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

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

Quick-change absorption column

Column has end caps held in place by springs; prefilled packs of absorbent can be exchanged quickly. Both ends of metal or plastic body tube of size which can hold adequate amount of absorbent are machined to provide seat for perforated plate and groove for its spring retainer ring

Slepian Spatial-Spectral Concentration on the Ball

We formulate and solve the Slepian spatial-spectral concentration problem on the three-dimensional ball. Both the standard Fourier-Bessel and also the Fourier-Laguerre spectral domains are considered since the latter exhibits a number of practical advantages (spectral decoupling and exact computation). The Slepian spatial and spectral concentration problems are formulated as eigenvalue problems, the eigenfunctions of which form an orthogonal family of concentrated functions. Equivalence between the spatial and spectral problems is shown. The spherical Shannon number on the ball is derived, which acts as the analog of the space-bandwidth product in the Euclidean setting, giving an estimate of the number of concentrated eigenfunctions and thus the dimension of the space of functions that can be concentrated in both the spatial and spectral domains simultaneously. Various symmetries of the spatial region are considered that reduce considerably the computational burden of recovering eigenfunctions, either by decoupling the problem into smaller subproblems or by affording analytic calculations. The family of concentrated eigenfunctions forms a Slepian basis that can be used be represent concentrated signals efficiently. We illustrate our results with numerical examples and show that the Slepian basis indeeds permits a sparse representation of concentrated signals.Comment: 33 pages, 10 figure

Progress in cartography, EROS program

During the past 7 years the Interior Department EROS (Earth Resources Observation Systems) program with NASA sponsorship has conducted cartographic research based on high altitude aerial and space photographs. The research has centered on the direct use of the image and its transformation into so-called photo or image maps. Today the cartographers of the Geological Survey have a real opportunity for making maps from data supplied by ERTS-1 which is dedicated to remote sensing of the earth