Effectiveness of two intensive treatment methods for smoking cessation and relapse prevention in patients with coronary heart disease: study protocol and baseline description

Contains fulltext : 111068.pdf (publisher's version ) (Open Access)BACKGROUND: There is no more effective intervention for secondary prevention of coronary heart disease than smoking cessation. Yet, evidence about the (cost-)effectiveness of smoking cessation treatment methods for cardiac inpatients that also suit nursing practice is scarce. This protocol describes the design of a study on the (cost-)effectiveness of two intensive smoking cessation interventions for hospitalised cardiac patients as well as first results on the inclusion rates and the characteristics of the study population. METHODS/DESIGN: An experimental study design is used in eight cardiac wards of hospitals throughout the Netherlands to assess the (cost-)effectiveness of two intensive smoking cessation counselling methods both combined with nicotine replacement therapy. Randomization is conducted at the ward level (cross-over). Baseline and follow-up measurements after six and 12 months are obtained. Upon admission to the cardiac ward, nurses assess patients' smoking behaviour, ensure a quit advice and subsequently refer patients for either telephone counselling or face-to-face counselling. The counselling interventions have a comparable structure and content but differ in provider and delivery method, and in duration. Both counselling interventions are compared with a control group receiving no additional treatment beyond the usual care. Between December 2009 and June 2011, 245 cardiac patients who smoked prior to hospitalisation were included in the usual care group, 223 in the telephone counselling group and 157 in the face-to-face counselling group. Patients are predominantly male and have a mean age of 57 years. Acute coronary syndrome is the most frequently reported admission diagnosis. The ultimate goal of the study is to assess the effects of the interventions on smoking abstinence and their cost-effectiveness. Telephone counselling is expected to be more (cost-)effective in highly motivated patients and patients with high SES, whereas face-to-face counselling is expected to be more (cost-)effective in less motivated patients and patients with low SES. DISCUSSION: This study examines two intensive smoking cessation interventions for cardiac patients using a multi-centre trial with eight cardiac wards. Although not all eligible patients could be included and the distribution of patients is skewed in the different groups, the results will be able to provide valuable insight into effects and costs of counselling interventions varying in delivery mode and intensity, also concerning subgroups. TRIAL REGISTRATION: Dutch Trial Register NTR2144

Determinants of providing smoking cessation care in five groups of healthcare professionals: A cross-sectional comparison

Public Health and primary carePrevention, Population and Disease management (PrePoD

Test Selection in Jaundice: A Comparison between Physician Behavior and a Diagnostic Model

Abstract:The results of an observational study aimed at a formal assessment of clinicians’ test-selection behavior are presented. We first make a proposal for diagnostic test usage in the latter phases of jaundice diagnosis. Next we compute a probabilistic estimate of the patient diagnosis, based on the COMIK algorithm. From the proposal and the probabilistic estimate we can predict the “test-selection behavior” of clinicians. The assessment follows from a tabulation of the predicted behavior against the tests selected by clinicians. It is shown that for most tests, the predictions are consistent with the observed test-selection behavior at a statistically significant level. Discussions of discrepancies between prediction and observation, and reasons for deviations from general guidelines, provide new dimensions for medical education. The methodology applied is a useful tool to improve medical care for the jaundiced patient.</jats:p

Campagnes over schade van roken zijn absoluut noodzakelijk

Campaigns about the health damage of smoking are absolutely necessary Results from the International Tobacco Control Policy Evaluation (ITC) Project show that Dutch smokers have less knowledge and awareness of the health damage of smoking compared to many other countries. This lack of knowledge and awareness of the health damage of smoking suggests that educational campaigns about the harm of smoking are very much needed in the Netherlands. The Ministry of Health has decided to end all educational campaigns about lifestyle, including smoking, which is a big mistake for effective tobacco control