Lynne Buchanan

Evidence-based practice to assist women in hospital settings to quit smoking and reduce cardiovascular disease risk

Smoking and obesity are widely recognized cardiovascular risk factors for significant morbidity and mortality in women. Although women still smoke less than men do, smoking among women is on the increase, especially in younger women and teenagers. Reduction of cardiovascular risk through smoking cessation while maintaining weight is a major goal of intervention. The purpose of this article is to discuss best care practices for women with tobacco addiction using a 3-point integration of clinical expertise, the best available evidence gained from systematic research, and an analysis of satisfaction with care data. A model for a smoking cessation intervention with weight management content is presented using a conceptual framework of social learning theory, self-efficacy judgments, and the 4 principal sources of self-efficacy information. The specific aims of this pilot study are to (1) test the feasibility of the study methods and procedures, including subject accrual, attrition, and reliability of the instruments and protocol; (2) explore utilization of and satisfaction with the intervention; and (3) describe the impact of the intervention on primary (smoking biomarker) and secondary (weight/body mass index, depression, partner support, and smoking cessation self-efficacy temptations) outcomes. Results show that the study is feasible, but modifications are needed to improve utilization and satisfaction with care. The primary outcome showed a reduction in the smoking biomarker while maintaining weight at the 2-month follow-up. There was also improvement in skills to manage temptation situations that supported the conceptual framework. Hypotheses are presented for a future experimental study.

A PDA intervention to sustain smoking cessation in clients with socioeconomic vulnerability

This article describes a pilot study to explore use of a personal digital assistant (PDA) to sustain smoking cessation after discharge in clients with socioeconomic vulnerability. The major aim is to describe technology acceptance (perceived ease of use, usefulness, and attitude), portability, technical difficulty, satisfaction, and use time. The sample includes 31 medical surgical clients with average age of 47.35 (±13.3), average household income of

Implementing smoking cessation guidelines for hospitalized Veterans: Cessation results from the VA-BEST trial

13,629 (±8,204), average number in the household of 2.67 (±2.22), and average education of 11th grade. The results demonstrate mean use time of 9.28 (±3.23) hr, or about 1 hr over 8 weeks. Technology acceptance responses indicate the PDA is viewed as useful to the task of smoking cessation but is not perceived as easy to use. The most beneficial aspect is the portability. There are benefits to a PDA smoking cessation intervention but more study is needed before it can be used in practice.

Nicotine patch plus lozenge gives greatest increases in abstinence from smoking at 6 months compared with placebo; smaller effects seen with nicotine patch alone, bupropion or nicotine lozenges alone or combined

PURPOSE To examine the impact of a nurse-initiated tobacco cessation intervention focused on providing guideline-recommended care to hospitalized smokers. DESIGN Pre-post quasi-experimental trial. SETTING General medical units of four US Department of Veterans Affairs hospitals. SUBJECTS 898 adult Veteran smokers (503 and 395 were enrolled in the baseline and intervention periods, respectively). INTERVENTION The intervention included academic detailing, adaptation of the computerized medical record, patient self-management support, and organizational support and feedback. MEASURES The primary outcome was self-reported 7-day point prevalence abstinence at six months. ANALYSIS Tobacco use was compared for the pre-intervention and intervention periods with multivariable logistic regression using generalized estimating equations to account for clustering at the nurse level. Predictors of abstinence at six months were investigated with best subsets regression. RESULTS Seven-day point prevalence abstinence during the intervention period did not differ significantly from the pre-intervention period at either three (adjusted odds ratio (AOR) and 95% confidence interval (CI95)=0.78 [0.51-1.18]) or six months (AOR=0.92; CI95=0.62-1.37). Predictors of abstinence included baseline self-efficacy for refraining from smoking when experiencing negative affect (p=0.0004) and perceived likelihood of staying off cigarettes following discharge (p<0.0001). CONCLUSIONS Tobacco use interventions in the VA inpatient setting likely require more substantial changes in clinician behavior and enhanced post-discharge follow-up to improve cessation outcomes.

An Exploratory Study of Multicomponent Treatment Intervention for Tobacco Dependency

Commentary on: PiperMESmithSSSchlamTR. A randomized placebo-controlled clinical trial of 5 smoking cessation pharmacotherapies. Arch Gen Psychiatry 2009;66:1253–62.