The Effects of a Value-Affirmation Writing Exercise on Stress and Craving for Nicotine in Electronic Nicotine Delivery System Users

Electronic nicotine delivery systems (ENDS) have become an increasingly popular choice to ingest nicotine, especially among adolescents. It is assumed that with a rise of ENDS usage, more people will be looking for strategies to help quit the devices. As previous research has revealed the efficacy of stress reduction interventions to aid in the cessation of nicotine, a stress reducing writing intervention based in self-affirmation, value affirmation, was evaluated for its ability to reduce anxiety and craving for nicotine in individuals using ENDS. Nicotine dependent participants (N = 92) using ENDS were randomly assigned to complete either a value affirmation writing exercise or a control writing exercise prior to viewing a video designed to induce anxiety. While anxiety and craving for nicotine significantly increased across conditions following the video stressor, no significant differences were observed between groups. Commentary on the results and implications of this study are discussed

A conceptual framework and protocol for defining clinical decision support objectives applicable to medical specialties.

BackgroundThe U.S. Centers for Medicare and Medicaid Services established the Electronic Health Record (EHR) Incentive Program in 2009 to stimulate the adoption of EHRs. One component of the program requires eligible providers to implement clinical decision support (CDS) interventions that can improve performance on one or more quality measures pre-selected for each specialty. Because the unique decision-making challenges and existing HIT capabilities vary widely across specialties, the development of meaningful objectives for CDS within such programs must be supported by deliberative analysis.DesignWe developed a conceptual framework and protocol that combines evidence review with expert opinion to elicit clinically meaningful objectives for CDS directly from specialists. The framework links objectives for CDS to specialty-specific performance gaps while ensuring that a workable set of CDS opportunities are available to providers to address each performance gap. Performance gaps may include those with well-established quality measures but also priorities identified by specialists based on their clinical experience. Moreover, objectives are not constrained to performance gaps with existing CDS technologies, but rather may include those for which CDS tools might reasonably be expected to be developed in the near term, for example, by the beginning of Stage 3 of the EHR Incentive program. The protocol uses a modified Delphi expert panel process to elicit and prioritize CDS meaningful use objectives. Experts first rate the importance of performance gaps, beginning with a candidate list generated through an environmental scan and supplemented through nominations by panelists. For the highest priority performance gaps, panelists then rate the extent to which existing or future CDS interventions, characterized jointly as "CDS opportunities," might impact each performance gap and the extent to which each CDS opportunity is compatible with specialists' clinical workflows. The protocol was tested by expert panels representing four clinical specialties: oncology, orthopedic surgery, interventional cardiology, and pediatrics