Predicting smoking cessation outcome in a medical center from stage of readiness: contemplation versus action.

Background: This study shows the clinical utility of Prochaska and DiClemente's stages of readiness for treating nicotine dependence in a medical center.

Methods: Six hundred forty-eight patients were retrospectively studied in either the contemplation or the action stage of readiness.

Results: Statistical analysis showed the action stage to be the most significant predictor of smoking cessation at 6 months.

Nicotine patch therapy for smoking cessation combined with physician advice and nurse follow-up. One-year outcome and percentage of nicotine replacement.

Objective: To determine the efficacy of a 22-mg nicotine patch combined with the National Cancer Institute program for physician advice and nurse follow-up in providing withdrawal symptom relief, 1-year smoking cessation outcome, and percentage of nicotine replacement.

Design: Randomized, double-blind, placebo-controlled trial.

Subjects: Two-hundred forty healthy volunteers who were smoking at least 20 cigarettes per day.

Serum nicotine and cotinine levels during nicotine-patch therapy.

We related serum nicotine and cotinine levels while subjects were smoking their usual numbers of cigarettes to levels while wearing a nicotine patch under carefully controlled, smoke-free conditions in a clinical research center. Twenty-four volunteers who needed intensive treatment for severe nicotine dependence were admitted to the clinical research center and were treated with a 22 mg transdermal nicotine patch each day and an intensive smoking-cessation program. Serum nicotine and cotinine levels, withdrawal symptoms, and hours and quality of sleep were noted.

Nicotine dependence--treatment for the 1990s.

Physicians must recognize that nicotine is a powerfully addictive drug, and patients with nicotine dependence will have all the hallmarks of an addictive disorder. To successfully treat such patients will require compassion and patience on the part of the physician along with the realization that successful treatment will not be easy for most. As with other drugs, there is a very high relapse rate after initial abstinence and this can be discouraging for physicians and patients alike.

Alcoholism in a coronary care unit population.

To estimate prospectively the concordance between diagnoses of alcoholism by a physician and by use of a questionnaire-type screening test in patients in a coronary care unit, we studied 608 patients admitted to a coronary care unit in a 5 1/2-month period. The results from the Self-Administered Alcoholism Screening Test (SAAST) were compared with the diagnoses by physicians recorded in the medical records for the same patients. A strong association (P < 0.

Effects of the implementation of a smoke-free policy in a medical center.

The implementation of a smoke-free policy in this medical center was associated with a decrease in the prevalence of regular cigarette smoking from 16.7 percent to 13.8 percent and a smoking cessation rate of 22.

Inpatient treatment of severe nicotine dependence.

The most severely nicotine-dependent patients who have tried traditional treatment programs without success may require maximal intervention to achieve abstinence. In the Clinical Research Center at the Mayo Clinic, we assessed the feasibility of an inpatient treatment program for 24 such subjects, who were hospitalized (in groups of 6) for 2 consecutive weeks. A combination of behavioral, chemical-dependence, and transdermal nicotine-replacement therapy was provided in a smoke-free, protected milieu.

Recognizing excellence. Giving your AWE.

Nursing and hospital administrators have several methods of recognizing individual achievements. We developed an awards program to recognize excellence for an entire nursing unit. Our Award of Excellence uses rating factors to measure one unit against another.

A comprehensive model for the treatment of nicotine dependence in a medical setting.

We have summarized the basic components of a comprehensive model for the treatment of nicotine addiction in a medical setting. It is a labor-intensive program with emphasis on individual assessment and the development of individual treatment programs adaptable to all levels of nicotine dependence. We anticipate that this model will be increasingly used by medical centers in the future.

An integrated approach to the treatment of nicotine dependence in a medical center setting: description of the initial experience.

A nicotine-dependence treatment program can be implemented in a medical center setting by using a model that involves physician, patient, and nicotine-dependence counselor. The physician-referred and counselor-directed consultations are followed by a systematic relapse-prevention program. The counselors utilize behavioral approaches, the philosophy and principles of the addictive disorders field, and adjunctive pharmacologic therapy.

Development of smoke-free chemical dependency units.

Until recently, the country's chemical dependency units (CDUs) have not addressed nicotine dependence in a meaningful way for their patients. Most CDUs have accepted exemptions to the smoke-free hospital requirements enacted around the country. Twenty-nine CDU's have been identified which have developed progressive smoke-free policies and begun to treat nicotine dependence in the substance abuser.

Nicotine-replacement therapy with use of a transdermal nicotine patch--a randomized double-blind placebo-controlled trial.

The rate of smoking was significantly reduced in volunteer subjects by providing effective nicotine replacement, self-help material, and weekly visits with a nurse for 6 weeks. Nicotine-replacement therapy with a transdermal nicotine patch (Nicolan) almost doubled the 6-week smoking-cessation rate in comparison with that in a placebo group (77% versus 39%; P = 0.002) among subjects who were smoking at least 20 cigarettes per day at baseline.

Expression of tachykinins by ileal and lung carcinoid tumors assessed by combined in situ hybridization, immunocytochemistry, and radioimmunoassay.

Mid-gut carcinoid tumors have been shown to produce substance P, a tachykinin. A recent addition to this family of peptides is neurokinin A which is cleaved from the same precursor as substance P; beta-pre-pro-tachykinin. The authors have examined mid-gut and pulmonary carcinoid tumors for the presence of the two tachykinins, using immunocytochemical study and radioimmunoassay, and have applied the techniques of in situ hybridization and Northern blot analysis to investigate the expression of mRNA for beta-pre-pro-tachykinin.

The making of a smoke-free medical center.

The concept of smoke-free medical facilities is in its formative stages, and such policies have received broad support. Although smoking has been restricted at Mayo Medical Center for many years, in 1986 it was decided that the medical center should become smoke free. This report summarizes the methods used in developing and implementing a smoke-free policy.

Mesenteric fibromatosis complicating familial adenomatous polyposis: predisposing factors and results of treatment.

Between January 1975 and December 1983, 24 of 183 patients (13%) with familial adenomatous polyposis (FAP) seen at the Mayo Clinic had mesenteric fibromatosis (MF). MF was found most often in FAP patients with associated extra-colonic "Gardner" signs (19 patients) and those who had had previous abdominal surgery (20 patients). In 4 patients, MF appeared spontaneously.

Alcoholism in elderly persons: a study of the psychiatric and psychosocial features of 216 inpatients.

The medical records of 216 elderly persons, admitted to the hospital for treatment of alcoholism, were reviewed. Concern of family and friends was the most common factor motivating patients for admission. Patients with late-onset alcoholism reported an association between a life event and problem drinking more frequently than did the early-onset alcoholics.

Alcoholism in elderly persons: medical aspects and prognosis of 216 inpatients.

We describe 216 elderly patients (65 years of age or older) who were treated for alcoholism in an inpatient treatment program. Emphasis is placed on the demographics, medical characteristics, results of laboratory tests, outcome of treatment, and various comparisons of early- and late-onset alcoholism. The frequency of serious medical disorders among these patients was higher than would be expected for the overall population of a similar age.

Long-term follow-up of persons attending a community-based smoking-cessation program.

The long-term effectiveness of a smoking-cessation program based on education, behavior modification, and group support was evaluated. Because of the availability of long-term follow-up data, the natural history of cessation of smoking in persons who had attended a smoking-cessation program could be studied. At 1 year, the permanent rate of cessation of smoking was 22%, and permanent cessation continued to occur at least through 6 years of follow-up.

Discriminant analysis of the Self-Administered Alcoholism Screening Test.

For a sample of 1156 patients (520 alcoholics and 636 nonalcoholics), discriminant function analyses were performed on the total score, a nine-item version, and a two-item version of the Self-Administered Alcoholism Screening Test (SAAST). With sensitivities set at 90 and 95%, specificities for the total score and nine-item versions ranged from 96.4 to 99.

Computed tomography of benign mature teratomas of the mediastinum.

The computed tomography (CT) findings of five benign, mature teratomas of the anterior mediastinum collected during a ten-year period are described, and their case histories are reviewed. Three of the five were primarily cystic, with only small soft tissue components. One of the five contained equal cystic and solid elements.