scholarly journals Improving smoking cessation after myocardial infarction by systematically implementing evidence-based treatment methods: a prospective observational cohort study

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Leosdottir ◽  
S Warjerstam ◽  
H Ogmundsdottir Michelsen ◽  
M Schlyter ◽  
E Hag ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Smoking Cessation ◽  
Recurrent Event ◽  
Optimal Dosage ◽  
Evidence Based ◽  
Effective Measure ◽  
Treatment Methods ◽  
Evidence Based Treatment ◽  
Before And After

Abstract Background For smokers who suffer a myocardial infarction (MI), smoking cessation is the most effective measure to reduce recurrent event risk. Still, evidence-based treatment methods for aiding smoking cessation post-MI are underused. Purpose To compare the odds of smoking cessation at two-months post-MI before and after implementing a set of pre-specified routines for optimization of evidence-based treatment methods for smoking cessation, with start during admission. Methods Structured routines for early smoking cessation counselling and treatment optimization were implemented at six cardiac rehabilitation (CR) centres in Sweden. The routines included CR nurses providing current smokers hospitalized for acute MI with short consultation, written material, and optimal dosage of nicotine replacement therapy during admission, increasing early prescription of varenicline for eligible patients, and contacting the patients by telephone 3–5 days after discharge, after which usual care CR follow-up commenced. Centres were also encouraged to strive for continuity in nurse-patient care. Patient data was retrieved from the SWEDEHEART registry and medical records. Using logistic regression, we compared the odds for smoking cessation at two-months post-MI for currently smoking patients admitted with MI (a) before (n=188, median age 60 years, 23% females) and (b) after (n=195, median age 60 years, 29% females) routine implementation. Secondary outcomes included adherence to implemented routines and the association of each routine with smoking cessation odds at two-months. Results In total, 159 (85%) and 179 (92%) of enrolled patients attended the two-month CR follow-up, before and after implementation of the new routines. After implementation, a significantly larger proportion of patients (65% vs 54%) were abstinent from smoking at two-months (crude OR 1.60 [1.04–2.48], p=0.034) (Figure 1). Including only those counselled during admission (n=89), 74% (vs 54%) were abstinent at two-months (crude OR 2.50 [1.42–4.41], p=0.002). After the new routine implementation patients were counselled more frequently during admission (50% vs 6%, p<0.001), prescribed varenicline at discharge or during follow-up (23% vs 7%, p<0.001), and contacted by telephone during the first week post-discharge (18% vs 2%, p<0.001), compared to before implementation. Crude and adjusted associations between each routine and smoking cessation at two-months are shown in Table 1. Entering all routines into the regression model simultaneously, being prescribed varenicline before discharge or during follow-up had the strongest independent association with smoking abstinence at two-months (adjusted OR 4.09 [1.68–10.00], p=0.002). Conclusion Our results support that readily available methods for aiding smoking cessation can be implemented effectively in routine practice, with possible beneficial effects on smoking cessation for the high-risk group of smoking MI patients. FUNDunding Acknowledgement Type of funding sources: Foundation. Main funding source(s): The Swedish Heart and Lung AssociationPfizer AB

scholarly journals Improving Smoking Cessation After Myocardial Infarction by Systematically Implementing Evidence-Based Treatment Methods: A Retrospective Observational Cohort Study

2021 ◽  
Author(s):  
Margret Leosdottir ◽  
Sanne Wärjerstam ◽  
Halldora Ögmundsdottir Michelsen ◽  
Mona Schlyter ◽  
Emma Hag ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Smoking Cessation ◽  
Cardiac Rehabilitation ◽  
Post Myocardial Infarction ◽  
Optimal Dosage ◽  
Evidence Based ◽  
Post Discharge ◽  
Treatment Methods ◽  
Evidence Based Treatment

Abstract Background: Evidence-based methods for aiding smoking cessation post-myocardial infarction are effective yet underused in clinical practice. We compared the odds of smoking cessation at 2-months post-myocardial infarction before versus after implementing a set of pre-specified routines optimizing evidence-based treatment methods for smoking cessation, initiated during admission. Methods: Structured routines for early smoking cessation counselling and treatment optimization were implemented at six cardiac rehabilitation centres in Sweden. The routines included cardiac rehabilitation nurses providing current smokers hospitalized for acute myocardial infarction with short consultation, written material, and optimal dosage of nicotine replacement therapy during admission, increasing early prescription of varenicline for eligible patients, and contacting the patients by telephone 3-5 days after discharge, after which usual care follow-up commenced. Centres were also encouraged to strive for continuity in nurse-patient care. Using logistic regression, we compared the odds for smoking cessation at 2-months post-discharge for currently smoking patients admitted (a) before (n=188, median age 60 years, 23% females) and (b) after (n=195, median age 60 years, 29% females) routine implementation. Secondary outcomes included adherence to implemented routines and the association of each routine with smoking cessation odds at 2-months.Results: In total, 159 (85%) and 179 (92%) of enrolled patients attended the 2-month follow-up, before and after implementation of the new routines. After implementation, a significantly larger proportion of patients (65% vs 54%) were abstinent from smoking at 2-months (OR 1.60 [1.04-2.48], p=0.034). Including only those counselled during admission (n=89), 74% (vs 54%) were abstinent at 2-months (OR 2.50 [1.42-4.41], p=0.002). After the new routine implementation patients were counselled more frequently during admission (50% vs 6%, p<0.001), prescribed varenicline at discharge or during follow-up (23% vs 7%, p<0.001), and contacted by telephone during the first week post-discharge (18% vs 2%, p<0.001), compared to before. Being prescribed varenicline before discharge or during follow-up had the strongest independent association with smoking abstinence at 2-months (adjusted OR 4.09 [1.68-10.00], p=0.002).Conclusions: Our results support that readily available methods for aiding smoking cessation can be implemented effectively in routine practice, with possible beneficial effects on smoking cessation for the high-risk group of smoking myocardial infarction patients.

scholarly journals Improving smoking cessation after myocardial infarction by systematically implementing evidence-based treatment methods

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Margret Leosdottir ◽  
Sanne Wärjerstam ◽  
Halldora Ögmundsdottir Michelsen ◽  
Mona Schlyter ◽  
Emma Hag ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Smoking Cessation ◽  
Prognostic Value ◽  
Routine Practice ◽  
Evidence Based ◽  
Post Discharge ◽  
Evidence Based Treatment ◽  
Beneficial Effects ◽  
Before And After ◽  
Secondary Outcomes

AbstractWe compared the odds of smoking cessation at 2-months post-myocardial infarction (MI), before and after implementing routines optimizing use of evidence-based smoking cessation methods, with start during admission. The following routines were implemented at six Swedish hospitals: cardiac rehabilitation nurses offering smokers consultation during admission, optimizing nicotine replacement therapy and varenicline prescription, and contacting patients by telephone during the 1st week post-discharge. Using logistic regression, odds for smoking cessation at 2-months before (n smokers/n admitted = 188/601) and after (n = 195/632) routine implementation were compared. Secondary outcomes included adherence to implemented routines and assessing the prognostic value of each routine on smoking cessation. After implementation, a larger proportion of smokers (65% vs. 54%) were abstinent at 2-months (OR 1.60 [1.04–2.48]). Including only those counselled during admission (n = 98), 74% were abstinent (2.50 [1.42–4.41]). After implementation, patients were more often counselled during admission (50% vs. 6%, p < 0.001), prescribed varenicline (23% vs. 7%, p < 0.001), and contacted by telephone post-discharge (18% vs. 2%, p < 0.001). Being contacted by telephone post-discharge (adjusted OR 2.74 [1.02–7.35]) and prescribed varenicline (adjusted OR 0.39 [0.19–0.83]) predicted smoking cessation at 2-months. In conclusion, readily available methods for aiding smoking cessation can be implemented effectively in routine practice, with beneficial effects for post-MI patients.

scholarly journals Improving Smoking Cessation After Myocardial Infarction by Systematically Implementing Evidence-Based Treatment Methods: A Retrospective Observational Cohort Study

2021 ◽  
Author(s):  
Margret Leosdottir ◽  
Sanne Wärjerstam ◽  
Halldora Michelsen ◽  
Mona Schlyter ◽  
Emma Hag ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Smoking Cessation ◽  
High Risk Group ◽  
Routine Practice ◽  
Evidence Based ◽  
Post Discharge ◽  
Beneficial Effects ◽  
Before And After ◽  
Observational Cohort ◽  
Short Consultation

Abstract We compared the odds of smoking cessation at 2-months post-myocardial infarction (MI) before and after implementing routines, optimizing the use of evidence-based methods for smoking cessation, with start during admission. The following routines were implemented at six hospitals in Sweden: cardiac rehabilitation nurses offering smokers short consultation during admission, optimizing nicotine replacement therapy, increasing prescription of varenicline, and contacting patients by telephone during the 1st week post-discharge. Using logistic regression, odds for smoking cessation at 2-months post-MI before (n = 188) and after (n = 195) routine implementation were compared. Secondary outcomes included adherence to implemented routines. After implementation, a larger proportion of patients (65% vs 54%) were abstinent at 2-months (OR 1.60 [1.04–2.48], p = 0.034). Including only those counselled during admission, 74% were abstinent (OR 2.50 [1.42–4.41], p = 0.002). After implementation patients were more often counselled during admission (50% vs 6%, p < 0.001), prescribed varenicline (23% vs 7%, p < 0.001), and contacted by telephone post-discharge (18% vs 2%, p < 0.001). Being prescribed varenicline had the strongest association with smoking abstinence at 2-months (adjusted OR 4.09 [1.68-10.00], p = 0.002). In conclusion, readily available methods for aiding smoking cessation can be implemented effectively in routine practice, with beneficial effects on smoking cessation for the high-risk group of smoking MI patients.

scholarly journals AB0571 IS RITUXIMAB AN ADEQUATE GLUCOCORTICOID SPARING AGENT IN IDIOPATHIC INFLAMMATORY MYOPATHIES?

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1582.1-1582
Author(s):  
B. H. Egeli ◽  
S. Ergun ◽  
Y. K. Gursoy ◽  
A. Cetin ◽  
S. Ugurlu
Keyword(s):  
Disease Activity ◽  
Alternative Treatment ◽  
Statistical Power ◽  
Signs And Symptoms ◽  
Small Sample ◽  
Idiopathic Inflammatory Myopathies ◽  
Inflammatory Myopathies ◽  
Treatment Methods ◽  
Before And After

Background:Idiopathic inflammatory myopathies (IIM) are essentially treated aiming improvement of muscle function and extra muscular disease manifestations. The backbone of the treatment is corticosteroids enhancing the survival and patient quality of life. The lack of consensus on target-specific immunosuppressive treatment highlights the need for further studies evaluating alternative treatment methods. Rituximab is potentially a glucocorticoid-sparing agent which was reviewed in multiple studies with small sample sizes due to the rarity of the disease.Objectives:Higher statistical power can enhance the trustworthiness of alternative treatment methods yielding the main objective of this study.Methods:This retrospective study was conducted at a tertiary rheumatology center. Patients were diagnosed with an idiopathic inflammatory myopathy (dermatomyositis [DM], polymyositis [PM]) and were treated with rituximab in order to be included in this study. Clinical signs and symptoms of the presentation were noted during the first patient encounter as well as the follow-up. Parameters of disease activity including acute phase reactants, muscle enzyme levels, and disease-specific autoantibodies were analyzed.Results:The study includes 28 patients (20 DM, 8 PM). The age of diagnosis was 43.44 ± 15.77 years, follow-up duration was 60.7 ± 70.7 months. The presenting signs and symptoms of the patients are shown in Figure 1. The parameters of disease activity before and after treatment are summarized in Table 1. The mean corticosteroid dose decreased from 31.429 ±23.934 mg to 10.278 ±12.001 (p=0.001). Other treatment methods were methotrexate (n=18), Intravenous Immunoglobulin (IVIG) (n=7), and cyclophosphamide (n=2). There were not any deaths during the follow-up. Two patients were lost to follow-up.Table 1.The Parameters of Disease Activity Before and After TreatmentBefore TreatmentAfter TreatmentP ValueCPK, mean ± std (U/L)1426 ± 2049.92263.44 ± 265.630.004LDH, mean ± std (U/L)557.5 ± 365379.78 ± 192.10.03AST, mean ± std (U/L)62.52 ± 5930.16 ± 27.590.01ALT, mean ± std (U/L)56.48 ± 49.2127.64 ± 24.520.008ESR, mean ± std (mm/hour)26.38 ± 28.9820.39 ± 18.760.36CRP, mean ± std (mg/L)19.23 ± 46.1512.53 ± 26.670.5RF, mean ± std (U/mL)0 (0)N/AN/AANA, n (%)3 (10.71)N/AN/AFigure 1.The Presenting Signs and Symptoms of the PatientsConclusion:Rituximab is shown to be effective in treating myositis along with corticosteroids as well as a corticosteroid-sparing agent in retrospective studies and open-label clinical trials; however, lack of statistical power should be underlined. Long term decrease in steroid use and decrease in disease activity markers hints the effective use of rituximab as a glucocorticoid sparing agent as well as its safety with minimal side effects.Disclosure of Interests:None declared

scholarly journals Electronic cigarettes in standard smoking cessation treatment by tobacco counselors in Flanders: E-cigarette users show similar if not higher quit rates as those using commonly recommended smoking cessation aids

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Karolien Adriaens ◽  
Eline Belmans ◽  
Dinska Van Gucht ◽  
Frank Baeyens
Keyword(s):  
Smoking Cessation ◽  
Cohort Study ◽  
Replacement Therapy ◽  
Electronic Cigarettes ◽  
Evidence Based ◽  
Smoking Abstinence ◽  
Smoking Cessation Treatment ◽  
Cessation Treatment ◽  
Point Prevalence Abstinence

Abstract Background This interventional-cohort study tried to answer if people who smoke and choose an e-cigarette in the context of smoking cessation treatment by tobacco counselors in Flanders are achieving smoking abstinence and how they compare to clients who opt for commonly recommended (or no) aids (nicotine replacement therapy, smoking cessation medication). Methods Participants were recruited by tobacco counselors. They followed smoking cessation treatment (in group) for 2 months. At several times during treatment and 7 months after quit date, participants were asked to fill out questionnaires and to perform eCO measurements. Results One third of all participants (n = 244) achieved smoking abstinence 7 months after the quit date, with e-cigarette users having higher chances to be smoking abstinent at the final session compared to NRT users. Point prevalence abstinence rates across all follow-up measurements, however, as well as continuous and prolonged smoking abstinence, were similar in e-cigarette users and in clients having chosen a commonly recommended (or no) smoking cessation aid. No differences were obtained between smoking cessation aids with respect to product use and experiences. Conclusions People who smoke and choose e-cigarettes in the context of smoking cessation treatment by tobacco counselors show similar if not higher smoking cessation rates compared to those choosing other evidence-based (or no) smoking cessation aids.

scholarly journals Evaluating the Impact of Training Health Professionals to Deliver Brief Motivational and Skills-Based Interventions for Cannabis Use Disorder

2012 ◽  
Vol 2 ◽  
Author(s):  
Dion Alperstein ◽  
Jan Copeland
Keyword(s):  
Clinical Training ◽  
Health Workers ◽  
Clinical Skills ◽  
Cannabis Use ◽  
Evidence Based ◽  
Transfer Of Knowledge ◽  
Evidence Based Treatment ◽  
Cognitive Behavioural ◽  
The Impact

Background: While there is considerable evidence that brief motivational and skills-based interventions for substance use are effective, little is known regarding the transfer of knowledge from research to practice. This study aims to evaluate the effectiveness of two half-day didactic clinical training workshops for allied health workers, which did not incorporate feedback or supervision, via independent follow-up three months post training.Methods: In total, 1322 participants attended either or both of the evidence-based treatment workshops run by the National Cannabis Prevention and Information Centre. Of those participants, 495 (37%) completed an online follow-up evaluation three months later regarding their use of the newly learnt intervention(s).Results: At follow-up, 270 (54.5%) participants had an opportunity to use the skills and 144 (53.3%) of those participants reported having used the clinical skills taught in the workshop. Of those who used one of the interventions, 90 (62.5%) participants reported their clients had reduced or quit their cannabis use. Furthermore, 43 (30%) of these participants had attempted to train others in the workplace in the techniques learnt in the workshop.Conclusion: Even a half-day didactic clinical training workshop on evidence-based brief cognitive–behavioural techniques delivered to clinicians working in the field can improve knowledge and confidence among clinicians and outcomes among their clients with cannabis use related problems.

Temporal trends between association of evidence-based treatment and outcomes in patients with non-ST-elevation myocardial infarction

2018 ◽  
Vol 260 ◽  
pp. 1-6 ◽  
Author(s):  
Belén Alvarez-Alvarez ◽  
Charigan Abou Jokh Casas ◽  
Jose María Garcia Acuña ◽  
Belén Cid Alvarez ◽  
Rosa María Agra Bermejo ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Temporal Trends ◽  
St Elevation Myocardial Infarction ◽  
Evidence Based ◽  
Evidence Based Treatment ◽  
St Elevation

scholarly journals Cessation from Smoking Improves Innate Host Defense and Clearance of Experimentally Inoculated NasalStaphylococcus aureus

2018 ◽  
Vol 86 (4) ◽  
Author(s):  
Amy L. Cole ◽  
Mary Schmidt-Owens ◽  
Ashley C. Beavis ◽  
Christine F. Chong ◽  
Patrick M. Tarwater ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Interleukin 1 ◽  
Nasal Carriage ◽  
The United States ◽  
Content Type ◽  
Time Period ◽  
Serious Infections ◽  
Before And After ◽  
Enhanced Expression

ABSTRACTStaphylococcus aureusnasal carriage is transient in most humans and usually benign, but dissemination ofS. aureusto extranasal sites causes the majority of clinical infections, andS. aureusis a major cause of serious infections in the United States. A better understanding of innate nasal decolonization mechanisms is urgently needed, as are relevant models for studyingS. aureusclearance. Here, we screened a population of healthy smokers for nasalS. aureuscarriage and compared the participants' abilities to clear experimentally applied nasalS. aureusbefore and after completion of a smoking cessation program. We determined that cigarette smoking increases the mean nasalS. aureusload (2.6 × 104CFU/swab) compared to the load observed in healthy nonsmokers (1.7 × 103CFU/swab) and might increase the rate ofS. aureusnasal carriage in otherwise-healthy adults: 22 of 99 smokers carriedS. aureusat the screening visit, while only 4 of 30 nonsmokers screened positive during the same time period. Only 6 of 19 experimental inoculation studies in active smokers resulted inS. aureusclearance within the month of follow-up, while in the cessation group, 6 of 9 subjects cleared nasalS. aureusand carriage duration averaged 21 ± 4 days. Smoking cessation associated with enhanced expression ofS. aureus-associated interleukin-1β (IL-1β) and granulocyte colony-stimulating factor (G-CSF) in nasal fluids. Participants who failed to clearS. aureusexhibited a higher nasalS. aureusload and elevated nasal interleukin-1 receptor antagonist (IL-1RA) expression at the preexperiment study visits. We conclude that smokers exhibit higherS. aureusloads than nonsmokers and that innate immune pathways, including G-CSF expression and signaling through the IL-1 axis, are important mediators of nasalS. aureusclearance.

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