Effectiveness of a telephone-based intervention for smoking cessation in patients with severe mental disorders: study protocol for a randomized controlled trial

Mental disorders; Smoking cessation; TelephoneMalalties mentals; Deixar de fumar; TelèfonEnfermedades mentales; Dejar de fumar; TeléfonoBACKGROUND: Up to 75% of inpatients with mental disorders smoke, and their life expectancy is decreased by up to 25 years compared to the general population. Hospitalized patients without monitoring after discharge quickly return to prehospitalization levels of tobacco use. The aim of the 061 QuitMental study is to assess the effectiveness of a multicomponent and motivational telephone-based intervention to stop smoking through a quitline addressed to smokers discharged from mental health hospital wards. METHODS: A pragmatic randomized controlled trial, single blinded, will include 2:1 allocation to the intervention group (IG) and the control group (CG). The IG will receive telephone assistance to quit smoking (including psychological and psychoeducational support, and pharmacological treatment advice if required) proactively for 12 months, and the CG will receive only brief advice after discharge. The sample size, calculated with an expected difference of 15 points on smoking abstinence between groups (IG, 20% and CG, 5%), α = 0.05, β = 0.10, and 20% loss, will be 334 participants (IG) and 176 participants (CG). Participants are adult smokers discharged from psychiatric units of five acute hospitals. Measurements include dependent variables (self-reported 7-day point prevalence smoking abstinence (carbon monoxide verified), duration of abstinence, number of quit attempts, motivation, and self-efficacy to quit) and independent variables (age, sex, and psychiatric diagnoses). In data analysis, IG and CG data will be compared at 48 h and 1, 6, and 12 months post discharge. Multivariate logistic regression (odds ratio; 95% confidence interval) of dependent variables adjusted for potential confounding variables will be performed. The number needed to treat to achieve one abstinence outcome will be calculated. We will compare the abstinence rate of enrolled patients between groups. DISCUSSION: This trial evaluates an innovative format of a quitline for smokers with severe mental disorders regardless of their motivation to quit. If effective, the pragmatic nature of the study will permit transfer to routine clinical practice in the National Health System

Characteristics of resident physicians accessing a specialised mental health service: a retrospective study

Adult psychiatry; Medical education & training; Mental healthPsiquiatria d'adults; Educació i formació mèdica; Salut mentalPsiquiatría de adultos; Educación y formación médica; Salud mentalObjectives Little is known about resident physicians being treated at physician health programmes around the world despite the fact that it is a highly demanding training period. This study aims to describe the profiles of resident physicians accessing a specialised mental health service in Spain over a 20-year period and to compare them to consultant-grade physicians. Design Retrospective observational study. Setting Medical records of the Galatea Care Programme for Sick Physicians. Participants 1846 physicians registered at the Barcelona Medical Council-Association and admitted to the programme from January 1998 to December 2018. Primary and secondary outcome measures Number of admissions, sociodemographic and clinical variables, including medical specialty, main diagnosis and need of hospitalisation. Results Residents accounted for 18.1% (n=335) of the sample and admissions increased over the years. Most residents (n=311; 94.5%) and consultant-grade physicians (n=1391; 92.8%) were self-referred. The most common specialty among residents was family medicine (n=107; 31.9%), followed by internal medicine (n=18; 5.4%), paediatrics (n=14; 4.2%), psychiatry (n=13; 3.9%) and anaesthesiology (n=13; 3.9%). Residents, regardless of year of training, mainly asked for help because of adjustment (n=131; 39.1%), affective (n=77; 23%), anxiety disorders (n=40; 18.8%) and addictions (n=19; 5.7%). There were no significant differences between groups in the main diagnosis and in the variables related to need of hospitalisation. The percentage of residents accessing the programme was higher than in the reference population registered at the Barcelona Medical Council-Association (18.1% vs 7.6%; z=7.2, p<0.001) as was the percentage of family medicine residents (31.9% vs 19.6%; z=5.7, p<0.001). Conclusions Residents are more likely than consultant-grade physicians to seek help when suffering from mental disorders. Local primary prevention actions since the beginning of their training period and having access to a well-known highly reliable programme may partly explain these findings

Manual per a la prevenció i l’abordatge del consum d’alcohol i els problemes relacionats en l’àmbit hospitalari

Consum d’alcohol; Hospitals; PrevencióConsumo de alcohol; Hospitales; PrevenciónAlcohol consumption; Hospitals; PreventionAquest manual és el fruit de la col·laboració d’un ampli grup de professionals experts que treballen en l’àmbit clínic i de recerca en els problemes derivats del consum d’alcohol, i pretén ser una eina útil per que els hospitals i els i les professionals puguin actuar de forma preventiva

Tractament de manteniment amb metadona: manual de pràctica clínica

Tractament de manteniment amb metadona; Pràctica clínica; DrogodependènciesTratamiento de mantenimiento con metadona; Práctica clínica; DrogodependenciasMethadone maintenance treatment; Clinical practice; Drug addictionsEl Manual pretén ser una eina útil per disminuir la variabilitat de la pràctica clínica i garantir un nivell òptim de qualitat i millora de l'atenció sanitària en el tractament de manteniment amb metadona (TMM). Aplica les normes bàsiques utilitzades per a la preparació de guies de pràctica clínica; en primer lloc, incloent-hi la millor evidència possible sobre la base de revisions sistemàtiques de la literatura, en segon lloc, amb recomanacions clares i curtes, i en tercer lloc, en absència d’una evidència fiable en la literatura, incorporant-hi la opinió d’experts per mitjà de tècniques de consens com el mètode Delphi