Understanding Lung Cancer Resources and Barriers Among Worksites With Mostly Male Employees in Eight Rural Kentucky Counties: A Focus Group Discussion.

Kentucky has the highest cancer incidence and mortality rates in the United States, and lung cancer is Kentucky's leading cause of cancer deaths. Males in Kentucky have higher lung incidence and mortality rates than females. Through support from the SelfMade Health Network, Kentucky developed a Regional Resource Lead Organization that collaboratively developed a multi-component worksite intervention on lung cancer among male populations. The intervention targets eight Kentucky counties. The first component and focus of this manuscript included focus group meetings with organizational representatives in each county that provide health, educational, and social services to men and worksites. The focus groups discussed four distinct areas: (a) lung cancer-related resources and services in each county; (b) perceived ways men in worksites learn about and access health-related services; (c) identification of potential challenges and barriers to reaching men in worksites; and (d) creation of linkages and potential partnerships between community organizations and worksites. Forty-five organizational representatives participated in the eight focus groups. Most resources and services discussed were related to tobacco treatment. Employers were the most commonly perceived way men learn about and access health-related services, while attitudes and behaviors were the most commonly perceived barriers preventing men from accessing services. The most common potential linkages and partnerships across all areas were community organizations and groups, employers, health-care providers, and mass media. Partnering with employers may provide an opportunity to reach males with lung cancer prevention and control resources and services.

Exploring the experiences and opinions of hospital pharmacists working 24/7 shifts.

OBJECTIVES: The expansion of out-of-hours pharmacy services results from a drive to improve patient care and promote integration into the wider healthcare team. However, there has been little attempt to explore these intended outcomes as well as the potential problems arising from working out of hours. The aim of this study was to explore the experiences and views of pharmacists who work shifts as part of a 24/7 pharmacy service. METHODS: Semistructured interviews with shift-working pharmacists were conducted. Data were analysed using a framework approach. RESULTS: Pharmacists described the positive impact they had on patient safety by ensuring the prompt supply of time-critical medicines and their proactive role in preventing adverse drug events. Pharmacists' on-site presence and attendance at handover promoted integration into the wider team and facilitated unplanned interventions. However, requests for non-urgent supplies were a source of frustration. Disparity of pharmacists' perceptions of senior support demonstrated a need to explore communication further and the importance of non-technical skills, such as communication in service provision. Shift work appeared to be a double-edged sword for work-life balance, preventing participation in regular hobbies, but providing flexibility. Service improvements could include technician support, greater feedback provision and improved ordering processes. CONCLUSIONS: Overall, pharmacists believed the shift service exhibited numerous advantages over a traditional remote on-call service, particularly in improving aspects of patient safety and integration into the wider healthcare team. Clarity of the service scope and development of non-technical skills are areas for improvement and development.

Terminate lung cancer (TLC) study-A mixed-methods population approach to increase lung cancer screening awareness and low-dose computed tomography in Eastern Kentucky.

For low dose CT lung cancer screening to be effective in curbing disease mortality, efforts are needed to overcome barriers to awareness and facilitate uptake of the current evidence-based screening guidelines. A sequential mixed-methods approach was employed to design a screening campaign utilizing messages developed from community focus groups, followed by implementation of the outreach campaign intervention in two high-risk Kentucky regions. This study reports on rates of awareness and screening in intervention regions, as compared to a control region.

Basal insulin peglispro demonstrates preferential hepatic versus peripheral action relative to insulin glargine in healthy subjects.

OBJECTIVE: We evaluated the endogenous glucose production (EGP) and glucose disposal rate (GDR) over a range of doses of basal insulin peglispro (BIL) and insulin glargine in healthy subjects. RESEARCH DESIGN AND METHODS: This was a single-center, randomized, open-label, four-period, incomplete-block, crossover study conducted in eight healthy male subjects. Subjects had 8-h euglycemic clamps performed with primed, continuous infusions of BIL (5.1 to 74.1 mU/min) in three dosing periods and insulin glargine (20 or 30 mU/m(2)/min) in a fourth period, targeted to achieve 50-100% suppression of EGP. D-[3-(3)H] glucose was infused to assess rates of glucose appearance and disappearance. RESULTS: Mean BIL and insulin glargine concentrations (targeted to reflect the differences in intrinsic affinities of the two basal insulins) ranged from 824 to 11,400 and 212 to 290 pmol/L, respectively, and increased accordingly with increases in dose. Suppression of EGP and stimulation of GDR were observed with increasing concentrations of both insulins. At insulin concentrations where EGP was significantly suppressed, insulin glargine resulted in increased GDR. In contrast, at comparable suppression of EGP, BIL had minimal effect on GDR at lower doses and had substantially less effect on GDR than insulin glargine at higher doses. CONCLUSIONS: The novel basal insulin analog BIL has relative hepatopreferential action and decreased peripheral action, compared with insulin glargine, in healthy subjects.

Hyperglycemia associated with pasireotide: results from a mechanistic study in healthy volunteers.

CONTEXT: Pasireotide (SOM230) is a somatostatin analog with affinity for somatostatin receptor subtypes sst1₋3 and sst5. Clinical trials have demonstrated the efficacy of pasireotide in treating Cushing's disease and acromegaly but have also shown adverse effects on glucose metabolism. OBJECTIVE: The aim of the study was to evaluate the mechanism of pasireotide-associated hyperglycemia. DESIGN: We conducted a randomized, single-center, open-label study. SUBJECTS AND INTERVENTION: Forty-five healthy male volunteers were randomized to pasireotide 600 (n = 19), 900 (n = 19), or 1200 µg (n = 7) sc twice a day for 7 days. Randomization to 1200 µg was discontinued because of increased severity of gastrointestinal adverse events in this arm. An oral glucose tolerance test (OGTT), a hyperglycemic clamp test, and a hyperinsulinemic-euglycemic clamp test were performed on 3 consecutive days at baseline and treatment end. MAIN OUTCOME MEASURE: The effect of pasireotide on insulin secretion and hepatic/peripheral insulin sensitivity was measured. The secondary objective was to evaluate the effects of pasireotide on oral glucose absorption. RESULTS: Pasireotide treatment resulted in significant decreases in insulin AUC0-180 min during both the hyperglycemic clamp test (-77.5%; P < .001 in both dose groups) and the OGTT (-61.9%; P < .001 in both dose groups). Suppression of glucagon levels was less pronounced. No significant changes in hepatic or peripheral insulin sensitivity were found during the hyperinsulinemic-euglycemic clamp test. Additionally, significant increases in glucose AUC0₋180 min (+67.4%) and decreases in AUC0₋180 min glucagon-like peptide-1 (-46.7%) and glucose-dependent insulinotropic polypeptide levels (-69.8%) were observed during the OGTT. No dose dependency or unexpected adverse events were observed. CONCLUSIONS: Pasireotide-associated hyperglycemia is related to decreases in insulin secretion and incretin hormone responses, without changes in hepatic/peripheral insulin sensitivity.

Remogliflozin etabonate, a selective inhibitor of the sodium-glucose transporter 2, improves serum glucose profiles in type 1 diabetes.

OBJECTIVE: Remogliflozin etabonate (RE), an inhibitor of the sodium-glucose transporter 2, improves glucose profiles in type 2 diabetes. This study assessed safety, tolerability, pharmacokinetics, and pharmacodynamics of RE in subjects with type 1 diabetes. RESEARCH DESIGN AND METHODS: Ten subjects managed with continuous subcutaneous insulin infusion were enrolled. In addition to basal insulin, subjects received five randomized treatments: placebo, prandial insulin, 50 mg RE, 150 mg RE, and mg RE 500. RESULTS: Adverse events and incidence of hypoglycemia with RE did not differ from placebo and prandial insulin groups. RE significantly increased urine glucose excretion and reduced the rise in plasma glucose concentration after oral glucose. RE reduced incremental adjusted weighted mean glucose (0-4 h) values by 42-49 mg/dL and mean glucose (0-10 h) by 52-69 mg/dL. CONCLUSIONS: RE can be safely administered with insulin in type 1 diabetes and reduces plasma glucose concentrations compared with placebo.

Physician and staff perceptions of barriers to colorectal cancer screening in Appalachian Kentucky.

BACKGROUND: Data indicate that in 1997 to 1999, only 44% of Appalachian Kentuckians underwent colorectal cancer screening consistent with guidelines. We investigated the reasons for, barriers to, and follow-up of colorectal cancer (CRC) screening recommendations in primary care practices seeing patients from Appalachian Kentucky. METHODS: A mixed-methods [qualitative (focus group) and quantitative (survey)] approach was used to gather and analyze data in five primary care practices. A total of 34 participated in the focus groups. RESULTS: In focus groups, physicians and office staff reported a number of indicators for CRC screening; physician, patient, and procedural barriers to CRC screening; and strategies to overcome these barriers to screening. Most physicians used personal experience to guide screening, but it was unclear what was meant by personal experience. Commonly cited patient barriers to screening were fear and embarrassment. Physicians reported several approaches to overcome these barriers, including establishing trust and educating patients. Survey data identified a number of resources to assist practices in promoting screening, most commonly, patient educational materials. Finally, fecal occult blood test was most commonly recommended because it is inexpensive and easy to administer. CONCLUSIONS: Our mixed methods approach not only helped to understand the physicians' perceptions of the problems and barriers to CRC screening in Appalachian Kentucky, but also elucidated how practices endeavor to overcome these barriers and identified the additional resources practices would like in order to promote CRC screening.

Evaluation of educational materials on colorectal cancer screening in Appalachian Kentucky.

INTRODUCTION: Despite the availability of preventive screening for colorectal cancer, compliance with screening recommendations in Appalachian Kentucky is low. Although there are various cancer education materials available, none focus on Appalachian populations and few on low-literacy populations. The purpose of this study was to assess the type of information needed in written educational materials about colorectal cancer for Appalachian populations in Kentucky. METHODS: Seven focus groups were held in two Appalachian regions of Kentucky. Thirty-four members of the community participated in four focus groups held for the general public, and 15 staff members of primary care physicians' offices participated in three focus groups. One facilitator led all seven focus groups using a moderator's guide. Participants were asked to review and rank two fact sheets and two brochures about colorectal cancer according to perceived effectiveness. RESULTS: There was consensus between the general public focus groups and physician office staff focus groups about the ranking of materials. All groups preferred the Centers for Disease Control and Prevention's Screen for Life: National Colorectal Cancer Action Campaign fact sheet and brochure to the other materials. They indicated that factors such as print size, inclusion of diagrams, and clear and simple presentation of the information were important and made the materials easier to use and understand. A consensus was also reached among groups on the relative importance of types of information that should be provided in the materials. CONCLUSION: The use of educational materials to communicate messages about cancer screening is important in increasing awareness and providing valuable health information. Members of the Appalachian community and staff members of physicians' offices preferred and recommended use of Screen for Life materials for low-literacy and Appalachian populations over other educational materials.

Young and elderly type 2 diabetic patients inhaling insulin with the AERx insulin diabetes management system: a pharmacokinetic and pharmacodynamic comparison.

The objective of this study was to compare the pharmacokinetics (PK), pharmacodynamics (PD), and safety of inhaled insulin delivered by the AERx iDMS in young and elderly patients with type 2 diabetes. Twenty-seven young (18-45 years, inclusive) and 28 elderly (>/= 65 years) type 2 diabetic patients were enrolled in this study. A single inhalation of 1.57 mg (45 IU, effect comparable to 6 s.c. units) of regular human insulin was administered to each patient on each of 2 dosing days, and blood samples were drawn up to 360 minutes postdosing to generate the PK/PD curves. AUC(0-360 min) and Cmax values of inhaled insulin were comparable between young and elderly subjects (p = 0.476 for AUC(0-360 min) and p = 0.414 for Cmax). However, the elderly group had significantly less glucose reduction, as indicated by plasma glucose AOC(0-360) (area over the curve) values (p = 0.011). The intrasubject variability of inhaled insulin using the AERx iDMS was similar for young and elderly subjects and was similar to what has previously been reported for soluble insulin administered subcutaneously. Inhaled insulin was well tolerated in these patients, and no changes in pulmonary function tests were observed. A single inhalation of insulin using the AERx iDMS demonstrated comparable insulin PK profiles between the elderly and young type 2 patients but less glucose reduction in the elderly. Based on these results, elderly diabetic patients may need to inhale more insulin than young patients to achieve similar glycemic control. Long-term clinical trials using the AERx device will be useful to study age-related differences.

Intravenous glargine and regular insulin have similar effects on endogenous glucose output and peripheral activation/deactivation kinetic profiles.

OBJECTIVE: To compare the effects of intravenously administered long-acting insulin analog glargine and regular human insulin on activation and deactivation of endogenous glucose output (EGO) and peripheral glucose uptake. RESEARCH DESIGN AND METHODS: In this single-center, randomized, double-blind, crossover euglycemic glucose clamp study, 15 healthy male volunteers (aged 27 +/- 4 years, BMI 24.2 +/- 0.7 kg/m(2) [mean +/- SE]) received a primed continuous intravenous infusion of 40 mU/m(2) of insulin glargine or regular human insulin on 2 different study days in a randomized order. Euglycemia was maintained at 90 mg/dl using a simultaneous variable intravenous infusion of 20% dextrose containing D-[3-(3)H]glucose. EGO and peripheral glucose disposal kinetics were determined during a 4-h insulin infusion activation period and a 3-h deactivation period. RESULTS: The results demonstrated no significant difference in activation or deactivation kinetics with respect to EGO and peripheral glucose disposal between insulin glargine and regular human insulin when given intravenously. The mean +/- SE time required for 50% suppression of EGO after insulin infusion was 73 +/- 23 min for regular insulin and 57 +/- 20 min for insulin glargine (NS). The mean maximum rate of glucose disposal was 10.10 +/- 0.77 and 9.90 +/- 0.85 mg. kg(-1). min(-1) for regular insulin and insulin glargine, respectively (NS). The mean time required for 50% suppression of incremental glucose disposal rate (GDR), defined as the time required for activation from the basal glucose disappearance rate (R(d)) to half-maximum insulin-stimulated R(d), was 32 +/- 5 and 42 +/- 10 min for regular insulin and insulin glargine, respectively (NS). The time required for deactivation from maximum insulin-stimulated GDR to half-maximum GDR after cessation of insulin infusion was 63 +/- 5 and 57 +/- 4 min for regular insulin and insulin glargine, respectively (NS). CONCLUSIONS: Activation and deactivation kinetics of EGO and peripheral glucose uptake as well as absolute disposal rate are similar between regular human insulin and insulin glargine when administered intravenously. Thus, the various biological actions of these insulin preparations when given subcutaneously are completely due to their different absorption kinetics.

Differential effects of metformin and troglitazone on cardiovascular risk factors in patients with type 2 diabetes.

OBJECTIVE: Traditional cardiovascular risk factors (CVRF) only partly explain the excessive risk of cardiovascular disease in patients with type 2 diabetes. There is now an increasing appreciation for many novel CVRF that occur largely as a result of insulin resistance and hyperinsulinemia. Therefore, we investigated whether diabetes medications that vary in their mechanism of action and ability to reduce insulin resistance may differ in their effects on both traditional and novel CVRF. RESEARCH DESIGN AND METHODS: We compared the addition of metformin or troglitazone therapy on CVRF in 22 subjects with type 2 diabetes who remained in poor glycemic control (with HbA1c >8.5%) while taking glyburide 10 mg twice daily. Subjects were initially randomized to either metformin 850 mg once daily or troglitazone 200 mg once daily. Both medications were then titrated upward as needed to achieve fasting plasma glucose <120 mg/dl. Measures of glucose control, insulin resistance, and CVRF (blood pressure, lipids, plasminogen activator inhibitor-1, C-reactive protein, fibrinogen, and small dense LDL) were assessed both before and after therapy. RESULTS: After 4 months of treatment, both metformin and troglitazone led to similar decreases in fasting plasma glucose and HbA1c. The reduction in insulin resistance determined by hyperinsulinemic-euglycemic clamp was nearly twofold greater with troglitazone than metformin. Metformin did not induce significant changes in blood pressure, LDL cholesterol, LDL size, HDL cholesterol, triglycerides, or plasminogen activator inhibitor-1. However, C-reactive protein did decrease by 33% (6 +/- 1 to 4 +/- 1 mg/l; P < 0.01) [corrected]. Troglitazone therapy was associated with increases in LDL size (26.21 +/- 0.22 to 26.56 +/- 0.25 nm; P=0.04) and HDL cholesterol (33 +/- 3 to 36 +/- 3 mg/dl; P=0.05) and decreases in triglycerides (197 +/- 19 to 155 +/- 23 mg/dl; P=0.07) and C-reactive protein by 60% (8 +/- 3 to 3 +/- 1 mg/l, P < 0.01) [corrected]. CONCLUSIONS: For patients with type 2 diabetes in whom maximal sulfonylurea therapy failed, the addition of the insulin sensitizer troglitazone seemed to have greater benefits on several traditional and novel CVRF than metformin therapy. These differences were not related to glycemic improvement but reflected, in part, the greater reduction in insulin resistance obtained with addition of troglitazone. These data suggest that medications that more effectively address this underlying metabolic defect may be more beneficial in reducing cardiovascular risk in type 2 diabetes.