scholarly journals Evaluation of a Systems-Based Tobacco Cessation Program Using Bedside Volunteers

2018 ◽  
Vol 22 (3) ◽  
pp. 440-445 ◽  
Author(s):  
Denise S Taylor ◽  
Dominique Medaglio ◽  
Claudine T Jurkovitz ◽  
Freda Patterson ◽  
Zugui Zhang ◽  
...  
Keyword(s):  
Tobacco Cessation ◽  
Patient Characteristics ◽  
Post Discharge ◽  
Cessation Treatment ◽  
Opt Out ◽  
Artery Disease ◽  
Intent To Treat ◽  
The Cost ◽  
Referral Completion ◽  
Future Work

Abstract Introduction Hospitalization and post-discharge provide an opportune time for tobacco cessation. This study tested the feasibility, uptake, and cessation outcomes of a hospital-based tobacco cessation program, delivered by volunteers to the bedside with post-discharge referral to Quitline services. Patient characteristics associated with Quitline uptake and cessation were assessed. Methods Between February and November 2016, trained hospital volunteers approached inpatient tobacco users on six pilot units. Volunteers shared a cessation brochure and used the ASK-ADVISE-CONNECT model to connect ready to quit patients to the Delaware Quitline via fax-referral. Volunteers administered a follow-up survey to all admitted tobacco users via telephone or email at 3-months post-discharge. Results Of the 743 admitted tobacco users, 531 (72%) were visited by a volunteer, and 97% (531/547) of those approached, accepted the visit. Over one-third (201/531; 38%) were ready to quit and fax-referred to the Quitline, and 36% of those referred accepted Quitline services. At 3 months post-discharge, 37% (135/368) reported not using tobacco in the last 30 days; intent-to-treat cessation rate was 18% (135/743). In a multivariable regression model of Quitline fax-referral completion, receiving nicotine replacement therapy (NRT) during hospitalization was the strongest predictor (odds ratios [OR] = 1.97; 95% confidence interval [CI] = 1.34 to 2.90). In a model of 3-month cessation, receiving Quitline services (OR = 3.21, 95% CI = 1.35 to 7.68) and having coronary artery disease (OR = 2.28; 95% CI = 1.11 to 4.68) were associated with tobacco cessation, but a volunteer visit was not. Conclusions An “opt-out” tobacco cessation service using trained volunteers is feasible for connecting patients to Quitline services. Implications This study demonstrates the feasibility of a systems-based approach to link inpatients to evidence-based treatment for tobacco use. This model used trained bedside volunteers to connect inpatients to a state-funded Quitline after discharge that offers free cessation treatment of telephone coaching and cessation medications. Receiving NRT during hospitalization positively impacted Quitline referral, and engagement with Quitline resources was critical to tobacco abstinence post-discharge. Future work is needed to evaluate the cost-effectiveness and sustainability of this volunteer model.

scholarly journals Integration of Tobacco Treatment Services into Cancer Care at Stanford

2020 ◽  
Vol 17 (6) ◽  
pp. 2101 ◽  
Author(s):  
Kathleen Gali ◽  
Brittany Pike ◽  
Matthew S. Kendra ◽  
Cindy Tran ◽  
Priya Fielding-Singh ◽  
...  
Keyword(s):  
Cancer Care ◽  
Tobacco Cessation ◽  
Cancer Center ◽  
Treatment Services ◽  
Tobacco Treatment ◽  
Cessation Treatment ◽  
Opt Out ◽  
Patient Reported ◽  
Delivery Options ◽  
One Year

As part of a National Cancer Institute Moonshot P30 Supplement, the Stanford Cancer Center piloted and integrated tobacco treatment into cancer care. This quality improvement (QI) project reports on the process from initial pilot to adoption within 14 clinics. The Head and Neck Oncology Clinic was engaged first in January 2019 as a pilot site given staff receptivity, elevated smoking prevalence, and a high tobacco screening rate (95%) yet low levels of tobacco cessation treatment referrals (<10%) and patient engagement (<1% of smokers treated). To improve referrals and engagement, system changes included an automated “opt-out” referral process and provision of tobacco cessation treatment as a covered benefit with flexible delivery options that included phone and telemedicine. Screening rates increased to 99%, referrals to 100%, 74% of patients were reached by counselors, and 33% of those reached engaged in treatment. Patient-reported abstinence from all tobacco products at 6-month follow-up is 20%. In July 2019, two additional oncology clinics were added. In December 2019, less than one year from initiating the QI pilot, with demonstrated feasibility, acceptability, and efficacy, the tobacco treatment services were integrated into 14 clinics at Stanford Cancer Center.

The effects of long-term vigorous endurance exercise on the coronary arteries

2019 ◽  
Vol 67 (2) ◽  
Keyword(s):  
Endurance Training ◽  
Coronary Atherosclerosis ◽  
Calcium Score ◽  
The Other ◽  
Disease Phenotype ◽  
Male Athletes ◽  
Artery Disease ◽  
Future Work ◽  
Summary Data

Moderate endurance training is known to improve cardiovascular risk factors, and prolongs life expectancy. On the other hand, there has been some discussion whether “too much” exercise might have a contrarious effect by accelerating coronary atherosclerosis. The goal of this review was to evaluate the current literature on the effects of long-term vigorous endurance training on the coronary vasculature. In summary, data point to an increased calcium score, and a higher burden of atherosclerotic plaque in male athletes compared to sedentary controls. However, the plaques found in athletes were more prone to be calcified. The pathogenesis and clinical relevance of this athlete coronary artery disease phenotype remains incompletely understood and represents an area of important future work.

The effects of long-term vigorous endurance exercise on the coronary arteries

2019 ◽  
Vol 67 (2) ◽  
Keyword(s):  
Endurance Training ◽  
Coronary Atherosclerosis ◽  
Calcium Score ◽  
The Other ◽  
Disease Phenotype ◽  
Male Athletes ◽  
Artery Disease ◽  
Future Work ◽  
Summary Data

Moderate endurance training is known to improve cardiovascular risk factors, and prolongs life expectancy. On the other hand, there has been some discussion whether “too much” exercise might have a contrarious effect by accelerating coronary atherosclerosis. The goal of this review was to evaluate the current literature on the effects of long-term vigorous endurance training on the coronary vasculature. In summary, data point to an increased calcium score, and a higher burden of atherosclerotic plaque in male athletes compared to sedentary controls. However, the plaques found in athletes were more prone to be calcified. The pathogenesis and clinical relevance of this athlete coronary artery disease phenotype remains incompletely understood and represents an area of important future work.

An Analysis of the Cost-Effectiveness and Efficacy of Tobacco Cessation Aids

2007 ◽  
Author(s):  
Jason B. Brill ◽  
Jeffery Gertner ◽  
Wayne G. Horn ◽  
Marion A. Gregg
Keyword(s):  
Cost Effectiveness ◽  
Tobacco Cessation ◽  
The Cost

Progress and Prospects for the Development of Computer-Generated Actors for Military Simulation: Part 1-Introduction and Background

2003 ◽  
Vol 12 (3) ◽  
pp. 311-325 ◽  
Author(s):  
Martin R. Stytz ◽  
Sheila B. Banks
Keyword(s):  
Research Area ◽  
Background Information ◽  
Life Cycle Costs ◽  
Material Management ◽  
Reasoning System ◽  
Force Structure ◽  
The Cost ◽  
Future Work ◽  
Level Training ◽  
Made In

The development of computer-generated synthetic environments, also calleddistributed virtual environments, for military simulation relies heavily upon computer-generated actors (CGAs) to provide accurate behaviors at reasonable cost so that the synthetic environments are useful, affordable, complex, and realistic. Unfortunately, the pace of synthetic environment development and the level of desired CGA performance continue to rise at a much faster rate than CGA capability improvements. This insatiable demand for realism in CGAs for synthetic environments arises from the growing understanding of the significant role that modeling and simulation can play in a variety of venues. These uses include training, analysis, procurement decisions, mission rehearsal, doctrine development, force-level and task-level training, information assurance, cyberwarfare, force structure analysis, sustainability analysis, life cycle costs analysis, material management, infrastructure analysis, and many others. In these and other uses of military synthetic environments, computer-generated actors play a central role because they have the potential to increase the realism of the environment while also reducing the cost of operating the environment. The progress made in addressing the technical challenges that must be overcome to realize effective and realistic CGAs for military simulation environments and the technical areas that should be the focus of future work are the subject of this series of papers, which survey the technologies and progress made in the construction and use of CGAs. In this, the first installment in the series of three papers, we introduce the topic of computer-generated actors and issues related to their performance and fidelity and other background information for this research area as related to military simulation. We also discuss CGA reasoning system techniques and architectures.

scholarly journals Post-discharge tobacco cessation rates among hospitalized US veterans with and without diabetes

2012 ◽  
Vol 29 (7) ◽  
pp. e96-e101 ◽  
Author(s):  
S. A. Duffy ◽  
A. Munger ◽  
C. A. Karvonen-Gutierrez ◽  
J. D. Piette ◽  
T. A. Kao ◽  
...  
Keyword(s):  
Tobacco Cessation ◽  
Post Discharge ◽  
Us Veterans

scholarly journals Effect of Clarithromycin on Inflammatory Markers in Patients with Atherosclerosis

2003 ◽  
Vol 10 (4) ◽  
pp. 525-528 ◽  
Author(s):  
Hans F. Berg ◽  
Boulos Maraha ◽  
Gert-Jan Scheffer ◽  
Marcel F. Peeters ◽  
Jan A. J. W. Kluytmans
Keyword(s):  
Inflammatory Markers ◽  
Interleukin 2 ◽  
Patient Characteristics ◽  
Double Blind Study ◽  
Double Blind ◽  
Necrosis Factor Alpha ◽  
Treatment Groups ◽  
Reactive Protein ◽  
Factor Alpha ◽  
Artery Disease

ABSTRACT Atherosclerosis can to a certain extent be regarded as an inflammatory disease. Also, inflammatory markers may provide information about cardiovascular risk. Whether macrolide antibiotics, especially clarithromycin, have an anti-inflammatory effect in patients with atherosclerosis is not exactly known. To study this phenomenon, a placebo-controlled, randomized, double-blind study was performed. A total of 231 patients with documented coronary artery disease received a daily dose of either 500 mg of slow-release clarithromycin or placebo until the day of surgery. Levels of inflammatory markers (C-reactive protein, interleukin-2 receptor [IL-2R], IL-6, IL-8, and tumor necrosis factor alpha) were assessed during the preoperative outpatient visit, on the day of surgery, and 8 weeks after surgery. Also, changes in the levels of inflammatory markers between visits were determined by delta calculations. Baseline patient characteristics were balanced between the two treatment groups: the average age was 66 years (standard deviation [SD] = 9.0), 79% of the patients were male, and the average number of tablets used was 16 (SD = 9.3). The inflammatory markers of the groups as well as the delta calculations were not significantly changed. Treatment with clarithromycin did not influence the inflammatory markers in patients with atherosclerosis.

scholarly journals Exploring the optimal duration of video recording in a post-discharge eLearning platform for cardiac patients

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 705
Author(s):  
Borut Kirn
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Retention Rate ◽  
Local Population ◽  
Video Recording ◽  
Viewing Time ◽  
Post Discharge ◽  
Attention Span ◽  
Optimal Duration ◽  
Artery Disease

Background: On a post-discharge eLearning platform for patients with coronary artery disease, videos are used as the main educational media. Medical content takes a long time to be thoroughly explained, frequently exceeding the viewer’s attention span. To find the optimal duration for such an educational video, we studied the retention of video watching. Methods: In this study, 135 (88% male; age 62±9 years) patients with coronary artery disease actively used eLearning platform which included 60 video recordings with duration ranging from 21 sec to 303 sec. The videos were divided into two groups based on their duration (short < 100 sec and long > 100 sec). From the platform usage metadata, an average video retention rate was obtained as a ratio of video viewing time and total video duration for videos watched six times or more. Independent t-tests for mean values and f-test for variance were used to compare the groups. Results: In total, 35 (18 short and 17 long) videos were included in the study and were viewed (mean ± SD) 22 ± 11 times. The mean duration of short videos was: 80 sec ± 14 sec and of long videos it was: 160 sec ± 51 sec. The retention rate in the short and long group was 0.99 ± 0.05 and 0.94 ± 0.19 respectively. Average values were not signi­ficantly different (P = 0.33), but variances were (P < 0.05). Conclusions: This study shows that the effective attention span for a video recording of this kind, based on an eLearning set-up and local population, is up to 100 sec. Videos shorter than 100sec are mostly watched fully without a break. In contrast, longer videos are often rewound, and parts watched again or not watched to the full length at all.

scholarly journals Phone and Web-Based Tobacco Cessation Treatment: Real-World Utilization Patterns and Outcomes for 11,000 Tobacco Users

2008 ◽  
Vol 10 (5) ◽  
pp. e41 ◽  
Author(s):  
Susan M Zbikowski ◽  
Jenny Hapgood ◽  
Sara Smucker Barnwell ◽  
Tim McAfee
Keyword(s):  
Real World ◽  
Tobacco Cessation ◽  
Web Based ◽  
Cessation Treatment ◽  
Utilization Patterns

scholarly journals 992. Rethinking the 28-day HIV nPEP Dispensing Practice: A Pediatric ID Clinic Analysis

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S524-S525
Author(s):  
David Zhang ◽  
Julia Rosebush ◽  
Palak Bhagat ◽  
Allison Nelson ◽  
Veena Ramaiah ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Wholesale Price ◽  
Cost Savings ◽  
Patient Characteristics ◽  
Post Exposure Prophylaxis ◽  
Exposure Prophylaxis ◽  
The Cost ◽  
The University ◽  
Lost To Follow Up

Abstract Background In July 2017, The University of Chicago Comer Children’s Hospital Emergency Department (ED) transitioned from a 5-day to a 28-day HIV nPEP (non-occupational post-exposure prophylaxis) dispensation model in an effort to increase adherence. Anecdotal reports of patients lost to follow-up after ED discharge called into question the utility and cost-effectiveness of this practice. We analyzed HIV nPEP follow-up rates in our clinic, explored reasons for nonadherence, and performed basic cost-savings analyses to inform potential changes to our dispensation model. Methods A retrospective review of both electronic health and pharmacy records was conducted for patients prescribed 28-days of HIV nPEP in the ED and scheduled for outpatient follow-up in Pediatric ID clinic from July 2017-June 2019. Clinic provider documentation of nPEP adherence and reasons for nonadherence were examined. Patients were given an initial dose of nPEP regimen in the ED and provided all subsequent doses to complete at home. Using average wholesale price (AWP), we calculated the total cost of each regimen and potential savings if a shorter duration of HIV nPEP supply was dispensed. Results 50 patients received a 28-day supply of HIV nPEP. Please refer to Table 1 regarding baseline patient characteristics. Of these, only 19 (38%) patients had documented outpatient follow-up after nPEP initiation. Median time to follow-up was 6 days (IQR: 3.0-9.0 days). Of the 19 patients with follow-up, 3 admitted to medication non-adherence. Although side effects were elicited in a total of 9 patients (18%), only 1 cited medication intolerance as the reason for discontinuing their nPEP. Given the relatively short time to follow-up, a potential savings of $1720-2211/patient could be achieved if a 10-14 day supply was dispensed. Conclusion Outpatient follow-up after 28-day HIV nPEP dispensation in our ED was &lt; 40%, calling into question the cost-effectiveness of this dispensation model. While our current practice alleviates nPEP interruption due to potential insurance issues and pick-up delays, follow-up and adherence are not assured. The significant cost-savings with a shorter supply at the outset may encourage more robust follow-up and adherence. Disclosures All Authors: No reported disclosures

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