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

Cartographic evaluation of ERTS orbit and attitude data

There are no author-identified significant results in this report

Consumer decision making in mobile-banking service selection

This paper reports on the findings of a study of 267 consumers on the first order selection criteria within a decision making model that utilizes the Analytic Hierarchy Process (AHP) to evaluate mobile banking service selection. The AHP analysis of the first order selection criteria for the full data sample identified ‘Time Saving’ as the highest ranked factor followed by ‘Control’ then ‘Any Place’ and lastly ‘Cost’. The survey also reports on consumer usage patterns for internet and mobile services as well as exploring their experiences with mobile banking services

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

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

Sparse image reconstruction on the sphere: analysis and synthesis

We develop techniques to solve ill-posed inverse problems on the sphere by sparse regularisation, exploiting sparsity in both axisymmetric and directional scale-discretised wavelet space. Denoising, inpainting, and deconvolution problems, and combinations thereof, are considered as examples. Inverse problems are solved in both the analysis and synthesis settings, with a number of different sampling schemes. The most effective approach is that with the most restricted solution-space, which depends on the interplay between the adopted sampling scheme, the selection of the analysis/synthesis problem, and any weighting of the l1 norm appearing in the regularisation problem. More efficient sampling schemes on the sphere improve reconstruction fidelity by restricting the solution-space and also by improving sparsity in wavelet space. We apply the technique to denoise Planck 353 GHz observations, improving the ability to extract the structure of Galactic dust emission, which is important for studying Galactic magnetism.Comment: 11 pages, 6 Figure

A Study of Single Pulses in the Parkes Multibeam Pulsar Survey

We reprocessed the Parkes Multibeam Pulsar Survey, searching for single pulses out to a DM of 5000 pc cm$^{-3}$ with widths of up to one second. We recorded single pulses from 264 known pulsars and 14 Rotating Radio Transients. We produced amplitude distributions for each pulsar which we fit with log-normal distributions, power-law tails, and a power-law function divided by an exponential function, finding that some pulsars show a deviation from a log-normal distribution in the form of an excess of high-energy pulses. We found that a function consisting of a power-law divided by an exponential fit the distributions of most pulsars better than either log-normal or power-law functions. For pulsars that were detected in a periodicity search, we computed the ratio of their single-pulse signal-to-noise ratios to their signal-to-noise ratios from a Fourier transform and looked for correlations between this ratio and physical parameters of the pulsars. The only correlation found is the expected relationship between this ratio and the spin period. Fitting log-normal distributions to the amplitudes of pulses from RRATs showed similar behaviour for most RRATs. Here, however, there seem to be two distinct distributions of pulses, with the lower-energy distribution being consistent with noise. Pulse-energy distributions for two of the RRATS processed were consistent with those found for normal pulsars, suggesting that pulsars and RRATs have a common emission mechanism, but other factors influence the specific emission properties of each source class.Comment: 11 pages, 6 figures, 3 tables, accepted for publication in MNRA