (AHI) was offered at the second visit. Data taken from consent forms, hospital notes and hospital computer records were collated and anonymized prior to statistical analysis. A total of 12.1% of women had an ESS score of >10, suggesting possible OSA. Rates increased throughout pregnancy, although unfortunately, the attrition rate was high; 29.0% of women used the RUSleeping (RUS) meter, and only one (2.1%) met pre-specified criteria for OSA (AHI ≥ 15). This individual had OSA categorized as severe and underwent investigations for preeclampsia, eventually delivering by emergency caesarean section due to foetal distress. The accuracy of the ESS questionnaire, particularly the RUS monitor, to screen for OSA in the pregnant population remains unclear. Further research on a larger sample size using more user-friendly technology to confidently measure AHI would be beneficial. There are currently no guidelines regarding screening for OSA in the obese pregnant population, yet risks to both mother and foetus are well researched.
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Affiliation(s)
- H Longworth
- Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | - K McCallin
- School of Medical Education, University of Liverpool, Liverpool, UK
| | - R P Narayanan
- Department of Obesity and Endocrinology, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - M A Turner
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - S Quenby
- Lancaster University, Lancaster Medical School, Clinical Research Hub, Lancaster, Lancashire, UK
| | - D Rycroft
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - M Charnley
- Faculty of Education, Health and Community, Liverpool John Moores University, Liverpool, UK
| | - J Abayomi
- Faculty of Education, Health and Community, Liverpool John Moores University, Liverpool, UK
| | - J Topping
- Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | - A D Weeks
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - J P H Wilding
- Department of Obesity and Endocrinology, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
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Bandara HMD, Jin D, Mantell MA, Field KD, Wang A, Narayanan RP, Deskins NA, Emmert MH. Non-directed aromatic C-H amination: catalytic and mechanistic studies enabled by Pd catalyst and reagent design. Catal Sci Technol 2016; 6:5304-5310. [PMID: 28066540 DOI: 10.1039/c6cy00457a] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This manuscript describes the systematic development of pyridine-type ligands, which promote the Pd catalyzed, non-directed amination of benzene in combination with novel, hydroxylamine-based electrophilic amination reagents. DFT calculations and mechanistic experiments provide insights into the factors influencing the arene C-H amination protocol.
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Affiliation(s)
- H M D Bandara
- Department of Chemistry and Biochemistry, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA, USA
| | - D Jin
- Department of Chemistry and Biochemistry, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA, USA
| | - M A Mantell
- Department of Chemistry and Biochemistry, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA, USA
| | - K D Field
- Department of Chemistry and Biochemistry, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA, USA
| | - A Wang
- Department of Chemistry and Biochemistry, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA, USA
| | - R P Narayanan
- Department of Chemistry and Biochemistry, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA, USA
| | - N A Deskins
- Department of Chemical Engineering, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA, USA
| | - M H Emmert
- Department of Chemistry and Biochemistry, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA, USA
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Narayanan RP, Weeks AD, Quenby S, Rycroft D, Hart A, Longworth H, Charnley M, Abayomi J, Topping J, Turner MA, Wilding JPH. Fit for Birth - the effect of weight changes in obese pregnant women on maternal and neonatal outcomes: a pilot prospective cohort study. Clin Obes 2016; 6:79-88. [PMID: 26781604 DOI: 10.1111/cob.12129] [Citation(s) in RCA: 10] [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: 06/20/2015] [Revised: 11/15/2015] [Accepted: 11/19/2015] [Indexed: 01/15/2023]
Abstract
UNLABELLED The 'Fit for Birth' study aimed to explore patterns of gestational weight gain and their relationship with pregnancy outcomes. The study had three aims: 1. To explore the feasibility of conducting a large cohort study in this setting. 2. To describe patterns of weight gain through pregnancy in obese women. 3. To explore associations of weight change during pregnancy with outcomes. STUDY POPULATION Pregnant women with a BMI ≥ 30 kg m(-2) at first antenatal clinic visit. METHODS This was a single centre pilot observational study based at the Liverpool Women's Hospital, a large UK maternity hospital.Women were recruited into the study at their antenatal booking visit and had weights measured throughout pregnancy. Patterns of weight gain were described and related to maternal and neonatal outcomes. MAIN OUTCOME MEASURE The primary outcome was a composite measure consisting of any of 12 adverse maternal and foetal outcomes. This was compared by categorized pregnancy weight gain (<0 kg, 0-5 kg, 5.1-9 kg and >9 kg). RESULTS Eight hundred and twenty four women consented to participation between June 2009 and June 2010. Weight data were collected on 756 women. Only 385 women had weights measured in all three study assessment periods (6-20 weeks, 20 + 1 to 32 weeks and >32 weeks gestation) while 427 women had weights measured in period 3. Individual patterns of weight gain varied widely and missing data were common and non-random. There was a significant association between increased weight gain during pregnancy and poor maternal and foetal outcome. CONCLUSIONS Weight gain in obese women during pregnancy can be highly variable. Our study supports an association between increased weight gain in pregnancy and adverse perinatal outcomes.
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Affiliation(s)
- R P Narayanan
- Department of Obesity and Endocrinology, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - A D Weeks
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - S Quenby
- Biomedical Research Unit in Reproductive Health, University of Warwick, Coventry, UK
| | - D Rycroft
- Fit for Birth, School of Reproductive and Developmental Medicine, Liverpool Women's Hospital, Liverpool, UK
| | - A Hart
- Lancaster Medical School, Clinical Research Hub, Lancaster University, Lancaster, Lancashire, UK
| | - H Longworth
- Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | - M Charnley
- Faculty of Education, Health & Community, Liverpool John Moores University, Liverpool, UK
| | - J Abayomi
- Faculty of Education, Health & Community, Liverpool John Moores University, Liverpool, UK
| | - J Topping
- Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | - M A Turner
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - J P H Wilding
- Department of Obesity and Endocrinology, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
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Livingston M, Robinson JC, Brown CE, Narayanan RP, Holland D, Fryer AA, Heald AH. Are cholesterol levels being checked and managed appropriately in UK primary care type 2 diabetes? Int J Clin Pract 2015; 69:1389-91. [PMID: 26503576 DOI: 10.1111/ijcp.12717] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- M Livingston
- Department of Blood Sciences, Walsall Manor Hospital, Walsall, UK.
| | - J C Robinson
- Primis, The University of Nottingham, Nottingham, UK
| | - C E Brown
- Department of Endocrinology, Leighton Hospital, Crewe, UK
| | - R P Narayanan
- Manchester Academic Health Sciences Centre, School of Medicine, University of Manchester, Manchester, UK
| | - D Holland
- National Pathology Benchmarking Service, Department of Medicines Management, Keele University, Staffordshire, UK
| | - A A Fryer
- Department of Clinical Biochemistry, Keele University School of Medicine, University Hospital of North Staffordshire, Stoke-on-Trent, UK
| | - A H Heald
- Department of Endocrinology, Leighton Hospital, Crewe, UK
- Manchester Academic Health Sciences Centre, School of Medicine, University of Manchester, Manchester, UK
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Anderson SG, Narayanan RP, Malipatil NS, Roberts H, Dunn G, Heald AH. Socioeconomic deprivation independently predicts painful diabetic neuropathy in type 2 diabetes. Exp Clin Endocrinol Diabetes 2015; 123:423-7. [PMID: 26069072 DOI: 10.1055/s-0035-1549966] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Painful peripheral neuropathy in people with type 2 diabetes is a disabling complication. We explored associations of this condition with socioeconomic deprivation. RESEARCH DESIGN AND METHODS The Townsend index of socioeconomic deprivation was examined in the pseudonymised GP records of 15388 (44.1% female) individuals with type 2 diabetes in the Cheshire county of England, and related to prevalence of drug treated painful diabetic neuropathy. We also analysed prescription trends with respect to pharmacotherapy for neuropathy pain relief. RESULTS Treatment for neuropathic pain was initiated in 3 266 (21.2%) of patients. Those on treatment were older [68.2 (95% CI 67.8-68.7) vs. 66.6 (66.4-66.8) years] than those not on treatment. There was no difference in HbA1c (7%, 55 mmol/mol).There were significant differences between the groups for the Townsend deprivation index, with a greater proportion (30.6% vs. 22.8% of patients with treated neuropathic pain) having a score of ≥1 (Χ(2)=83.9, p<0.0001).Multivariate logistic regression analyses indicated that each unit increment in the Townsend index was associated with an 6% increased odds of requiring neuropathic pain treatment [odds ratio (95%CI) 1.06 (1.05-1.08), p<0.0001] independent of 5 year age band, BMI, gender, systolic BP, eGFR, HbA1C and total cholesterol. CONCLUSIONS In this study using pseudonymised clinical records, a higher level of socioeconomic deprivation seemingly may predispose to severe neuropathic pain in diabetes requiring pharmacological intervention. Targeted allocation of healthcare resources to this group may offer clinical benefits.
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Affiliation(s)
- S G Anderson
- Cardiovascular Sciences Research Group, The University of Manchester, Manchester, United Kingdom
| | - R P Narayanan
- Department of Obesity and Endocrinology, University of Liverpool
| | - N S Malipatil
- Vascular Research Group, The University of Manchester
| | - H Roberts
- Department of Medicine, Leighton Hospital, Crewe
| | - G Dunn
- Department of Podiatry, East Cheshire NHS Trust, Macclesfield
| | - A H Heald
- Department of Medicine, Leighton Hospital, Crewe
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Heald AH, Narayanan RP, Lowes D, Jarman E, Onyekwelu E, Qureshi Z, Laing I, Anderson SG. HOMA-S is associated with greater HbA1c reduction with a GLP-1 analogue in patients with type 2 diabetes. Exp Clin Endocrinol Diabetes 2012; 120:420-3. [PMID: 22639398 DOI: 10.1055/s-0032-1309046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Exenatide, a glucagon-like peptide-1 (GLP-1) analogue, is an effective glucoregulator for treating overweight individuals, not at target HbA1 c. This prospective study aimed to determine whether estimates of beta cell function (HOMA-B) and insulin sensitivity (HOMA-S) predict response to Exenatide treatment.Prospective data on 43 type 2 diabetes patients were collected for up to 2.8 years in UK primary care. HOMA-B and HOMA-S were estimated prior to initiating Exenatide, with monitoring of cardio-metabolic risk factors.Mean (SD) age and BMI pre-treatment were 54.1±10.5 years and 35.7±7.5 kg/m2 respectively. HbA1c decreased (mean reduction 0.9%, p=0.04; p for trend=0.01) in 61% of patients. In univariate analyses, HOMA-S as a measure of insulin sensitivity was inversely (β=- 0.41, p 0.009) related to change in HbA1c, with no relation for HOMA-B.In a random effects regression model that included age at baseline, weight, LDL-C, HDL-C and triglycerides, change in HbA1c (β= - 0.14, p<0.001) and HDL-C (β= - 0.52, p=0.011) were independently associated with increasing insulin sensitivity (r2=0.52). Thus patients with greater measured insulin sensitivity achieved greater reduction in HbA1c independent of the factors described above.In logistic regression those in the highest tertile of log-HOMA-S were 45% more likely to have a fall in HbA1c with an odds ratio (OR) of 0.55 (95% CI 0.47-0.66) p<0.0001 (log likelihood ratio for the model χ2=71.6, p<0.0001).Patients with greater measured insulin sensitivity achieve greater reduction in HbA1c with Exenatide. Determination of insulin sensitivity may assist in guiding outcome expectation in overweight patients treated with GLP-1 analogues.
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Affiliation(s)
- A H Heald
- Department of Medicine, Leighton Hospital, Crewe, UK.
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Narayanan RP, Bujawansa S, Qureshi Z, Rimmer M, Heald A. Hypogonadism secondary to hyperprolactinaemia: successful treatment but adverse consequences. Exp Clin Endocrinol Diabetes 2012; 120:311-3. [PMID: 22441722 DOI: 10.1055/s-0031-1297994] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
It is accepted that care must be taken in initiating testosterone replacement in hypogonadal individuals with historically low androgen levels. However less is reported about the influence of restoration of normal endogenous testosterone production on behaviour.Here we report how the adverse sequelae of successful treatment of hypogonadism secondary to hyperprolactinaemia, manifesting as irritability and low threshold to aggression, were managed through a joint approach between psychiatrist and physician.
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Narayanan RP, Mason JM, Taylor J, Long AF, Gambling T, New JP, Gibson JM, Young RJ. Telemedicine to improve glycaemic control: 3-year results from the Pro-Active Call Centre Treatment Support (PACCTS) trial. Diabet Med 2012; 29:284-5. [PMID: 21658126 DOI: 10.1111/j.1464-5491.2011.03352.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Narayanan RP. Medical students leading social revolutions. Clinical Teacher 2006. [DOI: 10.1111/j.1743-498x.2006.00079.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Swartz MA, Welch DF, Narayanan RP, Greenfield RA. Catalase-negative listeria monocytogenes causing meningitis in an adult. Clinical and laboratory features. Am J Clin Pathol 1991; 96:130-3. [PMID: 1906240 DOI: 10.1093/ajcp/96.1.130] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
A 63-year-old previously healthy woman presented with acute meningitis. Cultures of the cerebrospinal fluid yielded a serotype 1/2a isolate of Listeria monocytogenes that was biochemically typical in all respects, other than the reproducible lack of catalase production. During therapy, the patient developed oculomotor dysfunction that was attributed to an abscess in the internal capsule. This case report documents the existence of catalase-negative L. monocytogenes indicating that catalase production should not be a strict criterion for identification of Listeria. Furthermore, this clinical experience extends in vitro and experimental animal studies indicating that catalase production is not a necessary virulence factor for invasion by Listeria.
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Affiliation(s)
- M A Swartz
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City
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