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Biomedical subjects

D P Sachs

Publications and source records attributed to D P Sachs.

17 recordsLinked to original sources
PubMed1992

Effects of differing nicotine-replacement doses on weight gain after smoking cessation.

OBJECTIVE: To prospectively assess effects of doses of a nicotine-replacement agent on weight gain in men and women after smoking cessation. DESIGN: Four-week, randomized, double-blind clinical trial. SETTING: Outpatient medical clinic. STUDY PARTICIPANTS: Healthy volunteers who smoked at least 10 cigarettes per day. INTERVENTION: Pharmacologic: Random assignment to 0, 2, or 4 mg of nicotine polacrilex on a fixed-dose schedule (one piece per hour while awake). Behavioral: Brief, medical/behavioral counseling regarding smoking cessation. MAIN OUTCOME MEASURE: Weight change as a function of dose and gender only in participants abstinent for all 4 week. (Self-reported abstinence verified by breath carbon monoxide levels). RESULTS: Weight change in women abstinent for 4 weeks (n = 16) was +1.69, +0.33, and -0.26 kg in the placebo, 2-mg, and 4-mg groups, respectively, compared with +1.60, +1.45, and +1.18 kg for the men who were abstinent for 4 weeks (n = 19). Medication use did not differ as a function of dose or gender. CONCLUSIONS: Nicotine polacrilex suppressed, in a dose-related fashion, weight gain after smoking cessation in successfully treated women. Weight gain was not shown to be suppressed in men, possibly because of small sample size.

Adult↗
PubMed1992

Impact of a clinical preventive medicine curriculum for primary care faculty: results of a dissemination model.

BACKGROUND: This study was designed to test a dissemination model for providing clinical preventive medicine (CPM) training to general internal medicine faculty across the United States. METHODS: The model incorporated direct instruction of a few faculty as seminar facilitators who, in turn, taught a CPM curriculum to their faculty colleagues, who then could teach it to housestaff and students. The CPM curriculum consisted of six seminars that focused primarily on the risk factors for chronic diseases and on behavior change methods for modifying smoking, diet, and exercise. RESULTS: Faculty who participated in the seminars had significant pre- to post-test increase in knowledge and reported self-efficacy to implement CPM strategies with patients, as well as changes in CPM clinical practices. These faculty, in turn, successfully disseminated CPM information to their housestaff, who also had increases in self-efficacy and changed clinical practices regarding CPM topics. CONCLUSIONS: The successful implementation of the dissemination model attests to its viability as a mechanism for disseminating CPM curricula and increasing the emphasis on CMP issues in both clinical teaching and clinical encounters with patients.

Adult↗
PubMed1992

Transdermal clonidine reduced some withdrawal symptoms but did not increase smoking cessation.

BACKGROUND: Clonidine may be useful in controlling tobacco withdrawal and in facilitating smoking cessation. This study was developed to test the efficacy of transdermal clonidine in promoting smoking cessation. METHODS: We conducted a five-center, double-blind, placebo-controlled, randomized controlled trial of transdermal clonidine in conjunction with a minimal behavioral intervention for smoking cessation. The intervention was based on the American Lung Association's Freedom From Smoking program. Self report of not smoking was validated with exhaled air carbon monoxide of less than 8 ppm and salivary cotinine of less than 20 ng/mL. Transdermal clonidine therapy began 1 week before the target quit date: 0.1 mg/24 h for the first 4 days increasing to 0.2 mg/24 h for the next 3 days, if the lower dose was tolerated. The highest tolerated dose was then continued for 6 weeks after target quit day. Withdrawal symptoms were measured daily for the first 7 days after target quit day. RESULTS: A total of 213 patients were enrolled (106 active drug and 107 placebo). During the study, 15.5% of patients had drug therapy discontinued due to adverse effects, 24.5% (26/106) taking active drug vs 8.4% (9/107) receiving placebo. There was a significant reduction in anxiety score from 3.0 to 2.4 (placebo vs active) and irritability score from 2.2 to 1.7 (placebo vs active) during the first week after cessation. There was no reduction in other withdrawal symptoms. The overall 12-week abstinence rate was 33.0% (35/106) in the active drug group vs 34.5% (37/107) in the placebo group (not significant). CONCLUSION: This study demonstrated some reduction in early withdrawal symptoms with the use of a clonidine transdermal patch, but no increase in cessation rate, 6 weeks after medication had been discontinued.

Administration, Cutaneous↗
PubMed1991

Pharmacologic approaches to smoking cessation.

Only 25 years ago, tobacco dependence was believed to be a simple overuse problem. Research in the last 5 years has demonstrated a much more complex and profound neurochemical and behavioral disorder. Nicotine receptors in the locus coeruleus and the midbrain mesolimbic dopaminergic system activate both arousal state and enhance cognitive functioning (locus coeruleus) and activate the brain's "pleasure center" (mesolimbic system). Pharmacologic treatments, which must be completely integrated into the behavioral treatment plan, alter these profound central nervous system nicotine effects. Currently the only agent with clear scientific evidence for treatment efficacy is nicotine itself. Available only in a transmucosally delivered ion-exchange resin as nicotine polacrilex (Nicorette), nicotine should soon be available in other delivery forms that will have different absorption kinetics: transdermal patch, nasal spray, and vapor inhaler. Other agents in various phases of preclinical and clinical evaluation include 5-HT1A partial agonists such as buspirone; alpha 2-noradrenergic agonists such as clonidine; tricyclics such as doxepin; serotonin re-uptake antagonists such as fluoxetine; ACTH; 5-HT2 antagonists such as ritanserin; central excitatory amino acid inhibitors such as kynurenate; and calcium channel blockers.

Clonidine↗
PubMed1990

Direct repair of an extracranial vertebral artery pseudoaneurysm: case report and review of the literature.

A case of a 47-year-old man with weakness secondary to ossification of the posterior longitudinal ligament is presented. During removal of the ossified ligament, the patient's dominant right vertebral artery was injured. Although the bleeding from this artery was controlled intraoperatively, the patient developed an expanding cervical hematoma on the 3rd postoperative day. An angiogram demonstrated a large pseudoaneurysm of the right vertebral artery. The patient was taken back to the operating room where the cervical hematoma was removed, and direct repair of the pseudoaneurysm of the vertebral artery was performed. The previously reported cases of pseudoaneurysms of the extracranial vertebral artery are reviewed. We advocate the use of direct vascular repair as the treatment of choice in these lesions.

Hematoma↗
PubMed1990

Smoking cessation strategies: what works, what doesn't.

Health professionals can effectively help patients quit smoking with a minimal, intervention-oriented, office-based treatment program. Clear-cut, unequivocal, unambiguous, stop-smoking advice can produce sustained, 1-year abstinence rates in the 5% range. This capability has been clearly documented for physicians. Dental literature increasingly supports the same conclusion for dentists. These studies show that although the yield from such brief advice may seem small, it is 17 times greater than the yield which results from saying nothing. Moreover, because dentists and physicians see so many patients during the course of 1 year, the potential impact of such intervention is staggering. More than 3.5 million patients could be cured of tobacco dependence annually. While specialized smoking cessation treatment programs can achieve 1 year sustained abstinence rates as high as 70%, they reach relatively few patients and can only achieve such high success rates because of the intensive, time-consuming nature of their interventions. The impact of basic dental advice can be increased during regular follow-up visits, when "teachable moments" in dental health often occur. Impact of advice on the 1-year sustained abstinence rates can be increased by arranging to see the patient at regular follow-up visits after the target quit date has been set, making certain that the medication, nicotine polacrilex, is used correctly.(ABSTRACT TRUNCATED AT 250 WORDS)

Chewing Gum↗
PubMed1989

Pulmonary capillaritis and hemorrhage. A clue to the diagnosis of systemic necrotizing vasculitis.

Patients with systemic necrotizing vasculitis frequently present as diagnostic dilemmas. In previous series of patients with polyarteritis nodosa, less than one third were diagnosed antemortem. Although current clinical awareness of systemic necrotizing vasculitis is greater than in the past and procedures for the diagnosis of these diseases have improved, patients commonly present with atypical features. The diagnosis of a systemic necrotizing vasculitis frequently remains unsuspected or unproven until an involved tissue is biopsied. We report an unusual case of systemic necrotizing vasculitis in which the diagnosis was confirmed by a transbronchial biopsy of the lung which demonstrated pulmonary capillaritis with hemorrhage.

Aged↗
PubMed1989

Gingival response to nicotine polacrilex.

Nicotine polacrilex (Nicorette) is the only medication approved by the Food and Drug Administration for tobacco dependency treatment. It is available only by prescription. This study sought to determine whether this medication produced any adverse gingival effects. Thirty-one patients (91%) used the nicotine polacrilex for at least 1 month and 20 (59%) for 3 months or more. Five (15%) developed small (less than 2 mm), painless, clear, nonhemorrhagic vesicles which resolved immediately when patients were reinstructed to position the medication in different sites in the mouth. There were no changes in gingival color, contour, consistency and texture, tooth mobility, or periodontal pocket depth. Nicotine polacrilex does not appear to have any significant adverse effects on the gingiva even with up to 6 months of daily use.

Chewing Gum↗
PubMed1988

Direct methods of obtaining information on cigarette smoking in occupational studies.

Many occupational epidemiology studies require complete and accurate information on tobacco use to control for confounding by smoking and to assess interactions of smoking with workplace exposures. This paper reviews and evaluates the availability, reliability, validity, and efficiency of the various data sources and techniques for obtaining individual smoking data, including existing records, biological markers, and surveys. Emphasis is placed on the highly problematic issue of obtaining retrospective smoking histories. In general, the survey technique is currently deemed the most feasible approach for obtaining lifetime smoking histories. Both theoretical and practical aspects of smoking surveys are discussed in detail and are illustrated with a review of the recent literature and with data from two recent retrospective cohort studies conducted at the University of Pittsburgh. Several recommendations involving both the use of smoking data and areas for future methodologic research are presented. These include (1) justification for collecting smoking data in occupational studies based primarily on the potential for smoking to act as an effect modifier rather than solely as a confounder, (2) checks for reliability and validity in all studies which involve the collection of smoking data, (3) more methodologic research to better understand the impact that missing, unreliable, and invalid smoking data may have on the ability to detect and quantify important smoking-exposure interactions, and (4) an assessment of the correlation between biological markers and cigarette carcinogen exposure.

Epidemiologic Methods↗
PubMed1986

Cigarette smoking. Health effects and cessation strategies.

During the last 15 years substantial advances in the fields of analytical chemistry, behavioral pharmacology, neurologic sciences, and the behavioral sciences have produced new understanding and insight into why people smoke and how they can stop. These fundamental research efforts have now produced treatment strategies that have objectively documented success rates and that the physician can now implement in his office. Impressive as current results can be, when the physician is willing to spend appropriate and necessary time, effort, and energy, current research indicates that our basic neurochemical understanding of cigarette smoking should improve substantially and lead to even more effective treatment interventions in the next 10 years.

Affect↗
PubMed1978

Effects of rapid smoking. Physiologic evaluation of a smoking-cessation therapy.

We studied 24 healthy young male smokers to ascertain the medical safety of a highly effective smoking-abatement technique called rapid smoking. In comparison with results obtained after a 12-h cigarette fast or after normal smoking, statistically significant increases occurred after rapid smoking in heart and respiratory rates, systolic blood pressure, carboxyhemoglobin, and pH (p less than 0.05), while arterial PCO2, HCO3-, and serum [K+] fell (p less than 0.05). Rapid smoking produced alveolar hyperventilation in all subjects. In eight, arterial PO2 increased appropriately, but in 16, fell paradoxically (p less than 0.01); seven had arterial PO2 below 80 torr. Because this fall could represent ventilation/perfusion mismatch due to early bronchoconstrictive disease, in subjects with normal flow/volume loops and spirometry rapid smoking may be a simple, provocative screening test for early airway disease. Despite the changes produced there were no arrhythmias. Rapid smoking is safe for healthy subjects but should not now be used for higher-risk patients.

Adult↗