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Biomedical subjects

Hayden McRobbie

Publications and source records attributed to Hayden McRobbie.

10 recordsLinked to original sources
PubMed2007

Dependence potential of nicotine replacement treatments: effects of product type, patient characteristics, and cost to user.

OBJECTIVE: To assess the extent of long-term use of different nicotine replacement treatment products in smokers attending routine smoking cessation treatment and to examine the effect of nicotine replacement treatment cost on its long-term use. METHOD: 1518 consecutive patients prescribed nicotine replacement treatment at the East London Smokers' Clinic between January 2000 and November 2002 were followed up at 1-year. RESULTS: The rates of long-term use ranged from 2% for patch to 13% for nasal spray. Long-term use of nicotine replacement treatment was significantly more likely in more dependent smokers. Treatment cost, and whether it was provided free of charge, had no significant effect on its long-term use. CONCLUSIONS: Long-term use of nicotine replacement treatment is not uncommon. Its occurrence seems positively related to speed of nicotine delivery of individual products. For self-selected highly dependent smokers, long-term use of nicotine replacement treatment may be a necessary precondition for maintaining long-term abstinence. The findings have financial and clinical implications for providers of smoking cessation services.

Administration, Cutaneous↗
PubMed2006

Randomized controlled trial of a social support ('buddy') intervention for smoking cessation.

OBJECTIVE: To assess the effectiveness of including a social support intervention ('buddy system') in a group treatment programme to aid smoking cessation. METHODS: Five hundred and sixty-three smokers attended groups at a smokers' clinic. These groups were randomized either to be (a) groups in which smokers were paired with another person to provide mutual support (buddy condition: n=237 in 14 groups) or (b) to receive the same treatment without the buddy component (control: n=326 in 20 groups). Participants were seen weekly for the first 4 weeks after stopping then followed up again after 26 weeks. RESULTS: Smokers in the buddy condition were no more likely than smokers in the control condition to stay abstinent at 1, 4 or 26 weeks. The effect was in the right direction at week one post-quit but after controlling for potential confounders the difference was not significant (odds ratio=1.45 (95% CI; 0.92-2.29), p=0.06). CONCLUSIONS: We were unable to show that a buddy system improved abstinence rates of group treatment programmes. This might be due to the high level of social support already achieved through the groups. PRACTICE IMPLICATIONS: The buddy system is a simple and very low cost addition to a group treatment programme; but the results from this study suggest that the kind of buddy system tested may not add substantially to the success rates. However there may be merits in a more intensive or protracted form of buddying.

Adult↗
PubMed2006

Effectiveness of specialist group treatment for smoking cessation vs. one-to-one treatment in primary care.

OBJECTIVE: Using a quasi-experimental design, this paper contributes to an important debate about the most effective form of psychological treatment to aid smoking cessation: group treatment provided by specialists or one-to-one treatment provided in the community by primary care nurses or pharmacists. METHODS: Data were routinely collected from 1501 clients of a large London stop smoking service that offered both group and one-to-one treatment. RESULTS: A quarter (25%) of the clients were continuously abstinent 4 weeks post-quit: 30% for those receiving group treatment and 19% for one-to-one (Fisher's exact [2-sided]<.001). The difference between the specialist and community-based treatment remained after all possible confounding factors were controlled for (OR: 2.27, p<.001). CONCLUSIONS: In the same service with the same management structure and training programme, group treatment offered by the specialist service yielded higher success rates than counselling by trained primary care nurses and pharmacists.

Adult↗
PubMed2006

Best practice in smoking cessation services for pregnant women: results of a survey of three services reporting the highest national returns, and three beacon services.

AIMS: The NHS allocated dedicated funds to establish specialist smoking cessation services for pregnant smokers in England in 2000. An early survey revealed some uncertainty as to how the new services should work and monitor their outcome. The current survey focused on identifying examples of good practice in this difficult new field. METHOD: Three services with the highest number of successful four-week quitters reported for the 2003/4 monitoring year were identified from Department of Health (DH) monitoring records, and three services were nominated from those known in the field as examples of best practice. There was no overlap between the two groups. All six services provided in-depth interviews. RESULTS: All three highest ranking services that reported close to 100 per cent success rates included unaided quitters identified from hospital wards, rather then smokers actually treated. They had only minimal or average genuine treatment provision for pregnant smokers in place. The three beacon services far exceeded the national throughput and outcome average identified in the previous survey, and provided a wealth of useful information. Although they differed in staffing levels and other aspects of their activities, they all shared several key elements, including a systematic training of midwives in how to refer pregnant smokers, offering nicotine replacement treatment to almost all clients and having an efficient system of providing the prescriptions, offering flexible home visits, and providing intensive multi-session treatment delivered by a small number of dedicated staff. CONCLUSION: Smoking cessation services for pregnant women may need clearer guidance on what they are expected to provide, and how they should monitor their outcome. The key features of the beacon services can serve as a practical model of current best practice applicable across most PCTs.

Benchmarking↗
PubMed2004

Effect of glucose on tobacco withdrawal symptoms in recent quitters using bupropion or nicotine replacement.

RATIONALE AND OBJECTIVES: Glucose has been shown to alleviate the desire to smoke in abstaining heavy smokers and to increase 1-month abstinence rates on its own as well as when combined with nicotine patches. It is not known whether a single dose of glucose can provide additional withdrawal relief in patients who have already abstained for a period of time, and whether it can assist patients using bupropion. METHODS: Seventy-five volunteers from a smoking cessation clinic who maintained 1 week of validated continuous abstinence were randomized to receive four 3 mg dextrose or placebo (sorbitol) tablets. There were 31 bupropion and 44 NRT users. Measures of desire to smoke and of five withdrawal symptoms were taken before taking the tablets, and then at 5 min intervals for 20 min. RESULTS: Despite low baseline ratings of withdrawal discomfort, glucose tablets significantly reduced irritability and hunger in bupropion users. Two other effects including reduction in composite withdrawal score approached but did not reach statistical significance. The effects emerged 10-15 min after taking the tablets. No glucose effect was detected in patients using NRT. CONCLUSIONS: A single dose of glucose taken after a week of sustained abstinence may reduce withdrawal discomfort in patients on bupropion. Further research is warranted in combining glucose and bupropion, and in opportunistic use of glucose tablets in tempting situations during a smoking cessation attempt.

Adult↗
PubMed2004

The relationship between smoking cessation and mouth ulcers.

Patients who stop smoking often complain of aphthous (mouth) ulcers. This symptom is sometimes attributed to the use of smoking cessation medications, but little is known about it. We investigated the incidence, severity, and time course of mouth ulcers in abstaining smokers and the effect of different smoking cessation medications on the symptom. The sample consisted of 1234 smokers who sought treatment at a large smoking cessation clinic, maintained at least 1 week of continuous biochemically validated abstinence, and provided usable data. Participants assessed their mouth ulcers by rating a mouth ulcer item added to the Mood and Physical Symptoms Scale. Subjects made ratings weekly on three occasions while still smoking and over 4 weeks following smoking cessation. After stopping smoking, some 40% of patients developed mouth ulcers, mostly in the first 2 weeks. The problem was generally mild, but 8% reported severe ulceration. The ulcers resolved within 4 weeks in 60% of patients affected. The ulcer ratings in patients using oral nicotine replacement products were higher than in those using patch, nasal spray or bupropion in the first week of abstinence but not afterward. Mouth ulcers were more prevalent in more dependent smokers, and the occurrence of ulcers correlated with other tobacco withdrawal symptoms. Our results confirm that mouth ulcers are a common result of stopping smoking, affecting two in five quitters. Patients should be reassured that the lesions are a result of stopping smoking and not a side-effect of smoking cessation medication.

Adult↗
PubMed2003

Stopping smoking can cause constipation.

SETTING: Constipation is mentioned occasionally as a possible tobacco withdrawal symptom, but no systematic data have been published on this issue. DESIGN: Smokers' clinic patients provided ratings of their level of constipation on three occasions prior to their quit date, and then weekly after they stopped smoking. The total of 1067 participants maintained at least 1 week of continuous abstinence and provided usable data. FINDINGS: The three precessation ratings of constipation were stable. After cessation of smoking, the ratings increased significantly (P < 0.01). In 514 patients who maintained continuous abstinence for 4 weeks and provided complete data, constipation peaked at 2 weeks but remained elevated over the whole period. The net proportion of patients affected was 17%, including 9% who were symptom-free at baseline and became very or extremely constipated. In patients on nicotine replacement the increase in constipation, although significant, was less than in patients on bupropion. CONCLUSIONS: Clinicians treating smokers need to be aware of a possibility that one in six quitters develop constipation, and that for about one in 11 the problem can be severe. Descriptions of tobacco withdrawal syndrome should include constipation.

Bupropion↗