Smoking cessation activities by general practitioners and practice nurses

OBJECTIVES—To assess general practitioners' and practice nurses' self reported behaviour, attitudes, and knowledge in relation to smoking cessation.
DESIGN AND SETTING—Two postal surveys of random national samples of 303 GPs (survey 1) and 459 practice nurses (survey 2) covering England and Wales; effective response rates were 75% and 96%, respectively.
RESULTS—Survey 1 found that 96% of GPs accepted that intervening against smoking was part of their role and almost all (99%) said that they recorded smoking status when patients registered; 57% reported that they routinely updated their records on smoking status, 50% said they advised smokers to stop during most or all consultations, and 76% said they advised smokers to cut down if they cannot stop. A large majority (83%) said they either recommended or prescribed nicotine replacement therapy (NRT). Although most GPs (86%) thought that NRTs were effective, only a minority thought they were worth the cost (47%) or should be on National Health Service (NHS) prescription (32%). There was little evidence that previous training in smoking cessation was associated with more activity, more positive attitudes, or greater knowledge. Survey 2 found that almost all practice nurses (99%) agreed that intervening against smoking was part of their role and 95% said they advised patients to stop at least occasionally; 71% said they advised smokers to stop at most or all consultations. A majority (74%) said that they recommended NRT to their patients. As with the GPs most practice nurses thought that nicotine replacement was effective (79%), but fewer (42%) thought the cost was justified, and only about half (53%) thought it should be available on NHS prescription. Nurses who said they had been trained in smoking cessation engaged in more activity relating to smoking cessation, had more positive attitudes, and were more knowledgeable.
CONCLUSION—GPs and practice nurses accepted that intervening with smoking was an important part of their role and a large majority reported that they intervened at least with some smokers. This represents a promising baseline from which to proceed in terms of implementation of the new smoking cessation guidelines, but it is hoped that improvements can be made in terms of the frequency of updating records and intervening, and acceptance of the cost-effectiveness of NRT as a life preserving intervention.


Keywords: cessation interventions; general practitioners; practice nurse

Mining Missing Hyperlinks from Human Navigation Traces: A Case Study of Wikipedia

Hyperlinks are an essential feature of the World Wide Web. They are especially important for online encyclopedias such as Wikipedia: an article can often only be understood in the context of related articles, and hyperlinks make it easy to explore this context. But important links are often missing, and several methods have been proposed to alleviate this problem by learning a linking model based on the structure of the existing links. Here we propose a novel approach to identifying missing links in Wikipedia. We build on the fact that the ultimate purpose of Wikipedia links is to aid navigation. Rather than merely suggesting new links that are in tune with the structure of existing links, our method finds missing links that would immediately enhance Wikipedia's navigability. We leverage data sets of navigation paths collected through a Wikipedia-based human-computation game in which users must find a short path from a start to a target article by only clicking links encountered along the way. We harness human navigational traces to identify a set of candidates for missing links and then rank these candidates. Experiments show that our procedure identifies missing links of high quality

GP prescribing of nicotine replacement and bupropion to aid smoking cessation in England and Wales

Aims Prescribing nicotine replacement therapy (NRT) or bupropion for smoking cessation is of considerable importance to public health but little is known about prescribing practices. This paper examines general practitioners' (GPs') prescribing patterns in Britain where these drugs are reimbursed. The results have implications for other health-care systems considering introducing reimbursement.Design, participants and setting Postal survey conducted in 2002 of a random sample of 1088 GPs in England and Wales, of whom 642 (59%) responded.Measures Number of requests GPs reported having received from patients for NRT and bupropion over the past month, the number of prescriptions they reported issuing and ratings of attitudes to these medications.Findings GPs reported receiving an average of 4.3 requests for NRT and 1.9 for bupropion in the previous month. They reported issuing 3.5 prescriptions for NRT and 1.2 for bupropion. Almost all GPs accepted that NRT (95%) and bupropion (97%) should be reimbursable on National Health Service (NHS) prescription. However, a significant minority of those who received requests for prescriptions did not issue any (81% for NRT and 26% for bupropion). This was related to whether they thought these products should be available on NHS prescription for both NRT and bupropion (OR = 0.66, P < 0.05), which in turn was related to beliefs about whether smokers should have to pay for treatment themselves, the cost-effectiveness of NRT/bupropion and the low priority they would give NRT/bupropion in the drug budget. For bupropion, concern about side-effects independently predicted not prescribing [odds ratio (OR) = 1.46, P < 0.03].Conclusion In the British health-care system, which has a well-established system for technology assessment and professionally endorsed guidelines, a significant minority of GPs decline all patient requests for stop-smoking medicines

GPs' views on new national smoking cessation guidelines

Objectives: To assess GPs? views on recently published national smoking cessation guidelines that form the foundation of the government?s smoking cessation strategy.Design: Postal survey of a random sample of GPs. GPs were asked to judge the appropriateness, effectiveness and practicability of key recommendations for primary care in recent national smoking cessation guidelines.Setting: General practice, England and Wales.Subjects: 236 GPs, effective response rate: 62%.Results: Only 16% of GPs accepted that all the recommendations in the guidelines were appropriate; 43% accepted that it was appropriate to check the smoking status of known smokers when they visit the surgery and only 30% thought it was practicable to advise smokers to stop at every opportunity. However, 77% of GPs thought that they should provide assistance for smokers wanting to stop; 74% believed that they should refer smokers to specialist services if appropriate and a similar proportion (77%) believed that it was appropriate to recommend nicotine replacement. Conclusions: Recommendations that involved the GP being proactive in monitoring smoking status and advising smokers to stop were not widely supported. There was greater acceptance that GPs should assist smokers wanting to stop, either by recommending NRT or providing counselling or referral. It appears that GPs do not widely support those recommendations that would produce the greatest public health gains

New correction procedures for the fast field program which extend its range

A fast field program (FFP) algorithm was developed based on the method of Lee et al., for the prediction of sound pressure level from low frequency, high intensity sources. In order to permit accurate predictions at distances greater than 2 km, new correction procedures have had to be included in the algorithm. Certain functions, whose Hankel transforms can be determined analytically, are subtracted from the depth dependent Green's function. The distance response is then obtained as the sum of these transforms and the Fast Fourier Transformation (FFT) of the residual k dependent function. One procedure, which permits the elimination of most complex exponentials, has allowed significant changes in the structure of the FFP algorithm, which has resulted in a substantial reduction in computation time

The effects of test-based retention on student outcomes over time: Regression discontinuity evidence from Florida

Many American states require that students lacking basic reading proficiency after third grade be retained and remediated. We exploit a discontinuity in retention probabilities under Florida's test-based promotion policy to study its effects on student outcomes through high school. We find large positive effects on achievement that fade out entirely when retained students are compared to their same-age peers, but remain substantial through grade 10 when compared to students in the same grade. Being retained in third grade due to missing the promotion standard increases students' grade point averages and leads them to take fewer remedial courses in high school but has no effect on their probability of graduating.We are grateful to the Florida Department of Education for providing the primary dataset for this study. We thank Stefan Bauernschuster, Matthew Chingos, Andrew Ho, Paul Peterson, Ludger Woessmann, and the seminar participants at the National Bureau of Economic Research, Harvard University, the Ifo Institute, Mathematica Policy Research, Stanford University, the European Economic Association Meeting in Gothenburg, the European Association of Labour Economists Meeting in Turin and the Swedish Institute for Social Research for helpful comments. The Helios Education Foundation provided financial support for this research. The views contained herein are not necessarily those of the Helios Education Foundation. Any errors are our own. (Helios Education Foundation)http://sites.bu.edu/marcuswinters/files/2017/09/NBER-Grade-Retention.pdfhttp://sites.bu.edu/marcuswinters/files/2017/09/NBER-Grade-Retention.pdfAccepted manuscrip

International workshop on Time-Variable Phenomena in the Jovian System

Many of the scientifically interesting phenomena that occur in the Jovian system are strongly time variable. Some are episodic (e.g., Io volcanism); some are periodic (wave transport in Jupiters atmosphere); and some are exceedingly complex (magnetosphere - Io - Torus-Auroral interactions) and possibly unstable. To investigate this class of phenomena utilizing Voyager data and, in the future, Galileo results, a coherent program of ground based and earth-orbital observations, and of theory that spans the time between the missions, is required. To stimulate and help define the basis of such a scientific program researchers organized an International Workshop on the subject with the intent of publishing the proceedings which would represent the state of knowledge in 1987

Quantitative Economic Evaluations of HIV-Related Prevention and Treatment Services: A Review

Dr. Holtgrave and colleagues at the CDC set forth an extensive taxonomy of HIV prevention and treatment services and review reports of efforts to subject some of those services to formal economic evaluation. They find few services thus far to have been so evaluated, no evaluation to have focused solely upon behavioral outcomes and most economic evaluations to lack formal quantitative analyses