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      Teaching Residents how to Effectively Prescribe Nicotine Replacement Therapy on the Clinical Teaching Unit

      , , , , ,
      Canadian Journal of General Internal Medicine
      Dougmar Publishing Group, Inc.

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          Abstract

          Residents and medical students identified a lack of knowledge regarding Nicotine Replacement Therapy (NRT) as a barrier to smoking cessation counselling. We hypothesized that a teaching session on NRT during an inpatient Internal Medicine rotation would increase learner comfort in prescribing these products. Medical trainees on the Internal Medicine Clinical Teaching Unit (CTU) attended a teaching session during week 4 of an 8-week rotation. Pharmacy records from the 8-week period were retrospectively analyzed to determine NRT prescribing behaviour. Pre-intervention, 5.8% (13/225) of new admissions received a NRT prescription. Post-intervention, 17% (31/182) of new admissions received a NRT prescription. Using a Fisher’s exact test, the percentage of new admissions that received a prescription was significantly different (p<0.001) between the pre- and post-intervention time frames. This data suggests that integrating education on NRT into CTU teaching can significantly alter prescribing behaviour and improve access to NRT for patients who need it.

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          Developing COPD: a 25 year follow up study of the general population.

          Smokers are more prone to develop chronic obstructive pulmonary disease (COPD) than non-smokers, but this finding comes from studies spanning 10 years or less. The aim of this study was to determine the 25 year absolute risk of developing COPD in men and women from the general population. As part of the Copenhagen City Heart Study, 8045 men and women aged 30-60 years with normal lung function at baseline were followed for 25 years. Lung function measurements were collected and mortality from COPD during the 25 year observation period was analysed. The percentage of men with normal lung function ranged from 96% of never smokers to 59% of continuous smokers; for women the proportions were 91% and 69%, respectively. The 25 year incidence of moderate and severe COPD was 20.7% and 3.6%, respectively, with no apparent difference between men and women. Smoking cessation, especially early in the follow up period, decreased the risk of developing COPD substantially compared with continuous smoking. During the follow up period there were 2912 deaths, 109 of which were from COPD. 92% of the COPD deaths occurred in subjects who were current smokers at the beginning of the follow up period. The absolute risk of developing COPD among continuous smokers is at least 25%, which is larger than was previously estimated.
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            The surgeon general report on smoking and health 50 years later: breast cancer and the cost of increasing caution.

            Despite the Surgeon General's strong track record and the rapidly expanding body of solid scientific work demonstrating that smoking caused a wide range of diseases, the decision making process for concluding "causality" in Surgeon General reports has become increasingly cautious and defensive. Whereas, the 1964 report did not conclude that smoking caused heart disease, it recommended that "from the public health viewpoint [one should] assume that the established association has causative meaning rather than to suspend judgment until no uncertainty remains," the de facto practice has become to do just the opposite. In particular, the 2004 report reached an affirmative negative conclusion that active smoking did not cause breast cancer and the 2006 report on passive smoking only found the link "suggestive." In contrast, in 2005 the California EPA found both active and passive smoking caused breast cancer in younger women. The evidence has continued to strengthen since 2005: there are now 12 large cohort studies that consistently demonstrate a dose-response relationship with smoking before first birth and increased breast cancer risk. The Surgeon General's increasing caution is preventing young women around the world from appreciating the risks that smoking and secondhand smoke pose for developing breast cancer.
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              Evaluation of a hospital-based tobacco treatment service: outcomes and lessons learned.

              The efficacy of smoking cessation interventions for hospital patients has been well described, but we know little regarding implementation and outcomes of real-world programs. To describe the services provided and outcomes of an academic medical center-based tobacco treatment service (UKanQuit) located in the Midwestern United States. This is a descriptive observational study. Both quantitative and qualitative data of all patients treated by UKanQuit over a 1-year period were analyzed. Among 513 patients served, average interest in quitting was 7.9, standard deviation (SD) 2.9 on a scale of 0 to 10. More than 1 in 4 had been given an in-hospital medication to ameliorate withdrawal prior to seeing a counselor. Counselors recommended medication changes for 1 in 3 patients, helped 73% set a goal for quitting or reducing tobacco use, and fax referred 56% to quitlines. Six-month follow-up (response rate, 46%) found a 7-day abstinence rate of 32% among respondents for an intent-to-treat abstinence rate of 15%. Post-discharge, 74% made at least one serious quit attempt, 34% had used a quit smoking medication, but only 5% of those referred to the quitline reported using it. In a hospital setting, interest in quitting is high among smokers who requested to see a tobacco counselor but administration of inpatient medications remains low. Many smokers are making unassisted quit attempts post-discharge because utilization of cessation medications and quitline counseling were low. Fax-referral to quitline may not, on its own, fulfill guideline recommendations for post-discharge follow-up. Copyright © 2010 Society of Hospital Medicine.
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                Author and article information

                Journal
                Canadian Journal of General Internal Medicine
                Can Journ Gen Int Med
                Dougmar Publishing Group, Inc.
                2369-1778
                1911-1606
                November 13 2018
                October 15 2018
                : 13
                : 4
                : e17-e20
                Article
                10.22374/cjgim.v13i4.271
                dc00ba77-1010-450b-a374-e4302fb81cb9
                © 2018

                Copyright of articles published in all DPG titles is retained by the author. The author grants DPG the rights to publish the article and identify itself as the original publisher. The author grants DPG exclusive commercial rights to the article. The author grants any non-commercial third party the rights to use the article freely provided original author(s) and citation details are cited. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc/4.0/


                General medicine,Geriatric medicine,Neurology,Internal medicine
                General medicine, Geriatric medicine, Neurology, Internal medicine

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