Effectiveness of the Gold Standard Programme compared with other smoking cessation interventions in Denmark: a cohort study

Objectives: we compared the effectiveness of the Gold Standard Programme (a comprehensive smoking cessation intervention commonly used in Denmark) with other face-to-face smoking cessation programmes in Denmark after implementation in real life, and we identified factors associated with successful quitting. Design: prospective cohort study. Setting: a total of 423 smoking cessation clinics from different settings reported data from 2001 to 2013. Participants: in total, 82 515 patients were registered. Smokers ≥15 years old and attending a programme with planned follow-up were included. Smokers who did not want further contact, who intentionally were not followed up or who lacked information about the intervention they received were excluded. A total of 46 287 smokers were included. Interventions: various real-life smoking cessation interventions were identified and compared: The Gold Standard Programme, Come & Quit, crash courses, health promotion counselling (brief intervention) and other interventions. Main outcome: self-reported continuous abstinence for 6 months. Results: overall, 33% (11 184) were continuously abstinent after 6 months; this value was 24% when non-respondents were considered smokers. The follow-up rate was 74%. Women were less likely to remain abstinent, OR 0.83 (CI 0.79 to 0.87). Short interventions were more effective among men. After adjusting for confounders, the Gold Standard Programme was the only intervention with significant results across sex, increasing the odds of abstinence by 69% for men and 31% for women. In particular, compliance, and to a lesser degree, mild smoking, older age and not being disadvantaged were associated with positive outcomes for both sexes. Compliance increased the odds of abstinence more than 3.5-fold. Conclusions: over time, Danish smoking cessation interventions have been effective in real life. Compliance is the main predictor of successful quitting. Interestingly, short programmes seem to have relatively strong effects among men, but the absolute numbers are very small. Only the comprehensive Gold Standard Programme works across sexes

Effectiveness of the gold standard programmes (GSP) for smoking cessation in pregnant and non-pregnant women

Background: Smoking is considered the most important preventable risk factor in relation to the development of complications during pregnancy and delivery. The aim of this study was to evaluate the effectiveness of an intensive 6-week gold standard programme (GSP) on pregnant women in real life. Methods: This was a prospective cohort study based on data from a national Danish registry on smoking cessation interventions. The study population included 10,682 women of a fertile age. The pregnancy status of the study population was identified using the National Patient Registry. Results: The response rate to follow up was 76%. The continuous abstinence rate for both pregnant and non-pregnant smokers was 24–32%. The following prognostic factors for continuous abstinence were identified: programme format (individual/group), older age, heavy smoking, compliance with the programme, health professional recommendation, and being a disadvantaged smoker. Conclusions: The GSP seems to be as effective among pregnant smokers as among non-pregnant smoking women. Due to the relatively high effect and clinical significance, the GSP would be an attractive element in smoking cessation intervention among pregnant women

Fractures and Alcohol Abuse – Patient Opinion of Alcohol Intervention

Purpose: To clarify patient opinions about alcohol intervention in relation to surgery before investigating the effect in a Scandinavian multi-centre randomized trial. Material and Methods: A qualitative study. Thirteen consecutive alcohol patients with fractures participated after informed consent. They were interviewed during their hospital stay. The number of participants was based on the criteria of data-saturation. The analysis followed the applied qualitative framework model aimed at evaluation of specific participant needs within a larger overall project. Results: All patients regarded alcohol intervention in relation to surgery as a good idea. They did not consider quit drinking as a major problem during their hospital stay and had all remained abstinent in this period. About half of the patients were ready or partly ready to participate in an alcohol intervention. Patient opinions and their readiness to participate were expressed in four groups, which also reflected their readiness to stop drinking in the perioperative period, their general acceptance of supportive disulfiram as part of an alcohol intervention as well as their awareness of postoperative complications. Conclusion: This study clarified that the patients found alcohol intervention relevant in relation to surgery

Gold standard program for heavy smokers in a real-life setting

Background: High-intensity smoking cessation programs generally lead to more continuous abstinence, however, lower rates of success have been reported among heavy smokers. The aim was to evaluate continuous abstinence among heavy smokers during the intensive 6-week Gold Standard Program (GSP) and to identify modifiable factors associated with continuous abstinence. Methods: In this nationwide clinical study based on 36,550 smokers attending an intensive cessation program in Denmark. Heavy smoking was defined as ≥7 points in the Fagerström Nicotine Dependency Test, smoking ≥20 cigarettes daily or ≥20 pack-years. Results: Overall, 28% had a Fagerström score ≥7 points, 58% smoked ≥20 cigarettes daily and 68% smoked ≥20 pack-years. Continuous abstinence was 33% in responders (6-months response rate: 78%); however, abstinence was approximately 1–6% lower in the heavy smokers than the overall population. Attending GSP with an individual format (vs. group/other, OR 1.23–1.44); in a hospital setting (vs. pharmacy/municipality services, OR 1.05–1.11); and being compliant (attending the planned meetings OR 4.36–4.89) were associated with abstinence. Abstinence decreased in a dose-dependent manner with increasing smoking severity. Conclusions: Abstinence after GSP was 1–6% lower in the heavy smokers than in the overall study population. Modifiable factors may be used for small improvements in continued abstinence. However attempts to improve compliance seemed especially promising

The Gold Standard Programme: smoking cessation interventions for disadvantaged smokers are effective in a real-life setting

Objectives To evaluate the real-life effect of an evidence-based Gold Standard Programme (GSP) for smoking cessation interventions in disadvantaged patients and to identify modifiable factors that consistently produce the highest abstinence rates. Design Observational prospective cohort study. Setting GSPs in pharmacies, hospitals and communities in Denmark, reporting to the national Smoking Cessation Database. Participants Disadvantaged patients, defined as patients with a lower level of education and those receiving unemployment benefits. Interventions 6-week manualised GSP smoking cessation interventions performed by certified staff. Main outcome measures 6months of continuous abstinence, response rate: 80%. Results Continuous abstinence of the 16?377 responders was 34% (of all 20?588 smokers: 27%). Continuous abstinence was lower in 5738 smokers with a lower educational level (30% of responders and 23% of all) and in 840 unemployed (27% of responders and 19% of all). In respect to modifiable factors, continuous abstinence was found more often after programmes in one-on-one formats (vs group formats) among patients with a lower educational level, 34% (vs 25%, p=0.037), or among unemployed, 35% (vs 24%, p=0.099). The variable format' stayed in the final model of multivariable analyses in patients with a lower educational level, OR=1.31 (95% CI 1.05 to 1.63). Conclusions Although continuous abstinence was lower among disadvantaged smokers, the absolute difference was small. If the programme had been as effective in disadvantaged as in non-disadvantaged groups, there would have been an extra 46 or 8 quitters annually, respectively. Promoting individual interventions among those with a low education may increase the effectiveness of GSP

Risk reduction before surgery. The role of the primary care provider in preoperative smoking and alcohol cessation

<p>Abstract</p> <p>Background</p> <p>Daily smokers and hazardous drinkers are high-risk patients, developing 2-4 times more complications after surgery. Preoperative smoking and alcohol cessation for four to eight weeks prior to surgery halves this complication rate. The patients' preoperative contact with the surgical departments might be too brief for the hospital to initiate these programmes. Therefore, it was relevant to evaluate a new clinical practice which combined the general practitioner's (GP) referral to surgery with a referral to a smoking and alcohol intervention in the surgical pathway.</p> <p>Methods</p> <p>The design was an exploratory prospective trial. The outcome measured was the number of patients referred to a preoperative smoking and alcohol cessation programme at the same time as being referred for elective surgery by their GP. The participants consisted of 72 high-risk patients who were referred for elective surgery by 47 local participating GPs.</p> <p>The GPs, nurses, and specialists in internal medicine, prehabilitation and surgery developed new clinical practice guidelines based on the literature and interviews with 11 local GPs about the specific barriers for implementing a smoking and alcohol cessation programme. The role of the GP was to be the gatekeeper: identifying daily smokers and hazardous drinkers when referring them to surgery; handing out information on risk reduction; and referring those patients identified to a preoperative smoking and alcohol cessation programme. The role of the hospital was to contact these patients to initiate smoking and alcohol cessation at the hospital out-patient clinic for life-style intervention.</p> <p>Results</p> <p>The GPs increased their referral to the smoking and alcohol cessation programme from 0% to 10% (7/72 patients) in the study period.</p> <p>Conclusion</p> <p>The effect of the study was limited in integrating the efforts of primary care providers and hospital surgical departments in increasing the up-take of preoperative smoking and alcohol cessation programmes aimed at smokers and harmful drinkers referred for surgery. New strategies for cooperation between GPs and surgical departments are urgently needed.</p> <p>Trial registration</p> <p>J.nr. 2005-54-1781 in Danish Data Protection Agency.</p> <p>J.nr. 07 268136 in Scientific Ethical Committee for Copenhagen and Frederiksberg Municipalities.</p

Alveld hos lam - Kan vi forebygge sjukdommen?

Norsk senter for økologisk landbruk (NORSØK) og Universitetet i Oslo ved Farmasøytisk Institutt og Institutt for biovitenskap har gjennomført et arbeid for å skaffe mer kunnskap om årsaken til sjukdommen alveld hos lam på beite og undersøke muligheten for å finne forebyggende tiltak som kan hindre opptak av giftstoffer som framkaller sjukdommen. Andre samarbeidspartnere i prosjektet har vært NIVA, NIBIO og representanter for landbruksnæringa. Prosjektene har vært finansiert av Landbruksdirektoratet, Regionalt forskningsfond Midt-Norge, FMLA Sogn og Fjordane, FMLA Møre og Romsdal, Møre og Romsdal fylkeskommune. En spørreundersøkelse blant saueholdere i Sogn og Fjordane, Møre og Romsdal, Sør-Trøndelag og Hedmark viser at dødsårsaken hos lam på beite varierer mellom fylkene, og at dette er særlig tydelig når det gjelder alveld. Et annet hovedfunn er at en stor del av tapet av lam på utmarksbeite klassifiseres som «andre sjukdommer» eller «annet», altså at vi ikke har sikker kunnskap om tapsårsak. Forekomsten av alveld varierer mye fra år til år, men 31,7% av produsentene som deltok i spørreundersøkelsen hadde ett eller flere år mistet dyr pga alveld, noe en vurderer som en relativt høg prosentandel. Alveld var vanligst i Nord-Trøndelag, Møre og Romsdal og Sør-Trøndelag, der 22%-39% hadde mistet lam på grunn av alveld i 2014. Sjukdommen alveld skyldes påvirkning av ett eller flere levertoksiske stoffer. Cyanobakterier av artene Stigonema og Symplocastrum er analysert med hensyn på cyanotoksiner etter at de er satt i sammenheng med påvisning av sjukdommen i et utsatt beiteområde i Halsa kommune i Møre og Romsdal. Identifisering og karakterisering av toksiner fra de aktuelle artene er utført i samarbeid med laboratorier i Bad Elster, Tyskland og Trebon, Tsjekkia. Analysearbeidet er ikke endelig sluttført. Et delmål i prosjektet var, på bakgrunn av hypotesen om at det er forekomst av et eller flere levertoksiske stoffer som forårsaker sjukdom, å finne egna form, størrelse og vekt på en bolus som senere kan utvikles til å inneholde toksinfellende kjemikalier og slik kunne bidra til å ta hånd om giftstoffene i fordøyelseskanalen før de kommer over i blodet og forårsaker fysiologisk skade på dyret. Testbolus i tre ulike størrelser (3, 3,5 og 4 cm lengde) er produsert og testa på 6 lam på ca 2 mnd (vekt 16-22 kg). Bolus var lett å gi med en standard applikator som brukes til parasittmiddel. Røntgenfotografering av lamma viste at alle bolusene lå fint plassert i nettmagen etter at de var lagt inn. Oppholdstid på bolus i nettmagen var ca 4 uker, noe vi mener er tilstrekkelig til å være virksomme i den kritiske perioden for utvikling av alveld på utmarksbeite. Bolusene gjorde ikke skade på fordøyelseskanalen. Tilvekst på lamma som fikk bolus var ikke signifikant forskjellig fra kontrollgruppa. Vekt og størrelse på bolusene var hensiktsmessige og kan legges til grunn for videre arbeid. Et annet delmål i prosjektet var å undersøke potensialet til polykationet chitosan som et mulig utfellingsreagens for saponiner som blant annet finnes i romeplanten. Den produserte bolusen ga en kontrollert frisetting av chitosan over tid, avhengig av diameteren på åpningen i lokket på bolusen. Frisettingshastigheten kan derved kontrolleres ved å endre diameteren på åpningen. Det ble sett en tydelig utfelling ved tilsetning av en løsning med saponiner til en løsning med chitosan. Prosjektet har undersøkt og fått bekrefta muligheten for å bruke chitosan som et toksinfellende middel som kan frigis over tid fra en bolus i dyrets fordøyelseskanal. Arbeidet har gitt viktig ny kunnskap og er en nødvendig start på et større og mer omfattende arbeid for å se om vi kan utvikle forebyggende tiltak som i praktisk husdyrhold gir resultater i form av mindre tap, bedre dyrevelferd og bedre økonomi

Can we prevent alfabruni in lambs?

Saponins from Nartheciumossifragum and / or toxins from cyanobacteria have been found to be hepatotoxic and can cause photosensitization in mammals. In our preliminary study we have looked at whether it is possible to develop a bolus with toxinbinding substances which can be used in the Critical grazing period. We have developed and tested the shape, size and weight of a possible bolus, and conducted a precipitation reaction in a simulated sheep stomach

Costs and quality of life for prehabilitation and early rehabilitation after surgery of the lumbar spine

During the recent years improved operation techniques and administrative procedures have been developed for early rehabilitation. At the same time preoperative lifestyle intervention (prehabilitation) has revealed a large potential for additional risk reduction

Will emergency and surgical patients participate in and complete alcohol interventions? A systematic review

<p>Abstract</p> <p>Background</p> <p>In the everyday surgical life, staff may experience that patients with Alcohol Use Disorders (AUDs) seem reluctant to participate in alcohol intervention programs. The objective was therefore to assess acceptance of screening and intervention as well as adherence to the intervention program among emergency department (ED) and surgical patients with AUDs.</p> <p>Methods</p> <p>A systematic literature search was followed by extraction of acceptance and adherence rates in ED and surgical patients. Numbers needed to screen (NNS) were calculated. Subgroup analyses were carried out based on different study characteristics.</p> <p>Results</p> <p>The literature search revealed 33 relevant studies. Of these, 31 were randomized trials, 28 were conducted in EDs and 31 evaluated the effect of brief alcohol intervention. Follow-up was mainly conducted after six and/or twelve months.</p> <p>Four in five ED patients accepted alcohol screening and two in three accepted participation in intervention. In surgical patients, two in three accepted screening and the intervention acceptance rate was almost 100%. The adherence rate was above 60% for up to twelve months in both ED and surgical patients. The NNS to identify one eligible AUD patient and to get one eligible patient to accept participation in alcohol intervention varied from a few up to 70 patients.</p> <p>The rates did not differ between randomized and non-randomized trials, brief and intensive interventions or validated and self-reported alcohol consumption. Adherence rates were not affected by patients' group allocation and type of follow-up.</p> <p>Conclusions</p> <p>Most emergency and surgical patients with AUD accept participation in alcohol screening and interventions and complete the intervention program.</p