Smoking cessation: Brief interventions workAttracting smokers into treatment is vital
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very healthcare professional has sources Page 24) copied and at your fin- ments are available to them.
gertips to pass on to your patients.
about their previous attempts to quit.
diction is, attracting patients into treat-
the last time you tried?” Recent quit at-
a brief intervention format, treating to-
clinical encounter in just two- to three-
patches, cold turkey, quit lines or selfhelp initiatives? Find out how these
1. Determine stage of change and
motivation to quit
The format for brief interventions
involves the following five steps:
are you using now?” The intent of these
Organize to promote cessation
tients who score less than 7 are less suc-
rettes used per day and the time it takes
patients to have their first cigarette. In
insignificant but it is a key first step.
results in a three-fold increase in coun-
2.Collect a history of quit attempts
Some people have never tried to quit.
3.Provide NRT suggestions
Collect history of quit attempts
issue, be sure to calculate the long-term
no hard and fast rules but, in general, if
Provide NRT suggestions
haler spray, bupropion or varenicline.
perts feel that tailoring treatment to the
cents, if behavior therapy is not able to
ed, a spray,or an inhaler. Zyban’s rating
exposure is not established, but is being
The more convenient the better
scale, 1 is not bad at all and 10 is terri-
ble. If this score is greater than 5, the
tients to use gum, sprays, lozenges or in-
Encourage use of supportive behavioral
be more costly, the goal is to quit. Have
the first four- to six-weeks, start to wean
4.Encourage use of supportive behav-
their physicians, should be praised.
out if they still want to quit. Next, find
iors to avoid smoking (see Figure 4).
Follow up at next visit
is “free” when the product is purchased.
(cigarettes per day now vs prequit).
5.Follow up at next visit.
Ⅲ Assess withdrawal symptom control.
Guidelines suggest follow-up in the first
seven days after the cessation date. This
Nicotine Replacement Therapy
Rapid Acting (acute urges or daily use)
up is better than none but more inten-sive face-to-face interventions are more
(daily baseline replacement)
encourage them not to get discouraged.
NICOTINE WITHDRAWAL SCALE
On a scale of 1 to 10 with 1 being least and 10 being most,
have your patients indicate the severity of the following signs.
ncpp). By taking an active role in help-ing smokers quit osteopathic physi-
cians can have a dramatic impact onpublic health and the health of the
1. Fiore MC, Bailey WC, Cohen SJ,etal. Treating Tobacco Use and Depen-
dence. Clinical Practice Guideline.
Rockville, MD: US Department of
Evaluating and management of your patient’s responses to withdrawal
The total number of symptoms over 7 increases the risk of relapse.
Individual Score 1-4
2. O’Loughlin J, Tarasuk J, DiFranza J,
Low-level withdrawal: Increase behavioral strategies.
Paradis G. Measurement of nicotine de-pendence: reliability of selected meas-
Individual Score 5-6
Additional evaluation needed to determine relapse risk and coping skills.
ures of nicotine dependence among ado-lescents. Ann Epidemiol
Individual Score 7-10
Severe symptom. Use both behavioral and NRT interventions to reduce symptoms.
otti NA, Solberg LI, Gordon N, Ritz-woller D, Smith S, Hu W, Zapka J. To-bacco cessation services and patient
satisfaction in nine nonprofit HMOs.
events. Total abstinence in the first two
weeks carries a high degree of success.
Norman J. Montalto, DO, is the medical
visits. Physicians can use 1-to-10 scales
director of the West Virginia Tobacco Quit
to quantify severity (see Figure 7).
Line and clinical associate professor of
Family Medicine at the West Virginia
School of Medicine. Dr Montalto special-
izes in tobacco cessation and serves on the
speakers bureau for Pfizer and, Glaxo-
Smith Kline. He can be reached via e-mail
tivating patients into therapy is our re-
O cigarro é um dos produtos de consumo mais É o indivíduo que convive com fumantes e inalam a vendidos no mundo. Comanda legiões de compradores leais e fumaça de derivados do tabaco em ambientes fechados. tem um mercado em rápida expansão. Satisfeitíssimos, os Poluição Tabagística Ambiental (PTA), é a poluição decorrente fabricantes orgulham-se de ter lucros impressionant
editoriAL Metformin: myths, misunderstandings and lessons from history Gillian Shenfield Clinical trials of new drugs may overstate efficacy and could be minimised by a ‘start low, go slow’ approach not identify adverse effects. It is therefore unusual for the passage of time to reveal that a drug is less Also in 1957 an American group published similar toxic, has greater efficacy