scholarly journals Best Practices for Smoking Cessation Interventions in Primary Care

2009 ◽  
Vol 16 (4) ◽  
pp. 129-134 ◽  
Author(s):  
Andrew McIvor ◽  
John Kayser ◽  
Jean-Marc Assaad ◽  
Gerald Brosky ◽  
Penny Demarest ◽  
...  

BACKGROUND: In Canada, smoking is the leading preventable cause of premature death. Family physicians and nurse practitioners are uniquely positioned to initiate smoking cessation. Because smoking is a chronic addiction, repeated, opportunity-based interventions are most effective in addressing physical dependence and modifying deeply ingrained patterns of beliefs and behaviour. However, only a small minority of family physicians provide thorough smoking cessation counselling and less than one-half offer adjunct support to patients.OBJECTIVE: To identify the key steps family physicians and nurse practitioners can take to strengthen effective smoking cessation interventions for their patients.METHODS: A multidisciplinary panel of health care practitioners involved with smoking cessation from across Canada was convened to discuss best practices derived from international guidelines, including those from the United States, Europe, and Australia, and other relevant literature. The panellists subsequently refined their findings in the form of the present article.RESULTS: The present paper outlines best practices for brief and effective counselling for, and treatment of, tobacco addiction. By adopting a simple series of questions, taking 30 s to 3 min to complete, health care professionals can initiate smoking cessation interventions. Integrating these strategies into daily practice provides opportunities to significantly improve the quality and duration of patients’ lives.CONCLUSION: Tobacco addiction is the most important preventable cause of morbidity and mortality in Canada. Family physicians, nurse practitioners and other front-line health care professionals are well positioned to influence and assist their patients in quitting, thereby reducing the burden on both personal health and the public health care system.

2012 ◽  
Vol 25 (6) ◽  
pp. 591-599 ◽  
Author(s):  
William P. Wynn ◽  
Ron T. Stroman ◽  
Michaela M. Almgren ◽  
Kelly J. Clark

Annually there are 500 000 preventable deaths in the United States caused by smoking; as health care professionals, pharmacists have a unique opportunity to advise, assess, and assist patients to quit smoking. This review article provides pharmacists with a “toolbox” containing an overview of pharmacologic and nonpharmacologic methods for smoking cessation. Currently approved over-the-counter (OTC) and prescription medications (nicotine replacement therapy, varenicline, and bupropion) are summarized, and nonpharmacologic therapies discussed include cognitive therapy and hypnosis. In addition to traditional therapies some potential approaches to smoking cessation are addressed, including nicotine immunizations and electronic cigarettes.


2020 ◽  
Vol 51 (1) ◽  
pp. 62-67 ◽  
Author(s):  
Yonatan Weiss ◽  
Bonnie Bristow ◽  
Dalia Limor Karol ◽  
Margaret Fitch ◽  
Alison McAndrew ◽  
...  

Author(s):  
Kelly Potteiger ◽  
Adam Potteiger ◽  
William Pitney ◽  
Paul Wright

There is legislation in the United States designed to protect children and adolescents from the risks associated with concussion. The scope and reach of these laws vary greatly. Purpose: It is important that health care professionals are aware of the limitations of each law. Since 2009, every state in the nation and the District of Columbia passed legislation designed to protect student-athletes who suffer from concussions resulting from participation in sport. Method: Therefore, select components of state policies were identified including: 1) Affected entities, 2) Stipulations for concussion awareness/education, 3) Requirements for removal/return to play, and 4) Requirements for return to the classroom. Results: There is significant variance between the laws and not all children/adolescents are protected equally. Conclusion: Concussion policies are a minimum standard and, when available, best practices should be followed.


2021 ◽  
Vol 15 ◽  
pp. 117954682110152
Author(s):  
Jose Nativi-Nicolau ◽  
Nitasha Sarswat ◽  
Johana Fajardo ◽  
Muriel Finkel ◽  
Younos Abdulsattar ◽  
...  

Background: Because transthyretin amyloid cardiomyopathy (ATTR-CM) poses unique diagnostic and therapeutic challenges, referral of patients with known or suspected disease to specialized amyloidosis centers is recommended. These centers have developed strategic practices to provide multidisciplinary comprehensive care, but their best practices have not yet been well studied as a group. Methods: A qualitative survey was conducted by telephone/email from October 2019 to February 2020 among eligible healthcare providers with experience in the management of ATTR-CM at US amyloidosis centers, patients with ATTR-CM treated at amyloidosis centers, and patient advocates from amyloidosis patient support groups. Results: Fifteen cardiologists and 9 nurse practitioners/nurses from 15 selected amyloidosis centers participated in the survey, with 16 patients and 4 patient advocates. Among participating healthcare providers, the most frequently cited center best practices were diagnostic capability, multidisciplinary care, and time spent on patient care; the greatest challenges involved coordination of patient care. Patients described the “ideal” amyloidosis program as one that provides physicians with expertise in ATTR-CM, sufficient time with patients, comprehensive patient care, and opportunities to participate in research/clinical trials. The majority of centers host patient support group meetings, and patient advocacy groups provide support for centers with physician/patient education and research. Conclusions: Amyloidosis centers offer comprehensive care based on staff expertise in ATTR-CM, a multidisciplinary approach, advanced diagnostics, and time dedicated to patient care and education. Raising awareness of amyloidosis centers’ best practices among healthcare providers can reinforce the benefits of early referral and comprehensive care for patients with ATTR-CM.


1985 ◽  
Vol 11 (2) ◽  
pp. 195-225
Author(s):  
Karla Kelly

AbstractUntil recently, physicians have been the primary health care providers in the United States. In response to the rising health care costs and public demand of the past decade, allied health care providers have challenged this orthodox structure of health care delivery. Among these allied health care providers are nurse practitioners, who have attempted to expand traditional roles of the registered nurse.This article focuses on the legal issues raised by several major obstacles to the expansion of nurse practitioner services: licensing restrictions, third party reimbursement policies, and denial of access to medical facilities and physician back-up services. The successful judicial challenges to discriminatory practices against other allied health care providers will be explored as a solution to the nurse practitioners’ dilemma.


2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1952.2-1952
Author(s):  
B. A. Esbensen ◽  
I. K. Roelsgaard ◽  
S. K. Larsen ◽  
T. Thomsen

Background:Smoking is one of the most significant modifiable exosomes risk factors for rheumatoid arthritis (RA) (1). Studies suggest that 25-30% of people with RA in Denmark smoke (2). This is almost twice as many as in the background population in Denmark. People with RA have a significant increased risk of severe comorbidity including cardiovascular disease. In addition, there are indications that smokers with RA have a poorer effect of the medical inflammatory treatment compared to non-smokers, and consequently more difficult to achieve remission of the disease activity (3). Tobacco addiction is complex and can be a challenge in smoking cessation. In addition to physiological dependence, habits and social and environmental factors may influence addiction. Tobacco smoking is associated with an addiction to nicotine and it is unexplored how this addiction appears in people with RA.Objectives:The aim of this study was to examine from the patient’s perspective how tobacco addiction appears in people with rheumatoid arthritis.Methods:We conducted a qualitative study based on a hermeneutics approach. People with RA who previously had participated in a randomized controlled study (4) about smoking cessation conducted at the Center for Rheumatology and Spine Diseases at Rigshospitalet, Denmark were recruited for semi-structured interviews.Results:In total, 12 people with RA (50% female) were included in the study. The median age was 62 years and median RA disease duration was 12 years. The degree of physical dependence measured by Fagerströms Test for Nicotine dependence (FTND) was on average: 4.9 (score: 0-10, 0=nonphysical dependence).Three categories of how tobacco addiction appeared emerged during the analysis: 1)It develops into ingrown habitsreferring to the fact that smoking already in adolescence contributes to the development of specific physical, mental and social smoking behavior. Not all individuals considered themselves addicted to nicotine as they did not necessarily connect the nicotine to the ingrown habits. 2)The body craves for nicotinereferring to nicotine proved calming, while a lacking or insufficient dose caused withdrawal symptoms. Furthermore, smoking became a habit where a craving for smoking occurred in certain situations. 3)Ambivalence – for and againstreferring to the physical dependence and smoking habits making a smoking cessation difficult. Dependency to nicotine and challenges to quit smoking led to a feeling of ambivalence and a lack of control.Conclusion:Tobacco addiction appeared as a physical dependence and a habit, which, during a smoking cessation, led to ambivalent feelings. Therefore, based on this study, there is still a need for health professionals to talk to patients about smoking. But also, a need to articulate the complexity of addiction in order to support for smoking cessations. Information should be strengthened in the clinical practice in relation to nicotine’s implication in tobacco addiction as well as the consequences of tobacco smoking for individuals with RA.References:[1]Scott DL, Wolfe F, Huizinga TW. Lancet. 2010 ###[2]Loppenthin K, Esbensen BA, Jennum P, Ostergaard M, Tolver A, Thomsen T, et al. Clin Rheumatol. 2015. ###[3]Roelsgaard IK, Ikdahl E, Rollefstad S, Wibetoe G, Esbensen BA, Kitas GD, et al. Rheumatology (Oxford). 2019. ###[4]Roelsgaard IK, Thomsen T, Ostergaard M, Christensen R, Hetland ML, Jacobsen S, et al. Trials. 2017;18(1):570.###Disclosure of Interests:None declared


PEDIATRICS ◽  
1993 ◽  
Vol 91 (5) ◽  
pp. ii-ii

In June 1992, 35 health care professionals, child and disability advocates, researchers, clinicians, and parents met at Wingspread Center in Racine, Wisconsin, for an invitational conference on Culture and Chronic Illness in Childhood. The meeting had as its goal the identification of the state of knowledge on the interface between culture, chronic illness, child development, and family functioning so as to lay the foundations for "culturally appropriate" health policy formulation, "culturally sensitive" services, and "culturally competent" clinicians. The purpose of this special supplement is to establish a national agenda for research, policy, service delivery, and training in addressing the needs of all children with chronic illnesses and disabilities that takes the family, ethnicity, socioeconomic status, and culture into full account. To meet this task, five papers were commissioned. The first, by Newacheck et al, addresses the changes in incidence and prevalence of chronic illness and disability among children and youth by ethnic group. The second paper, by McManus et al, focuses on the trends in health services organization, delivery, and financing as they vary among ethnic groups in the United States. What emerges is a rhetoric of cultural sensitivity not paralleled in the organization or financing of health services. Groce and Zola's paper addresses how cultural attitudes and beliefs are the foundations of our perceptions about health and illness. Those perceptions at times are predisposed to conflict with a health care professional who, coming from a different culture, may hold different norms and beliefs. Brookins grounds her discussion within the context of child development and argues that for a child of color or one whose ethnic heritage is other than mainstream, the key to developmental success is bicultural competence—the ability to walk in and between two worlds.


2018 ◽  
Vol 38 (6) ◽  
pp. e1-e4 ◽  
Author(s):  
Christina Canfield ◽  
Sandra Galvin

Since 2010, health care organizations have rapidly adopted telemedicine as part of their health care delivery system to inpatients and outpatients. The application of telemedicine in the intensive care unit is often referred to as tele-ICU. In telemedicine, nurses, nurse practitioners, physicians, and other health care professionals provide patient monitoring and intervention from a remote location. Tele-ICU presence has demonstrated positive outcomes such as increased adherence to evidence-based care and improved perception of support at the bedside. Despite the successes, acceptance of tele-ICU varies. Known barriers to acceptance include perceptions of intrusiveness and invasion of privacy.


2007 ◽  
Vol 42 (9) ◽  
pp. 832-840 ◽  
Author(s):  
Lor Siv-Lee ◽  
Linda Morgan

Purpose This paper describes the implementation of wireless “intelligent” pump intravenous (IV) infusion technology in a not-for-profit academic, multicampus hospital system in the United States. Methods The process of implementing a novel infusion system in a multicampus health care institution (main campus plus three satellite campuses) is described. Details are provided regarding the timelines involved, the process for the development of the drug libraries, and the initial implementation within and across campuses. Results In early 2004, with the end of the device purchase contract period nearing, a multidisciplinary committee evaluated potential IV infusion pumps for hospital use. In April 2004, the committee selected the Plum A+ infusion system with Hospira MedNet software and wireless capabilities (Hospira Inc., Lake Forest, IL). Implementation of the single-channel IV infusion system took place July through October 2005 following installation of the wireless infrastructure throughout the multicampus facility. Implementation occurred in July, one campus at a time; the three smaller satellite campuses went “live” before the main campus. Implementation of the triple-channel IV infusion system took place in March 2006 when the wireless infrastructure was completed and fully functional throughout the campuses, software was upgraded, and drug library revisions were completed and uploaded. Conclusion “Intelligent” pump technology provided a framework to standardize drug concentrations used in the intensive care units. Implementation occurred transparently without any compromise of patient care. Many lessons were learned during implementation that explained the initial suboptimal compliance with safety software use. In response, the committee developed strategies to increase software utilization rates, which resulted in improved acceptance by nursing staff and steadily improving compliance rates. Wireless technology has supported remote device management, prospective monitoring, the avoidance of medication error, and the timely education of health care professionals regarding potential medication errors.


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