Effectiveness of specialist group treatment for smoking cessation vs. one-to-one treatment in primary care

OBJECTIVE: Using a quasi-experimental design, this paper contributes to an important debate about the most effective form of psychological treatment to aid smoking cessation: group treatment provided by specialists or one-to-one treatment provided in the community by primary care nurses or pharmacists. METHODS: Data were routinely collected from 1501 clients of a large London stop smoking service that offered both group and one-to-one treatment. RESULTS: A quarter (25%) of the clients were continuously abstinent 4 weeks post-quit: 30% for those receiving group treatment and 19% for one-to-one (Fisher's exact [2-sided]<.001). The difference between the specialist and community-based treatment remained after all possible confounding factors were controlled for (OR: 2.27, p<.001). CONCLUSIONS: In the same service with the same management structure and training programme, group treatment offered by the specialist service yielded higher success rates than counselling by trained primary care nurses and pharmacists.     

Encouraging smoking cessation among disadvantaged groups: a qualitative study of the financial aspects of cessation

Introduction and Aims. This study aimed to explore perceptions about financial aspects of smoking cessation among a group of disadvantaged welfare agency clients and their carers. Design and Methods. Qualitative focus groups and in‐depth interviews were supplemented with participant exit surveys about preferred smoking cessation strategies. Each discussion was audiotaped, transcribed and analysed using a thematic analysis. The setting was six non‐government community welfare service organisations operating in New South Wales, Australia. Eleven social services offered by these organisations participated. Thirty two clients participated in six client focus groups, 35 staff participated in six staff focus groups and eight manager telephone interviews were conducted. Results. Clients indicated that the cost of nicotine replacement therapy was a barrier to its use and that financial incentives were acceptable. Of the 16 possible strategies listed in the exit survey, the three selected as the most preferred by clients incorporated financial or non‐financial assistance. By contrast, staff and managers selected financial and non‐financial incentives as the least preferred and least feasible strategies. Discussion and Conclusions. The study found high acceptance of incentives as a smoking cessation strategy among a disadvantaged group of non‐government welfare service clients. The comparatively low level of desirability and feasibility from the perspective of service staff and managers suggests implementation of such an approach within the community service setting requires careful further testing.[Bonevski B, Bryant J, Paul C. Encouraging smoking cessation among disadvantaged groups: A qualitative study of the financial aspects of cessation. Drug Alcohol Rev 2011;30:411–418]     

Influence of bleaching and coloring on ethyl glucuronide content in human hair

Ethyl glucuronide (EtG) is increasingly used in forensic toxicology as a marker for alcohol use in analyses of hair samples, especially in abstinence control. Some cosmetic treatments are considered to markedly reduce the EtG content. In view of especially many women with coloured hair the present study was performed to further investigate the effect of a variety of colouring procedures (bleaching, tinting, permanent and semi‐permanent dyeing, henna) on the EtG content. Untreated hair samples (n = 12, EtG 13.9–64.7 pg/mg) were re‐analyzed (gas chromatography‐ negative chemical ionization mass spectrometry, 0.8 pg/mg quantification limit) after different treatment procedures. A decrease of the EtG content of at least 10% occurred in every case. The reduction in comparison to the untreated hair was expectedly high for permanent dyeing and bleaching with 18.1% of the initial content (median, range 0.0–50.9%) and 18.4% (0.0–46.7%), respectively. For henna this was 38.3% (0.0–83.0%), for tinting 70.4% (29.0–90.8%), for semi‐permanent dyeing 41.9% (0.0–77.4%). With permanent hair dye the EtG content was decreased to below 7 pg/mg in 10 of 12 cases, in 3 cases even below the LOD (0.2 pg/mg). Surprisingly henna treatment without oxidative component had a marked influence, EtG was below 2 pg/mg in 2 of 12 samples. The study showed that all tested coloration procedures markedly affected the deposited EtG content. Even temporary or henna coloration may have a marked effect. The present data support the recommendation to exclude hair samples with colour manipulations for analysis on the EtG content as a precaution in alcohol abstinence programs. Copyright © 2017 John Wiley & Sons, Ltd.     

Concordance between timeline follow-back and single-question assessment of self-reported smoking in a clinical trial

ABSTRACT

Background: Smoking cessation clinical trials assess tobacco abstinence using self-report and biomarkers. Optimum methods for each are unclear; a common question assesses smoking in the prior 7 days. In contrast, timeline follow-back (TLFB) is another technique often used to assess use of alcohol in treatment trials; it is used less frequently in studies of smoking cessation. The goal of this study was to assess concordance between the 7-day smoking question and a 7-day TLFB. Methods: Secondary analysis of data from a randomized clinical trial of smoking cessation was conducted at a busy, urban hospital emergency department (ED) from October 2010 to December 2012. At 1, 3, and 12 months, subjects were contacted by phone to assess smoking status. Those reporting abstinence at 3 months were asked to return for an in-person measurement of exhaled carbon monoxide. For this analysis, smoking status at 1 month was compared for subjects in response to 2 questions asked concurrently, addressing 7-day point prevalence tobacco use and a 7-day TLFB. Results: Of 780 subjects, 666 (85.4%) were available for 1-month follow-up. Of these, 99 (14.9%) reported no smoking in response to the 7-day question, and 96 (14.4%) reported no smoking in response to the 7-day TLFB. The overall proportionate agreement between the 2 methods was 98.6%, with a kappa of 0.95 (95% confidence interval [CI]: 0.91–0.98). Conclusions: A single question that assesses smoking at 7 days provides excellent concordance with the more detailed TLFB. The single question appears adequate to assess self-reported tobacco use in clinical trials of smoking cessation.     

Pharmacokinetics of ketamine and two metabolites in the dog

The plasma concentrations of ketamine, N-demethylketamine (I), and the cyclohexene metabolite (II) formed by oxidation of I were determined at various times after rapid i.v. administration of 15 mg of ketamine HCl/kg of body weight to dogs. A pharmacokinetic model that included two compartments for ketamine and one compartment for each metabolite was developed. Ketamine distributed rapidly with (t _1/2 averaging 1.95 min. The apparent volumes of the central and peripheral compartments for ketamine averaged 542 and 1940 ml/kg of body weight, respectively, and the (t _1/2 ) averaged 61 min. The model indicated that 62% of ketamine was transformed to I and that 11% of I was converted to II. The apparent volumes of distribution of I and II averaged 61% and 59% of body weight, respectively. The total body clearances (plasma) of ketamine, I, and II averaged 32.2, 89.4, and 8.54 ml/min/kg, respectively. Plasma protein binding was determined by equilibrium dialysis; it averaged 53.5% for ketamine (concentration range 0.34– 19.5 g/ml), 60.3% for I (0.05– 19.6 g/ml), and 70.1% for II (0.09– 0.58 g/ml). A minimum anesthetic concentration of 3 g ketamine HCl/ml plasma was used with the model to predict that the duration of ketamine anesthesia after an i.m. dose would not be significantly affected if the absorption t_1/2 varied from 0.48 to 31 min. The model also predicted that accumulation of I and II would not interfere with ketamine anesthesia that was prolonged by repeated doses, each dose administered i.v. on termination of anesthesia from the previous dose.     

预防全身麻醉诱导期间芬太尼所致咳嗽反应的临床研究

目的探讨静脉预先注射小剂量氯胺酮对全身麻醉诱导期间芬太尼所致咳嗽反应的预防作用。方法拟在全身麻醉下行择期手术患者40例,年龄18～65岁,体重40～80kg,美国麻醉学会(ASA)分级Ⅰ～Ⅱ级。患者随机分为2组,氯胺酮组(n=20)静脉注射氯胺酮0.15mg/kg,对照组(n=20)静脉注入等体积的0.9%氯化钠溶液;均于10s注射完毕,1min后,2组均静脉注射芬太尼3～5μg/kg,5s注射完毕。记录患者麻醉前和静脉注射芬太尼1min时(麻醉后)的咳嗽次数及其严重程度、收缩压、舒张压、心率。结果2组麻醉后收缩压、舒张压和心率间差异无统计学意义(P>0.05)。氯胺酮组咳嗽发生率低于对照组(P<0.05),出现咳嗽的时间晚于对照组(P<0.05),而咳嗽强度间差异无统计学意义(P>0.05)。结论静脉预先注射小剂量氯胺酮(0.15mg/kg)可有效降低麻醉诱导期间芬太尼所致咳嗽的发生率。     

Persistent decrease in heart rate after smoking cessation: A 1-year follow-up study

The heart rate of 11 smokers was collected throughout their first year of abstinence. One day after smoking cessation, we recorded a significant mean heart rate drop of 9.07 beats per min, from 74.18 to 65.11 beats per min. No significant variation was afterwards detected at any chosen time point (week 1, 2, 3, 4, 6, month 3, 6, 12). In fact, 1 year after cessation the mean heart rate was still 66.36 beats per min, well below initial baseline values. These data indicate that the decrease in heart rate following smoking cessation mostly represents a permanent return to individual normal values in the absence of nicotine self-administration. Nonetheless, three subjects did show a trend toward the recovery of their precessation heart rate and one subject fully recovered it between months 3 and 6 of abstinence. This trend suggests that, while heart rate adaptation to nicotine is largely of an acute nature, there may also be a chronic component. Its role, though usually minor, should become detectable in a few subjects, because of wide interindividual variability.     

A review of the treatment of male pattern hair loss

ABSTRACT

Introduction

Androgenetic alopecia is a common hair loss disorder affecting up to 80% of males by the age of 80. It is characterized by androgen related progressive thinning of hair in a defined pattern. It results in diminished self-esteem, reduced confidence and distress in affected men, irrespective of age or stage of baldness. An effective treatment for hair baldness is needed.     

盐酸氯胺酮喷雾剂的研制及释放度考察

目的制备盐酸氯胺酮喷雾剂。方法采用正交设计对盐酸氯胺酮 (KET)喷雾剂进行处方筛选 ;利用立式扩散池法考察制剂的体外释放性能和经鼻黏膜的渗透性。结果制备得到最优处方盐酸氯胺酮喷雾剂。结论盐酸氯胺酮喷雾剂经离体鼻黏膜具有良好的渗透性     

Efficacy of an internet program for smoking cessation during and after inpatient rehabilitation treatment: a quasi-randomized controlled trial

Objective

To test the feasibility and efficacy of an internet program for smoking cessation during and after inpatient treatment in rehabilitation centers.

Methods

A total of 7574 consecutively admitted inpatients from three German rehabilitation centers were assessed for smoking status. Daily smokers or former daily smokers who regularly used the internet and e-mail were proactively invited for study participation. Out of 749 eligible patients, 477 (64%) participated in the study and were randomly assigned to an intervention or an assessment only control group based on the calendar week of admission. Patients of the intervention group had the possibility to use an internet program for smoking cessation for a period of six months. The program provided at least one but up to seven individual counseling sessions through a computer expert system, informational websites and a message board.

Results

At six-months follow-up, seven-day point prevalence smoking abstinence was twice as high in the intervention group as in the control group (OR = 2.0; CI 1.1–3.8; p = .02).

Conclusions

Proactive recruitment of smokers in combination with the provision of an internet program for smoking cessation allow for an inexpensive and effective smoking cessation support during and after inpatient rehabilitation treatment.     

The alternative five-factor model of personality, nicotine dependence and relapse after treatment for smoking cessation

Personality is one of several factors that have been related to the initiation, maintenance and cessation of smoking. This paper aims to analyze the relationship between the alternative five-factor model of personality (AFFM), nicotine dependence (ND), nicotine use (NU) and cessation after twelve months of a cognitive–behavioral therapy combined with medication. In this prospective study, a sample of 103 smokers who were taking part in a workplace smoking cessation intervention, answered the Zuckerman–Kuhlman Personality Questionnaire. ND and NU were measured with the Fagerström Test for the Nicotine Dependence (FTND) and the number of cigarettes smoked per day (CPD), respectively. Tobacco cessation was self-reported at twelve months follow-up and biologically confirmed. Results varied according to gender. In men, low scores on Sociability predicted high ND and large number of CPD. In addition, low scores on Sensation Seeking and high scores on Impulsivity predicted also a high smoking rate at baseline. No personality traits were found to explain ND in women, but high Impulsivity–Sensation Seeking and General Activity predicted high CPD. Predictors of cessation also differed by gender. Apart from FTND level, high levels on Impulsivity predicted relapse in males. In women, high levels on Sociability predicted relapse. This model correctly classified two thirds of abstainers and relapsers for men and three fourths for women at 12 months. Furthermore an interaction between personality and gender was observed. The AFFM appears to have a substantial power for predicting cessation. Personality assessment when beginning treatment for smoking cessation could allow incorporating strategies to improve outcomes.     

Comparison of urine and hair testing for drugs of abuse in the control of abstinence in driver's license re-granting

The purpose of the study was to compare the detection rate of illicit drugs in urine and hair specimens. The samples were taken from subjects trying to regain their revoked driver's license after a drug- or alcohol-related traffic offence. In 2010, we screened 14 000 urine and 3900 hair samples for amphetamines, methamphetamines, cannabinoids, cocaine, opiates, methadone, and benzodiazepines as well as for ethylglucuronide. We used the low threshold values of the new German guidelines for Medical Psychological Assessment (MPA). Positive screening tests were confirmed with gas chromatography-mass spectrometry (GC-MS), gas chromatography-tandem mass spectrometry (GC-MS/MS) or liquid chromatography-tandem mass spectrometry (LC-MS/MS). The results show that positivity rates for methamphetamines, MDMA, cocaine, and monoacetylmorphine were 1.7-, 5.7-, 3.8- and 9.3-fold higher in hair than in urine. In contrast, the detection rate for benzodiazepines was higher in urine than in hair (oxazepam, 0.21% versus 0%, nordiazepam 0.10% versus 0.03%). The positivity rate in hair for ethylglucuronide was 6-fold (12.7%) that for urine testing (2.1%). The study reveals that in the control of abstinence in the context of driving license re-granting there are in part large differences of positivity rates for some drugs or metabolites between hair and urine samples. These differences should be kept in mind by physicians and psychologists in traffic medicine who are ordering the drug testing.     

硬膜外麻醉辅助氯胺酮复合丙泊酚用于乳腺癌根治术

目的观察硬膜外麻醉辅助氯胺酮复合丙泊酚用于乳腺癌根治术的效果及安全性。方法40例ASAⅠ～Ⅱ级择期硬膜外阻滞下实施乳腺癌根治术的患者,随机分成两组,每组20例。Ⅰ组:氟哌啶加杜冷丁分次静脉注射;Ⅱ组:氯胺酮复合丙泊酚微量注射泵连续静脉输注。Ⅰ组静注氟哌啶0.05mg/kg、杜冷丁1～1.5mg/kg,必要时追加剂量1～2次;Ⅱ组丙泊酚-氯胺酮以质量比2:1配成混合液(PK液),按丙泊酚剂量2～4mg/kg·h剂量微量注射泵连续静脉输注,根据手术进程及病人的反应调整给药速度,于手术结束前15min停止输注。术中监测心率(HR)、心电图(ECG)、血压(BP)、脉搏血氧饱和度(SPO2),同时观察麻醉效果及呼吸抑制情况,有无恶心、呕吐,眼球震颤、复视、幻觉以及记录清醒时间。术后24h记录术中有无恶梦、知晓和其他异常心理,询问病人对此麻醉方式的满意程度。结果两组患者血压、心率变化无显著性差异(P>0.05)。麻醉效果:Ⅱ组优于Ⅰ组。出现呼吸抑制:Ⅰ组6例,Ⅱ组无,两组差异显著(P<0.05)。恶心及呕吐:两组都无。麻醉恢复:Ⅰ组唤之即醒,Ⅱ组手术结束10～15min唤之能睁眼,但有多语、无力、头晕等现象。病人满意率:Ⅰ组8例,Ⅱ组18例,两组间差异显著(P<0.05)。结论硬膜外麻醉辅助氯胺酮复合丙泊酚用于乳腺癌根治术麻醉效果佳,生命体征平稳,不良反应少,安全性好。     

氟哌噻吨美利曲辛治疗氯胺酮依赖者焦虑抑郁的疗效观察

目的探讨氟哌噻吨美利曲辛治疗氯胺酮依赖者焦虑抑郁的临床疗效和安全性。方法将60例氯胺酮依赖者随机分成2组。研究组30例,予氟哌噻吨美利曲辛治疗（日剂量2～3片,bid）;对照组30例,予劳拉西泮治疗（日剂量2～4mg,bid）。疗程均为6周。于治疗前及治疗1、2、4、6周末,采用汉密尔顿焦虑量表（HAMA）和汉密尔顿抑郁量表（HAMD）进行疗效评定,用不良反应量表（TESS）和实验室检查评定安全性。结果两组6周末共脱落12例,余48例完成6周治疗。两组内HAMA、HAMD评分比较差异均有统计学意义（P〈0．05或P〈0．01）。两组间6周末比较,HAMA评分研究组和对照组分别为8．44±2．12和9．26±2．07,差异无统计学意义（P〉0．05）;HAMD评分研究组和对照组分别为9．36±2．00和11．06±2．71,差异有统计学意义（P〈0．05或P〈0．01）。两组临床疗效比较,研究组有效率为80％,对照组有效率为43％,差异有统计学意义（P〈0．05）。结论氟哌噻吨美利曲辛能够显著改善氯胺酮依赖者的焦虑抑郁情绪,安全性和耐受性较好,且无潜在药物依赖性。     

A summary of the recommendations for smoking cessation interventions: the quality assurance in the treatment of drug dependence project

This report presents outlines for approaches to smoking cessation. These recommendations are based on a meta-analysis of the treatment-outcome literature, a survey of current treatment practices and the views of a panel of experts. Face-to-face intervention to assist smokers to stop smoking needs to be considered in the context of a public policy approach to reducing the prevalence of smoking. The nature of face-to-face interventions is determined by the time available to practitioners. Where there is no time to intervene (e.g. in some primary health care settings) quality self-help materials should be prominently displayed. Where there is only 10 minutes or less, attention should be focused on personalizing the health effects of smoking, providing firm advice to quit, providing self-help material, setting a quit date (if appropriate), identifying social support for cessation and organizing a follow-up visit. If there is more time to intervene (up to one hour) the previous techniques can be expanded on and supplemented with nicotine replacement and discussion of methods for dealing with high-risk situations. Longer interventions would use all of these methods, presenting them in more detail, and may also address stress management and minimization of weight gain.     

The internet and the industrial revolution in smoking cessation counselling

The internet can provide wide access to online smoking cessation programmes developed by highly qualified professionals. Compared with one-to-one counselling in smoking cessation clinics or on telephone quitlines, the mass-level dissemination of automatised, individualised counselling on the internet is comparable to the industrial revolution, when skilled craftsmen working in small shops were replaced by huge plants. Hundreds of websites provide information and advice on smoking cessation, but very few of them have been evaluated scientifically. Therefore, it is not yet known whether web-based smoking cessation interventions are effective in the long term, and which of their components are most effective for subgroups of smokers. Claims for efficacy found on some popular websites have not been evaluated. The internet is being used increasingly by tobacco companies to promote their products. The overall effect of internet smoking cessation programs on smoking prevalence is unknown. Greater efforts should be expended to improve the reach and efficacy of smoking cessation websites. [Etter J-F. The internet and the industrial revolution in smoking cessation counselling. Drug Alcohol Rev 2006;25:79-84]