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Adler A, Bader JS, Basnight B, Booth BW, Cai J, Cho E, Collins JH, Ge Y, Grothendieck J, Keating K, Marshall T, Persikov A, Scott H, Siegelmann R, Singh M, Taggart A, Toll B, Wan KH, Wyschogrod D, Yaman F, Young EM, Celniker SE, Roehner N. Ensemble Detection of DNA Engineering Signatures. ACS Synth Biol 2024; 13:1105-1115. [PMID: 38468602 DOI: 10.1021/acssynbio.3c00398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
Synthetic biology is creating genetically engineered organisms at an increasing rate for many potentially valuable applications, but this potential comes with the risk of misuse or accidental release. To begin to address this issue, we have developed a system called GUARDIAN that can automatically detect signatures of engineering in DNA sequencing data, and we have conducted a blinded test of this system using a curated Test and Evaluation (T&E) data set. GUARDIAN uses an ensemble approach based on the guiding principle that no single approach is likely to be able to detect engineering with perfect accuracy. Critically, ensembling enables GUARDIAN to detect sequence inserts in 13 target organisms with a high degree of specificity that requires no subject matter expert (SME) review.
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Affiliation(s)
- Aaron Adler
- Raytheon BBN, Cambridge, Massachusetts 02138, United States
| | - Joel S Bader
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland 21218, United States
| | - Brian Basnight
- Raytheon BBN, Cambridge, Massachusetts 02138, United States
| | - Benjamin W Booth
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, United States
| | - Jitong Cai
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland 21218, United States
| | - Elizabeth Cho
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland 21218, United States
| | - Joseph H Collins
- Department of Chemical Engineering, Worcester Polytechnic Institute, Worcester, Massachusetts 01609, United States
| | - Yuchen Ge
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland 21218, United States
| | | | - Kevin Keating
- Department of Chemical Engineering, Worcester Polytechnic Institute, Worcester, Massachusetts 01609, United States
| | - Tyler Marshall
- Raytheon BBN, Cambridge, Massachusetts 02138, United States
| | - Anton Persikov
- Department of Computer Science, Princeton University, Princeton, New Jersey 08544, United States
| | - Helen Scott
- Raytheon BBN, Cambridge, Massachusetts 02138, United States
| | - Roy Siegelmann
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland 21218, United States
| | - Mona Singh
- Department of Computer Science, Princeton University, Princeton, New Jersey 08544, United States
| | | | - Benjamin Toll
- Raytheon BBN, Cambridge, Massachusetts 02138, United States
| | - Kenneth H Wan
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, United States
| | | | - Fusun Yaman
- Raytheon BBN, Cambridge, Massachusetts 02138, United States
| | - Eric M Young
- Department of Chemical Engineering, Worcester Polytechnic Institute, Worcester, Massachusetts 01609, United States
| | - Susan E Celniker
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, United States
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Thomas NA, Ward R, Tanner NT, Rojewski AM, Toll B, Gebregziabher M, Silvestri GA. Factors Associated With Smoking Cessation Attempts in Lung Cancer Screening: A Secondary Analysis of the National Lung Screening Trial. Chest 2023; 163:433-443. [PMID: 36162480 PMCID: PMC10103689 DOI: 10.1016/j.chest.2022.08.2239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Lung cancer remains the leading cause of cancer-related mortality in the United States. The National Lung Screening Trial (NLST) demonstrated a 20% reduction in lung cancer mortality resulting from lung cancer screening (LCS) with an additive reduction from smoking abstinence. However, successful smoking cessation within LCS is variable. RESEARCH QUESTION What patient and treatment factors are associated with attempts to quit smoking among those screened for lung cancer? STUDY DESIGN AND METHODS In a secondary analysis of the American College of Radiology Imaging Network arm of the NLST, patient demographics, patient smoking behaviors, and tobacco treatment variables were stratified by patient smoking status. The Cox proportional hazards ratio was used to evaluate each variable's effect on attempting to quit smoking. RESULTS Seven thousand three hundred sixty-nine patients were smoking actively at enrollment in the NLST. Of the patients who reported they were smoking, 73.4% did not receive any pharmacologic tobacco treatment. More patients who attempted to quit received pharmacologic tobacco treatment than those who continued to smoke: (nicotine replacement therapy [NRT], 18.0% vs 12.4% [P < .01]; bupropion, 7.9% vs 6.9% [P = .02]; both NRT and bupropion, 5.6% vs 3.9% [P < .01]). Stable users were more likely to be women (47.8% vs 43.8%; P < .01), to be African American (8.2% vs 6.3%; P = .007), to be unmarried (43.2% vs 36.9% [P < .01]), and to have less than a college education (47.7% vs 42.3%; P < .01). Patients with high dependence who received dual therapy with bupropion and NRT showed the highest likelihood of quit attempt (hazard ratio, 2.07; 95% CI, 1.75-2.44). INTERPRETATION In this analysis, only one-quarter of patients who underwent LCS and who smoked were treated with pharmacologic therapy, which is associated with increased likelihood of attempting to quit. Certain characteristics are associated with difficulty with attempting to quit smoking. Those with high nicotine dependence benefitted most from dual pharmacologic therapy.
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Affiliation(s)
- Nina A Thomas
- Division of Pulmonary and Critical Care, CU Cancer Center, University of Colorado, Denver, CO.
| | - Ralph Ward
- Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Veterans Affairs Hospital, Medical University of South Carolina, Charleston, SC; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Nichole T Tanner
- Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Veterans Affairs Hospital, Medical University of South Carolina, Charleston, SC; Thoracic Oncology Research Group, Medical University of South Carolina, Charleston, SC; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | - Alana M Rojewski
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | - Benjamin Toll
- Thoracic Oncology Research Group, Medical University of South Carolina, Charleston, SC; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | - Mulugeta Gebregziabher
- Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Veterans Affairs Hospital, Medical University of South Carolina, Charleston, SC; Thoracic Oncology Research Group, Medical University of South Carolina, Charleston, SC; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Gerard A Silvestri
- Thoracic Oncology Research Group, Medical University of South Carolina, Charleston, SC; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
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Bernstein SL, Dziura J, Weiss J, Brooks AH, Miller T, Vickerman KA, Grau LE, Pantalon MV, Abroms L, Collins LM, Toll B. Successful Optimization of Tobacco Dependence Treatment in the Emergency Department: A Randomized Controlled Trial Using the Multiphase Optimization Strategy. Ann Emerg Med 2023; 81:209-221. [PMID: 36585318 PMCID: PMC9868063 DOI: 10.1016/j.annemergmed.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 06/23/2022] [Accepted: 08/08/2022] [Indexed: 12/29/2022]
Abstract
STUDY OBJECTIVE Tobacco dependence treatment initiated in the hospital emergency department (ED) is effective. However, trials typically use multicomponent interventions, making it difficult to distinguish specific components that are effective. In addition, interactions between components cannot be assessed. The Multiphase Optimization Strategy allows investigators to identify these effects. METHODS We conducted a full-factorial, 24 or 16-condition optimization trial in a busy hospital ED to examine the performance of 4 tobacco dependence interventions: a brief negotiation interview; 6 weeks of nicotine replacement therapy with the first dose delivered in the ED; active referral to a telephone quitline; and enrollment in SmokefreeTXT, a free short-messaging service program. Study data were analyzed with a novel mixed methods approach to assess clinical efficacy, cost-effectiveness, and qualitative participant feedback. The primary endpoint was tobacco abstinence at 3 months, verified by exhaled carbon monoxide using a Bedfont Micro+ Smokerlyzer. RESULTS Between February 2017 and May 2019, we enrolled 1,056 adult smokers visiting the ED. Odd ratios (95% confidence intervals) from the primary analysis of biochemically confirmed abstinence rates at 3 months for each intervention, versus control, were: brief negotiation interview, 1.8 (1.1, 2.8); nicotine replacement therapy, 2.1 (1.3, 3.2); quitline, 1.4 (0.9, 2.2); SmokefreeTXT, 1.1 (0.7, 1.7). There were no statistically significant interactions among components. Economic and qualitative analyses are in progress. CONCLUSION The brief negotiation interview and nicotine replacement therapy were efficacious. This study is the first to identify components of ED-initiated tobacco dependence treatment that are individually effective. Future work will address the scalability of the brief negotiation interview and nicotine replacement therapy by offering provider-delivered brief negotiation interviews and nicotine replacement therapy prescriptions.
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Affiliation(s)
- Steven L Bernstein
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT; Yale Center for Implementation Science, New Haven, CT; Yale Cancer Center, New Haven, CT.
| | - James Dziura
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - June Weiss
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Avis H Brooks
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Ted Miller
- Pacific Institute of Research and Evaluation, Calverton, MD
| | | | - Lauretta E Grau
- Yale Center for Implementation Science, New Haven, CT; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT
| | - Michael V Pantalon
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Lorien Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health at George Washington University, Washington, DC
| | - Linda M Collins
- The Methodology Center and Department of Human Development and Family Studies, Pennsylvania State University, State College, PA
| | - Benjamin Toll
- Yale Cancer Center, New Haven, CT; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
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Li X, Toll B, Carpenter M, Nietert P, George M. Repetitive transcranial magnetic stimulation for tobacco treatment in cancer patients. Brain Stimul 2023. [DOI: 10.1016/j.brs.2023.01.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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5
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Shelley D, Wang VHC, Taylor K, Williams R, Toll B, Rojewski A, Foley KL, Rigotti N, Ostroff JS. Accelerating integration of tobacco use treatment in the context of lung cancer screening: Relevance and application of implementation science to achieving policy and practice. Transl Behav Med 2022; 12:1076-1083. [PMID: 36227937 PMCID: PMC9677484 DOI: 10.1093/tbm/ibac076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Based on the findings from the National Lung Screening Trial, the U.S. Preventive Services Task Force recommends annual low dose computed tomography (LDCT) lung cancer screening (LCS) among high-risk adults. Approximately 54% of individuals seeking LCS report current cigarette smoking. Effective smoking cessation interventions, offered at the time of LCS, enhances the health benefits of screening that are attributable to reductions in lung cancer overall and tobacco-related mortality. Considering these data, the Centers for Medicare & Medicaid Services' (CMS) 2015 decision to cover LCS with LDCT required that radiology imaging facilities make tobacco cessation interventions available for people who smoke. In February 2022, CMS reversed their 2015 coverage requirement for delivering tobacco use treatment at the time of LDCT; CMS retained the requirement for counseling during the shared decision-making visit prior to the exam. The policy change does not diminish the importance of offering high-quality tobacco cessation services in conjunction with routine LDCT for LCS. However, LCS programs face a range of barriers to implementing tobacco use treatment in their settings. As a result, implementation has lagged. Closing the "evidence to practice" gap is the focus of implementation science, a field that offers a set of rigorous methods and a systematic approach to identifying and overcoming contextual barriers to implementing evidence-based guidelines in a range of clinical settings. In this paper, we describe how implementation science frameworks and methods can be used to help guide LCS programs in their efforts to integrate tobacco use treatment and discuss policy changes needed to further facilitate the delivery of TUT as an essential component of the LCS process.
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Affiliation(s)
| | | | | | | | - Benjamin Toll
- Medical University of South Carolina, Charleston, SC, USA
| | - Alana Rojewski
- Medical University of South Carolina, Charleston, SC, USA
| | - Kristie L Foley
- Wake Forest University Health Sciences, Winston-Salem, NC, USA
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Cummings M, Warren G, Nahhas G, Toll B. OA03.01 Implementation of an Opt-Out Smoking Cessation Service for Oncology Patients. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Sillero-Rejon C, Leonards U, Munafò MR, Hedge C, Hoek J, Toll B, Gove H, Willis I, Barry R, Robinson A, Maynard OM. Avoidance of tobacco health warnings? An eye-tracking approach. Addiction 2021; 116:126-138. [PMID: 32506597 DOI: 10.1111/add.15148] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/22/2019] [Accepted: 05/29/2020] [Indexed: 11/27/2022]
Abstract
AIMS Among three eye-tracking studies, we examined how cigarette pack features affected visual attention and self-reported avoidance of and reactance to warnings. DESIGN Study 1: smoking status × warning immediacy (short-term versus long-term health consequences) × warning location (top versus bottom of pack). Study 2: smoking status × warning framing (gain-framed versus loss-framed) × warning format (text-only versus pictorial). Study 3: smoking status × warning severity (highly severe versus moderately severe consequences of smoking). SETTING University of Bristol, UK, eye-tracking laboratory. PARTICIPANTS Study 1: non-smokers (n = 25), weekly smokers (n = 25) and daily smokers (n = 25). Study 2: non-smokers (n = 37), smokers contemplating quitting (n = 37) and smokers not contemplating quitting (n = 43). Study 3: non-smokers (n = 27), weekly smokers (n = 26) and daily smokers (n = 26). MEASUREMENTS For all studies: visual attention, measured as the ratio of the number of fixations to the warning versus the branding, self-reported predicted avoidance of and reactance to warnings and for study 3, effect of warning on quitting motivation. FINDINGS Study 1: greater self-reported avoidance [mean difference (MD) = 1.14; 95% confidence interval (CI) = 0.94, 1.35, P < 0.001, ηp2 = 0.64] and visual attention (MD = 0.89, 95% CI = 0.09, 1.68, P = 0.03, ηp2 = 0.06) to long-term warnings, but not for reactance (MD = 0.14, 95% CI = -0.04, 0.32, P = 0.12, ηp2 = 0.03). Increased visual attention to warnings on the upper versus lower half of the pack (MD = 1.8; 95% CI = 0.33, 3.26, P = 0.02, ηp2 = 0.08). Study 2: higher self-reported avoidance of (MD = 0.70; 95% CI = 0.59,0.80, P < 0.001, ηp2 = 0.61) and reactance to (MD = 0.37; 95% CI = 0.27, 0.47, P < 0.001, ηp2 = 0.34) loss-framed warnings but little evidence of a difference for visual attention (MD = 0.52; 95% CI = -0.54, 1.58, P = 0.30, ηp2 = 0.01). Greater visual attention, avoidance and reactance to pictorial versus text-only warnings (all Ps < 0.001, ηp2 > 0.25). Study 3: greater self-reported avoidance of (MD = 0.37; 95% CI = 0.25, 0.48, P < 0.001, ηp2 = 0.33) and reactance to (MD = 0.14; 95% CI = 0.05, 0.23, P = 0.003, ηp2 = 0.11) highly severe warnings but findings were inconclusive as to whether there was a difference in visual attention (MD = -0.55; 95% CI = -1.5, 0.41, P = 0.24, ηp2 = 0.02). CONCLUSIONS Subjective and objective (eye-tracking) measures of avoidance of health warnings on cigarette packs produce different results, suggesting these measure different constructs. Visual avoidance of warnings indicates low-level disengagement with warnings, while self-reported predicted avoidance reflects higher-level engagement with warnings.
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Affiliation(s)
- Carlos Sillero-Rejon
- School of Psychological Science, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, Bristol, UK
- The National Institute for Health Research Applied Research Collaboration West (NIHR AC West), University Hospitals Bristol NHS Foundation Trust, UK
| | - Ute Leonards
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Marcus R Munafò
- School of Psychological Science, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, Bristol, UK
| | - Craig Hedge
- School of Psychology, University of Cardiff, Cardiff, UK
| | - Janet Hoek
- Department of Public Health, University of Otago, Otago, New Zealand
| | - Benjamin Toll
- Department of Public Health Sciences, Medical University of South Carolina and Hollings Cancer Center, Charleston, SC, USA
| | - Harry Gove
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Isabel Willis
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Rose Barry
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Abi Robinson
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Olivia M Maynard
- School of Psychological Science, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, Bristol, UK
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Leone FT, Zhang Y, Evers-Casey S, Evins AE, Eakin MN, Fathi J, Fennig K, Folan P, Galiatsatos P, Gogineni H, Kantrow S, Kathuria H, Lamphere T, Neptune E, Pacheco MC, Pakhale S, Prezant D, Sachs DPL, Toll B, Upson D, Xiao D, Cruz-Lopes L, Fulone I, Murray RL, O’Brien KK, Pavalagantharajah S, Ross S, Zhang Y, Zhu M. Initiating Pharmacologic Treatment in Tobacco-Dependent Adults. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med 2020; 202:e5-e31. [PMID: 32663106 PMCID: PMC7365361 DOI: 10.1164/rccm.202005-1982st] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background: Current tobacco treatment guidelines have established the efficacy of available interventions, but they do not provide detailed guidance for common implementation questions frequently faced in the clinic. An evidence-based guideline was created that addresses several pharmacotherapy-initiation questions that routinely confront treatment teams. Methods: Individuals with diverse expertise related to smoking cessation were empaneled to prioritize questions and outcomes important to clinicians. An evidence-synthesis team conducted systematic reviews, which informed recommendations to answer the questions. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach was used to rate the certainty in the estimated effects and the strength of recommendations. Results: The guideline panel formulated five strong recommendations and two conditional recommendations regarding pharmacotherapy choices. Strong recommendations include using varenicline rather than a nicotine patch, using varenicline rather than bupropion, using varenicline rather than a nicotine patch in adults with a comorbid psychiatric condition, initiating varenicline in adults even if they are unready to quit, and using controller therapy for an extended treatment duration greater than 12 weeks. Conditional recommendations include combining a nicotine patch with varenicline rather than using varenicline alone and using varenicline rather than electronic cigarettes. Conclusions: Seven recommendations are provided, which represent simple practice changes that are likely to increase the effectiveness of tobacco-dependence pharmacotherapy.
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Tanner NT, Thomas NA, Ward R, Rojewski A, Gebregziabher M, Toll B, Silvestri GA. Association of Cigarette Type With Lung Cancer Incidence and Mortality: Secondary Analysis of the National Lung Screening Trial. JAMA Intern Med 2019; 179:1710-1712. [PMID: 31633739 PMCID: PMC6806424 DOI: 10.1001/jamainternmed.2019.3487] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
This study uses data from the National Lung Screening Trial to investigate the association of cigarette tar level, flavor, and filter status with lung cancer diagnosis, mortality, and all-cause mortality.
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Affiliation(s)
- Nichole T Tanner
- Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Hospital, Charleston, South Carolina.,Thoracic Oncology Research Group, Medical University of South Carolina, Charleston.,Hollings Cancer Center, Medical University of South Carolina, Charleston
| | - Nina A Thomas
- Thoracic Oncology Research Group, Medical University of South Carolina, Charleston
| | - Ralph Ward
- Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Hospital, Charleston, South Carolina.,Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Alana Rojewski
- Hollings Cancer Center, Medical University of South Carolina, Charleston.,Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Mulugeta Gebregziabher
- Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Hospital, Charleston, South Carolina.,Thoracic Oncology Research Group, Medical University of South Carolina, Charleston.,Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Benjamin Toll
- Thoracic Oncology Research Group, Medical University of South Carolina, Charleston.,Hollings Cancer Center, Medical University of South Carolina, Charleston.,Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Gerard A Silvestri
- Thoracic Oncology Research Group, Medical University of South Carolina, Charleston.,Hollings Cancer Center, Medical University of South Carolina, Charleston
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Li X, Toll B, Carpenter M, George M, Dancy M, Wilson D. Efficacy, safety and tolerability of repetitive transcranial magnetic stimulation for smoking cessation in lung cancer: a preliminary report. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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11
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O'Leary T, Weiss J, Toll B, Brandt C, Bernstein SL. Automated Generation of CONSORT Diagrams Using Relational Database Software. Appl Clin Inform 2019; 10:60-65. [PMID: 30674042 DOI: 10.1055/s-0038-1677043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Investigators conducting prospective clinical trials must report patient flow using the Consolidated Standards of Reporting Trials (CONSORT) statement. Depending on how data are collected, this can be a laborious, time-intensive process. However, because many trials enter data electronically, CONSORT diagrams may be generated in an automated fashion. OBJECTIVE Our objective was to use an off-the-shelf software to develop a technique to generate CONSORT diagrams automatically. METHODS During a recent trial, data were entered into FileMaker Pro, a commercially available software, at enrollment and three waves of follow-up. Patient-level data were coded to automatically generate CONSORT diagrams for use by the study team. RESULTS From August 2012 to July 2014, 1,044 participants were enrolled. CONSORT diagrams were generated weekly for study team meetings to track follow-ups at 1, 6, and 12 months, for 960 (92%), 921 (90%), and 871 (88%) participants who were contacted or deceased, respectively. Reasons for loss to follow-up were captured at each follow-up. CONCLUSION CONSORT diagrams can be generated using a standard software for any trial and can facilitate data collection, project management, and reporting.
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Affiliation(s)
- Teresa O'Leary
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut.,Yale Center for Implementation Science, Yale School of Medicine, New Haven, Connecticut
| | - June Weiss
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut.,Yale Center for Implementation Science, Yale School of Medicine, New Haven, Connecticut
| | - Benjamin Toll
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Cynthia Brandt
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut.,Yale Center for Implementation Science, Yale School of Medicine, New Haven, Connecticut.,Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut
| | - Steven L Bernstein
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut.,Yale Center for Implementation Science, Yale School of Medicine, New Haven, Connecticut.,Yale Comprehensive Cancer Center, Yale School of Medicine, New Haven, Connecticut
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12
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Bernstein SL, Dziura J, Weiss J, Miller T, Vickerman KA, Grau LE, Pantalon MV, Abroms L, Collins LM, Toll B. Tobacco dependence treatment in the emergency department: A randomized trial using the Multiphase Optimization Strategy. Contemp Clin Trials 2018; 66:1-8. [PMID: 29287665 PMCID: PMC5851600 DOI: 10.1016/j.cct.2017.12.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 11/29/2017] [Accepted: 12/25/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Tobacco dependence remains the leading preventable cause of death in the developed world. Smokers are disproportionately from lower socioeconomic groups, and may use the hospital emergency department (ED) as an important source of care. A recent clinical trial demonstrated the efficacy of a multicomponent intervention to help smokers quit, but the independent contributions of those components is unknown. METHODS This is a full-factorial (16-arm) randomized trial in a busy hospital ED of 4 tobacco dependence interventions: brief motivational interviewing, nicotine replacement therapy, referral to a telephone quitline, and a texting program. The trial utilizes the Multiphase Optimization Strategy (MOST) and a novel mixed methods analytic design to assess clinical efficacy, cost effectiveness, and qualitative participant feedback. The primary endpoint is tobacco abstinence at 3months, verified by participants' exhaled carbon monoxide. RESULTS Study enrollment began in February 2017. As of April 2017, 52 of 1056 planned participants (4.9%) were enrolled. Telephone-based semi-structured participant interviews and in-person biochemical verification of smoking abstinence are completed at the 3-month follow-up. Efficacy and cost effectiveness analyses will be conducted after follow-up is completed. DISCUSSION The goal of this study is to identify a clinically efficacious, cost-effective intervention package for the initial treatment of tobacco dependence in ED patients. The efficacy of this combination can then be tested in a subsequent confirmatory trial. Our approach incorporates qualitative feedback from study participants in evaluating which intervention components will be tested in the future trial. TRIAL REGISTRATION Trial (NCT02896400) registered in ClinicalTrials.gov on September 6, 2016.
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Affiliation(s)
- Steven L Bernstein
- Department of Emergency Medicine, Yale School of Medicine, United States; Department of Health Policy, Yale School of Public Health, United States; Yale Cancer Center, New Haven, CT, United States.
| | - James Dziura
- Department of Emergency Medicine, Yale School of Medicine, United States; Department of Health Policy, Yale School of Public Health, United States
| | - June Weiss
- Department of Emergency Medicine, Yale School of Medicine, United States
| | - Ted Miller
- Pacific Institute of Research and Evaluation, Calverton, MD, United States
| | | | - Lauretta E Grau
- Department of Health Policy, Yale School of Public Health, United States
| | - Michael V Pantalon
- Department of Emergency Medicine, Yale School of Medicine, United States
| | - Lorien Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health at George Washington University, United States
| | - Linda M Collins
- The Methodology Center and Department of Human Development and Family Studies, Pennsylvania State University, College Station, PA, United States
| | - Benjamin Toll
- Yale Cancer Center, New Haven, CT, United States; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
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Grau LE, Pham T, O'Leary T, Weiss J, Toll B, Bernstein SL. Smokers' Perspectives on Texting for Tobacco Dependence Treatment: A Qualitative Analysis. Nicotine Tob Res 2017; 19:307-313. [PMID: 27613935 DOI: 10.1093/ntr/ntw184] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 07/12/2016] [Indexed: 12/30/2022]
Abstract
Background Numerous evidence-based pharmacologic and behavioral approaches exist for the treatment of tobacco dependence. Short-message service texting is a newer modality which shows promise, but smokers' perspectives on texting have not been widely explored. Objective To use a qualitative research approach to elicit from a sub-sample of participants in a pilot clinical trial their perspectives concerning the feasibility, acceptability, and personal relevance of a publicly available texting program for smoking cessation. Methods Adult smokers enrolled in the intervention arm in a randomized trial of tobacco treatment were interviewed by telephone. Consenting subjects engaged in a 15-30min semi-structured interview with a trained research assistant, discussing their experience with and attitudes about the texting program and how it affected their tobacco use. Interviews were audio-recorded, transcribed verbatim, and analyzed thematically. Descriptive statistics were calculated for the 16 Likert-formatted items. Results Of 30 subjects in the intervention arm, 25 (83%) agreed to participate in the qualitative interviews. In general subjects found the program helpful. Common themes were that the texts served as a form of social support, provided useful strategies to reduce tobacco use, validated subjects' attempts to quit, and offered welcome distractions from cravings. Subjects were satisfied with the frequency, timing, and number of texts, although some improvements were suggested. Conclusions Texting was perceived as feasible, acceptable, and helpful in smokers' attempts to abstain from tobacco. Implications The major themes identified included the program being a valued source of external support that provided useful strategies to reduce tobacco use. Subjects were satisfied with the frequency, timing, and number of texts. Texting was perceived as feasible, acceptable, and helpful in smokers' attempts to abstain from tobacco. Suggestions to improve the program primarily concerned increasing customizable options and using simple, declarative sentences.
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Affiliation(s)
- Lauretta E Grau
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT
| | - Timothy Pham
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Teresa O'Leary
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - June Weiss
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Benjamin Toll
- Department of Psychiatry, Yale School of Medicine, New Haven, CT.,Yale Cancer Center, New Haven, CT.,Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Steven L Bernstein
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT.,Yale Cancer Center, New Haven, CT.,Department of Health Policy, Yale School of Public Health, New Haven, CT
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Cartmel B, Jones B, Fucito L, Tanoue L, Sather P, Toll B. Lung Cancer Screening at Smilow Cancer Hospital and Yale Cancer Center. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.06.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Baldassarri S, Chupp G, Leone F, Warren G, Toll B. Chest Health-care Provider Perceptions of Electronic Cigarettes. Chest 2016. [DOI: 10.1016/j.chest.2016.08.1417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Ramaswamy AT, Toll B, Chagpar AB, Judson BL. Reply to smoking cessation for patients with cancer: "The Emperor's New Clothes". Cancer 2016; 122:2926. [PMID: 27285587 DOI: 10.1002/cncr.30152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 05/19/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Apoorva T Ramaswamy
- Department of Otolaryngology, New York-Presbyterian University Hospital of Columbia and Cornell, New York, New York
| | - Benjamin Toll
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina;, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Anees B Chagpar
- Department of Psychiatry, Yale University School of Medicine;, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Benjamin L Judson
- Department of Psychiatry, Yale University School of Medicine;, Department of Surgery, Yale University School of Medicine; Yale Cancer Center, New Haven, Connecticut
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Bernstein SL, Weiss JM, Toll B, Zbikowski SM. Association Between Utilization of Quitline Services and Probability of Tobacco Abstinence in Low-Income Smokers. J Subst Abuse Treat 2016; 71:58-62. [PMID: 27776679 DOI: 10.1016/j.jsat.2016.08.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 08/02/2016] [Accepted: 08/15/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Quitlines (QL) are an effective means for smoking cessation, but a paucity of data exist examining the dose-response relationship between use of QL services and quit rates, especially among low-income smokers. The purpose of this study was to study the relationship between tobacco abstinence and use of QL services among low-income smokers. METHODS Secondary analysis of a randomized trial of every- or some-day smokers aged 18 years or older visiting an urban emergency department. Inclusion criteria included self-pay or Medicaid insurance, as a proxy for low-income and low socioeconomic status. Intervention participants received a motivational interview, 6 weeks of nicotine patches and gum, a referral faxed to the state-sponsored QL, a booster call, and a quitline brochure. Control participants received the brochure. Smoking status was assessed by phone at 1 and 3 months, with confirmation via exhaled carbon monoxide testing at 3 months for those reporting abstinence. QL usage was obtained by utilization data from the QL database. RESULTS Of 778 subjects, 197 (25.3%) reported any use of QL services at 3 months. Participants were trichotomized: no QL usage, 1 call only, and >1 call (583, 99, and 98 participants, respectively). Quit rates at 3 months in these no, low-, and high-use groups were, respectively, 7.2%, 9.1%, and 15.3% (P=0.03). Participants who used the QL had a median of 28 total minutes of telephone contact. CONCLUSION Among low-income smokers, greater use of QL services is associated with higher abstinence. Whether this resulted from a direct effect of the QL, or greater motivation among smokers using QL services cannot be determined from these data.
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Affiliation(s)
- Steven L Bernstein
- Department of Emergency Medicine, New Haven, CT, United States; Yale Comprehensive Cancer Center, New Haven, CT, United States; Yale School of Medicine, New Haven, CT, United States.
| | - June-Marie Weiss
- Department of Emergency Medicine, New Haven, CT, United States; Yale School of Medicine, New Haven, CT, United States
| | - Benjamin Toll
- Department of Psychiatry, New Haven, CT, United States; Yale Comprehensive Cancer Center, New Haven, CT, United States; Yale School of Medicine, New Haven, CT, United States; Medical University of South Carolina, Seattle, WA, United States; Hollings Cancer Center, Seattle, WA, United States
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Chambers D, Simpson L, Hill-Briggs F, Neta G, Vinson C, Chambers D, Beidas R, Marcus S, Aarons G, Hoagwood K, Schoenwald S, Evans A, Hurford M, Rubin R, Hadley T, Barg F, Walsh L, Adams D, Mandell D, Martin L, Mignogna J, Mott J, Hundt N, Kauth M, Kunik M, Naik A, Cully J, McGuire A, White D, Bartholomew T, McGrew J, Luther L, Rollins A, Salyers M, Cooper B, Funaiole A, Richards J, Lee A, Lapham G, Caldeiro R, Lozano P, Gildred T, Achtmeyer C, Ludman E, Addis M, Marx L, Bradley K, VanDeinse T, Wilson AB, Stacey B, Powell B, Bunger A, Cuddeback G, Barnett M, Stadnick N, Brookman-Frazee L, Lau A, Dorsey S, Pullmann M, Mitchell S, Schwartz R, Kirk A, Dusek K, Oros M, Hosler C, Gryczynski J, Barbosa C, Dunlap L, Lounsbury D, O’Grady K, Brown B, Damschroder L, Waltz T, Powell B, Ritchie M, Waltz T, Atkins D, Imel ZE, Xiao B, Can D, Georgiou P, Narayanan S, Berkel C, Gallo C, Sandler I, Brown CH, Wolchik S, Mauricio AM, Gallo C, Brown CH, Mehrotra S, Chandurkar D, Bora S, Das A, Tripathi A, Saggurti N, Raj A, Hughes E, Jacobs B, Kirkendall E, Loeb D, Trinkley K, Yang M, Sprowell A, Nease D, Lyon A, Lewis C, Boyd M, Melvin A, Nicodimos S, Liu F, Jungbluth N, Lyon A, Lewis C, Boyd M, Melvin A, Nicodimos S, Liu F, Jungbluth N, Flynn A, Landis-Lewis Z, Sales A, Baloh J, Ward M, Zhu X, Bennett I, Unutzer J, Mao J, Proctor E, Vredevoogd M, Chan YF, Williams N, Green P, Bernstein S, Rosner JM, DeWitt M, Tetrault J, Dziura J, Hsiao A, Sussman S, O’Connor P, Toll B, Jones M, Gassaway J, Tobin J, Zatzick D, Bradbury AR, Patrick-Miller L, Egleston B, Olopade OI, Hall MJ, Daly MB, Fleisher L, Grana G, Ganschow P, Fetzer D, Brandt A, Farengo-Clark D, Forman A, Gaber RS, Gulden C, Horte J, Long J, Chambers RL, Lucas T, Madaan S, Mattie K, McKenna D, Montgomery S, Nielsen S, Powers J, Rainey K, Rybak C, Savage M, Seelaus C, Stoll J, Stopfer J, Yao S, Domchek S, Hahn E, Munoz-Plaza C, Wang J, Delgadillo JG, Mittman B, Gould M, Liang S, Kegler MC, Cotter M, Phillips E, Hermstad A, Morton R, Beasley D, Martinez J, Riehman K, Gustafson D, Marsch L, Mares L, Quanbeck A, McTavish F, McDowell H, Brown R, Thomas C, Glass J, Isham J, Shah D, Liebschutz J, Lasser K, Watkins K, Ober A, Hunter S, Lamp K, Ewing B, Iwelunmor J, Gyamfi J, Blackstone S, Quakyi NK, Plange-Rhule J, Ogedegbe G, Kumar P, Van Devanter N, Nguyen N, Nguyen L, Nguyen T, Phuong N, Shelley D, Rudge S, Langlois E, Tricco A, Ball S, Lambert-Kerzner A, Sulc C, Simmons C, Shell-Boyd J, Oestreich T, O’Connor A, Neely E, McCreight M, Labebue A, DiFiore D, Brostow D, Ho PM, Aron D, Harvey J, McHugh M, Scanlon D, Lee R, Soltero E, Parker N, McNeill L, Ledoux T, McIsaac JL, MacLeod K, Ata N, Jarvis S, Kirk S, Purtle J, Dodson E, Brownson R, Mittman B, Curran G, Curran G, Pyne J, Aarons G, Ehrhart M, Torres E, Miech E, Miech E, Stevens K, Hamilton A, Cohen D, Padgett D, Morshed A, Patel R, Prusaczyk B, Aron DC, Gupta D, Ball S, Hand R, Abram J, Wolfram T, Hastings M, Moreland-Russell S, Tabak R, Ramsey A, Baumann A, Kryzer E, Montgomery K, Lewis E, Padek M, Powell B, Brownson R, Mamaril CB, Mays G, Branham K, Timsina L, Mays G, Hogg R, Fagan A, Shapiro V, Brown E, Haggerty K, Hawkins D, Oesterle S, Hawkins D, Catalano R, McKay V, Dolcini MM, Hoffer L, Moin T, Li J, Duru OK, Ettner S, Turk N, Chan C, Keckhafer A, Luchs R, Ho S, Mangione C, Selby P, Zawertailo L, Minian N, Balliunas D, Dragonetti R, Hussain S, Lecce J, Chinman M, Acosta J, Ebener P, Malone PS, Slaughter M, Freedman D, Flocke S, Lee E, Matlack K, Trapl E, Ohri-Vachaspati P, Taggart M, Borawski E, Parrish A, Harris J, Kohn M, Hammerback K, McMillan B, Hannon P, Swindle T, Curran G, Whiteside-Mansell L, Ward W, Holt C, Santos SL, Tagai E, Scheirer MA, Carter R, Bowie J, Haider M, Slade J, Wang MQ, Masica A, Ogola G, Berryman C, Richter K, Shelton R, Jandorf L, Erwin D, Truong K, Javier JR, Coffey D, Schrager SM, Palinkas L, Miranda J, Johnson V, Hutcherson V, Ellis R, Kharmats A, Marshall-King S, LaPradd M, Fonseca-Becker F, Kepka D, Bodson J, Warner E, Fowler B, Shenkman E, Hogan W, Odedina F, De Leon J, Hooper M, Carrasquillo O, Reams R, Hurt M, Smith S, Szapocznik J, Nelson D, Mandal P, Teufel J. Proceedings of the 8th Annual Conference on the Science of Dissemination and Implementation : Washington, DC, USA. 14-15 December 2015. Implement Sci 2016; 11 Suppl 2:100. [PMID: 27490260 PMCID: PMC4977475 DOI: 10.1186/s13012-016-0452-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A1 Introduction to the 8th Annual Conference on the Science of Dissemination and Implementation: Optimizing Personal and Population Health David Chambers, Lisa Simpson D1 Discussion forum: Population health D&I research Felicia Hill-Briggs D2 Discussion forum: Global health D&I research Gila Neta, Cynthia Vinson D3 Discussion forum: Precision medicine and D&I research David Chambers S1 Predictors of community therapists’ use of therapy techniques in a large public mental health system Rinad Beidas, Steven Marcus, Gregory Aarons, Kimberly Hoagwood, Sonja Schoenwald, Arthur Evans, Matthew Hurford, Ronnie Rubin, Trevor Hadley, Frances Barg, Lucia Walsh, Danielle Adams, David Mandell S2 Implementing brief cognitive behavioral therapy (CBT) in primary care: Clinicians' experiences from the field Lindsey Martin, Joseph Mignogna, Juliette Mott, Natalie Hundt, Michael Kauth, Mark Kunik, Aanand Naik, Jeffrey Cully S3 Clinician competence: Natural variation, factors affecting, and effect on patient outcomes Alan McGuire, Dominique White, Tom Bartholomew, John McGrew, Lauren Luther, Angie Rollins, Michelle Salyers S4 Exploring the multifaceted nature of sustainability in community-based prevention: A mixed-method approach Brittany Cooper, Angie Funaiole S5 Theory informed behavioral health integration in primary care: Mixed methods evaluation of the implementation of routine depression and alcohol screening and assessment Julie Richards, Amy Lee, Gwen Lapham, Ryan Caldeiro, Paula Lozano, Tory Gildred, Carol Achtmeyer, Evette Ludman, Megan Addis, Larry Marx, Katharine Bradley S6 Enhancing the evidence for specialty mental health probation through a hybrid efficacy and implementation study Tonya VanDeinse, Amy Blank Wilson, Burgin Stacey, Byron Powell, Alicia Bunger, Gary Cuddeback S7 Personalizing evidence-based child mental health care within a fiscally mandated policy reform Miya Barnett, Nicole Stadnick, Lauren Brookman-Frazee, Anna Lau S8 Leveraging an existing resource for technical assistance: Community-based supervisors in public mental health Shannon Dorsey, Michael Pullmann S9 SBIRT implementation for adolescents in urban federally qualified health centers: Implementation outcomes Shannon Mitchell, Robert Schwartz, Arethusa Kirk, Kristi Dusek, Marla Oros, Colleen Hosler, Jan Gryczynski, Carolina Barbosa, Laura Dunlap, David Lounsbury, Kevin O'Grady, Barry Brown S10 PANEL: Tailoring Implementation Strategies to Context - Expert recommendations for tailoring strategies to context Laura Damschroder, Thomas Waltz, Byron Powell S11 PANEL: Tailoring Implementation Strategies to Context - Extreme facilitation: Helping challenged healthcare settings implement complex programs Mona Ritchie S12 PANEL: Tailoring Implementation Strategies to Context - Using menu-based choice tasks to obtain expert recommendations for implementing three high-priority practices in the VA Thomas Waltz S13 PANEL: The Use of Technology to Improve Efficient Monitoring of Implementation of Evidence-based Programs - Siri, rate my therapist: Using technology to automate fidelity ratings of motivational interviewing David Atkins, Zac E. Imel, Bo Xiao, Doğan Can, Panayiotis Georgiou, Shrikanth Narayanan S14 PANEL: The Use of Technology to Improve Efficient Monitoring of Implementation of Evidence-based Programs - Identifying indicators of implementation quality for computer-based ratings Cady Berkel, Carlos Gallo, Irwin Sandler, C. Hendricks Brown, Sharlene Wolchik, Anne Marie Mauricio S15 PANEL: The Use of Technology to Improve Efficient Monitoring of Implementation of Evidence-based Programs - Improving implementation of behavioral interventions by monitoring emotion in spoken speech Carlos Gallo, C. Hendricks Brown, Sanjay Mehrotra S16 Scorecards and dashboards to assure data quality of health management information system (HMIS) using R Dharmendra Chandurkar, Siddhartha Bora, Arup Das, Anand Tripathi, Niranjan Saggurti, Anita Raj S17 A big data approach for discovering and implementing patient safety insights Eric Hughes, Brian Jacobs, Eric Kirkendall S18 Improving the efficacy of a depression registry for use in a collaborative care model Danielle Loeb, Katy Trinkley, Michael Yang, Andrew Sprowell, Donald Nease S19 Measurement feedback systems as a strategy to support implementation of measurement-based care in behavioral health Aaron Lyon, Cara Lewis, Meredith Boyd, Abigail Melvin, Semret Nicodimos, Freda Liu, Nathanial Jungbluth S20 PANEL: Implementation Science and Learning Health Systems: Intersections and Commonalities - Common loop assay: Methods of supporting learning collaboratives Allen Flynn S21 PANEL: Implementation Science and Learning Health Systems: Intersections and Commonalities - Innovating audit and feedback using message tailoring models for learning health systems Zach Landis-Lewis S22 PANEL: Implementation Science and Learning Health Systems: Intersections and Commonalities - Implementation science and learning health systems: Connecting the dots Anne Sales S23 Facilitation activities of Critical Access Hospitals during TeamSTEPPS implementation Jure Baloh, Marcia Ward, Xi Zhu S24 Organizational and social context of federally qualified health centers and variation in maternal depression outcomes Ian Bennett, Jurgen Unutzer, Johnny Mao, Enola Proctor, Mindy Vredevoogd, Ya-Fen Chan, Nathaniel Williams, Phillip Green S25 Decision support to enhance treatment of hospitalized smokers: A randomized trial Steven Bernstein, June-Marie Rosner, Michelle DeWitt, Jeanette Tetrault, James Dziura, Allen Hsiao, Scott Sussman, Patrick O’Connor, Benjamin Toll S26 PANEL: Developing Sustainable Strategies for the Implementation of Patient-Centered Care across Diverse US Healthcare Systems - A patient-centered approach to successful community transition after catastrophic injury Michael Jones, Julie Gassaway S27 PANEL: Developing Sustainable Strategies for the Implementation of Patient-Centered Care across Diverse US Healthcare Systems - Conducting PCOR to integrate mental health and cancer screening services in primary care Jonathan Tobin S28 PANEL: Developing Sustainable Strategies for the Implementation of Patient-Centered Care across Diverse US Healthcare Systems - A comparative effectiveness trial of optimal patient-centered care for US trauma care systems Douglas Zatzick S29 Preferences for in-person communication among patients in a multi-center randomized study of in-person versus telephone communication of genetic test results for cancer susceptibility Angela R Bradbury, Linda Patrick-Miller, Brian Egleston, Olufunmilayo I Olopade, Michael J Hall, Mary B Daly, Linda Fleisher, Generosa Grana, Pamela Ganschow, Dominique Fetzer, Amanda Brandt, Dana Farengo-Clark, Andrea Forman, Rikki S Gaber, Cassandra Gulden, Janice Horte, Jessica Long, Rachelle Lorenz Chambers, Terra Lucas, Shreshtha Madaan, Kristin Mattie, Danielle McKenna, Susan Montgomery, Sarah Nielsen, Jacquelyn Powers, Kim Rainey, Christina Rybak, Michelle Savage, Christina Seelaus, Jessica Stoll, Jill Stopfer, Shirley Yao and Susan Domchek S30 Working towards de-implementation: A mixed methods study in breast cancer surveillance care Erin Hahn, Corrine Munoz-Plaza, Jianjin Wang, Jazmine Garcia Delgadillo, Brian Mittman Michael Gould S31Integrating evidence-based practices for increasing cancer screenings in safety-net primary care systems: A multiple case study using the consolidated framework for implementation research Shuting (Lily) Liang, Michelle C. Kegler, Megan Cotter, Emily Phillips, April Hermstad, Rentonia Morton, Derrick Beasley, Jeremy Martinez, Kara Riehman S32 Observations from implementing an mHealth intervention in an FQHC David Gustafson, Lisa Marsch, Louise Mares, Andrew Quanbeck, Fiona McTavish, Helene McDowell, Randall Brown, Chantelle Thomas, Joseph Glass, Joseph Isham, Dhavan Shah S33 A multicomponent intervention to improve primary care provider adherence to chronic opioid therapy guidelines and reduce opioid misuse: A cluster randomized controlled trial protocol Jane Liebschutz, Karen Lasser S34 Implementing collaborative care for substance use disorders in primary care: Preliminary findings from the summit study Katherine Watkins, Allison Ober, Sarah Hunter, Karen Lamp, Brett Ewing S35 Sustaining a task-shifting strategy for blood pressure control in Ghana: A stakeholder analysis Juliet Iwelunmor, Joyce Gyamfi, Sarah Blackstone, Nana Kofi Quakyi, Jacob Plange-Rhule, Gbenga Ogedegbe S36 Contextual adaptation of the consolidated framework for implementation research (CFIR) in a tobacco cessation study in Vietnam Pritika Kumar, Nancy Van Devanter, Nam Nguyen, Linh Nguyen, Trang Nguyen, Nguyet Phuong, Donna Shelley S37 Evidence check: A knowledge brokering approach to systematic reviews for policy Sian Rudge S38 Using Evidence Synthesis to Strengthen Complex Health Systems in Low- and Middle-Income Countries Etienne Langlois S39 Does it matter: timeliness or accuracy of results? The choice of rapid reviews or systematic reviews to inform decision-making Andrea Tricco S40 Evaluation of the veterans choice program using lean six sigma at a VA medical center to identify benefits and overcome obstacles Sherry Ball, Anne Lambert-Kerzner, Christine Sulc, Carol Simmons, Jeneen Shell-Boyd, Taryn Oestreich, Ashley O'Connor, Emily Neely, Marina McCreight, Amy Labebue, Doreen DiFiore, Diana Brostow, P. Michael Ho, David Aron S41 The influence of local context on multi-stakeholder alliance quality improvement activities: A multiple case study Jillian Harvey, Megan McHugh, Dennis Scanlon S42 Increasing physical activity in early care and education: Sustainability via active garden education (SAGE) Rebecca Lee, Erica Soltero, Nathan Parker, Lorna McNeill, Tracey Ledoux S43 Marking a decade of policy implementation: The successes and continuing challenges of a provincial school food and nutrition policy in Canada Jessie-Lee McIsaac, Kate MacLeod, Nicole Ata, Sherry Jarvis, Sara Kirk S44 Use of research evidence among state legislators who prioritize mental health and substance abuse issues Jonathan Purtle, Elizabeth Dodson, Ross Brownson S45 PANEL: Effectiveness-Implementation Hybrid Designs: Clarifications, Refinements, and Additional Guidance Based on a Systematic Review and Reports from the Field - Hybrid type 1 designs Brian Mittman, Geoffrey Curran S46 PANEL: Effectiveness-Implementation Hybrid Designs: Clarifications, Refinements, and Additional Guidance Based on a Systematic Review and Reports from the Field - Hybrid type 2 designs Geoffrey Curran S47 PANEL: Effectiveness-Implementation Hybrid Designs: Clarifications, Refinements, and Additional Guidance Based on a Systematic Review and Reports from the Field - Hybrid type 3 designs Jeffrey Pyne S48 Linking team level implementation leadership and implementation climate to individual level attitudes, behaviors, and implementation outcomes Gregory Aarons, Mark Ehrhart, Elisa Torres S49 Pinpointing the specific elements of local context that matter most to implementation outcomes: Findings from qualitative comparative analysis in the RE-inspire study of VA acute stroke care Edward Miech S50 The GO score: A new context-sensitive instrument to measure group organization level for providing and improving care Edward Miech S51 A research network approach for boosting implementation and improvement Kathleen Stevens, I.S.R.N. Steering Council S52 PANEL: Qualitative methods in D&I Research: Value, rigor and challenge - The value of qualitative methods in implementation research Alison Hamilton S53 PANEL: Qualitative methods in D&I Research: Value, rigor and challenge - Learning evaluation: The role of qualitative methods in dissemination and implementation research Deborah Cohen S54 PANEL: Qualitative methods in D&I Research: Value, rigor and challenge - Qualitative methods in D&I research Deborah Padgett S55 PANEL: Maps & models: The promise of network science for clinical D&I - Hospital network of sharing patients with acute and chronic diseases in California Alexandra Morshed S56 PANEL: Maps & models: The promise of network science for clinical D&I - The use of social network analysis to identify dissemination targets and enhance D&I research study recruitment for pre-exposure prophylaxis for HIV (PrEP) among men who have sex with men Rupa Patel S57 PANEL: Maps & models: The promise of network science for clinical D&I - Network and organizational factors related to the adoption of patient navigation services among rural breast cancer care providers Beth Prusaczyk S58 A theory of de-implementation based on the theory of healthcare professionals’ behavior and intention (THPBI) and the becker model of unlearning David C. Aron, Divya Gupta, Sherry Ball S59 Observation of registered dietitian nutritionist-patient encounters by dietetic interns highlights low awareness and implementation of evidence-based nutrition practice guidelines Rosa Hand, Jenica Abram, Taylor Wolfram S60 Program sustainability action planning: Building capacity for program sustainability using the program sustainability assessment tool Molly Hastings, Sarah Moreland-Russell S61 A review of D&I study designs in published study protocols Rachel Tabak, Alex Ramsey, Ana Baumann, Emily Kryzer, Katherine Montgomery, Ericka Lewis, Margaret Padek, Byron Powell, Ross Brownson S62 PANEL: Geographic variation in the implementation of public health services: Economic, organizational, and network determinants - Model simulation techniques to estimate the cost of implementing foundational public health services Cezar Brian Mamaril, Glen Mays, Keith Branham, Lava Timsina S63 PANEL: Geographic variation in the implementation of public health services: Economic, organizational, and network determinants - Inter-organizational network effects on the implementation of public health services Glen Mays, Rachel Hogg S64 PANEL: Building capacity for implementation and dissemination of the communities that care prevention system at scale to promote evidence-based practices in behavioral health - Implementation fidelity, coalition functioning, and community prevention system transformation using communities that care Abigail Fagan, Valerie Shapiro, Eric Brown S65 PANEL: Building capacity for implementation and dissemination of the communities that care prevention system at scale to promote evidence-based practices in behavioral health - Expanding capacity for implementation of communities that care at scale using a web-based, video-assisted training system Kevin Haggerty, David Hawkins S66 PANEL: Building capacity for implementation and dissemination of the communities that care prevention system at scale to promote evidence-based practices in behavioral health - Effects of communities that care on reducing youth behavioral health problems Sabrina Oesterle, David Hawkins, Richard Catalano S68 When interventions end: the dynamics of intervention de-adoption and replacement Virginia McKay, M. Margaret Dolcini, Lee Hoffer S69 Results from next-d: can a disease specific health plan reduce incident diabetes development among a national sample of working-age adults with pre-diabetes? Tannaz Moin, Jinnan Li, O. Kenrik Duru, Susan Ettner, Norman Turk, Charles Chan, Abigail Keckhafer, Robert Luchs, Sam Ho, Carol Mangione S70 Implementing smoking cessation interventions in primary care settings (STOP): using the interactive systems framework Peter Selby, Laurie Zawertailo, Nadia Minian, Dolly Balliunas, Rosa Dragonetti, Sarwar Hussain, Julia Lecce S71 Testing the Getting To Outcomes implementation support intervention in prevention-oriented, community-based settings Matthew Chinman, Joie Acosta, Patricia Ebener, Patrick S Malone, Mary Slaughter S72 Examining the reach of a multi-component farmers’ market implementation approach among low-income consumers in an urban context Darcy Freedman, Susan Flocke, Eunlye Lee, Kristen Matlack, Erika Trapl, Punam Ohri-Vachaspati, Morgan Taggart, Elaine Borawski S73 Increasing implementation of evidence-based health promotion practices at large workplaces: The CEOs Challenge Amanda Parrish, Jeffrey Harris, Marlana Kohn, Kristen Hammerback, Becca McMillan, Peggy Hannon S74 A qualitative assessment of barriers to nutrition promotion and obesity prevention in childcare Taren Swindle, Geoffrey Curran, Leanne Whiteside-Mansell, Wendy Ward S75 Documenting institutionalization of a health communication intervention in African American churches Cheryl Holt, Sheri Lou Santos, Erin Tagai, Mary Ann Scheirer, Roxanne Carter, Janice Bowie, Muhiuddin Haider, Jimmie Slade, Min Qi Wang S76 Reduction in hospital utilization by underserved patients through use of a community-medical home Andrew Masica, Gerald Ogola, Candice Berryman, Kathleen Richter S77 Sustainability of evidence-based lay health advisor programs in African American communities: A mixed methods investigation of the National Witness Project Rachel Shelton, Lina Jandorf, Deborah Erwin S78 Predicting the long-term uninsured population and analyzing their gaps in physical access to healthcare in South Carolina Khoa Truong S79 Using an evidence-based parenting intervention in churches to prevent behavioral problems among Filipino youth: A randomized pilot study Joyce R. Javier, Dean Coffey, Sheree M. Schrager, Lawrence Palinkas, Jeanne Miranda S80 Sustainability of elementary school-based health centers in three health-disparate southern communities Veda Johnson, Valerie Hutcherson, Ruth Ellis S81 Childhood obesity prevention partnership in Louisville: creative opportunities to engage families in a multifaceted approach to obesity prevention Anna Kharmats, Sandra Marshall-King, Monica LaPradd, Fannie Fonseca-Becker S82 Improvements in cervical cancer prevention found after implementation of evidence-based Latina prevention care management program Deanna Kepka, Julia Bodson, Echo Warner, Brynn Fowler S83 The OneFlorida data trust: Achieving health equity through research & training capacity building Elizabeth Shenkman, William Hogan, Folakami Odedina, Jessica De Leon, Monica Hooper, Olveen Carrasquillo, Renee Reams, Myra Hurt, Steven Smith, Jose Szapocznik, David Nelson, Prabir Mandal S84 Disseminating and sustaining medical-legal partnerships: Shared value and social return on investment James Teufel
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Abstract
BACKGROUND Smoking cessation clinical trials assess tobacco abstinence using self-report and biomarkers. Optimum methods for each are unclear; a common question assesses smoking in the prior 7 days. In contrast, timeline follow-back (TLFB) is another technique often used to assess use of alcohol in treatment trials; it is used less frequently in studies of smoking cessation. The goal of this study was to assess concordance between the 7-day smoking question and a 7-day TLFB. METHODS Secondary analysis of data from a randomized clinical trial of smoking cessation was conducted at a busy, urban hospital emergency department (ED) from October 2010 to December 2012. At 1, 3, and 12 months, subjects were contacted by phone to assess smoking status. Those reporting abstinence at 3 months were asked to return for an in-person measurement of exhaled carbon monoxide. For this analysis, smoking status at 1 month was compared for subjects in response to 2 questions asked concurrently, addressing 7-day point prevalence tobacco use and a 7-day TLFB. RESULTS Of 780 subjects, 666 (85.4%) were available for 1-month follow-up. Of these, 99 (14.9%) reported no smoking in response to the 7-day question, and 96 (14.4%) reported no smoking in response to the 7-day TLFB. The overall proportionate agreement between the 2 methods was 98.6%, with a kappa of 0.95 (95% confidence interval [CI]: 0.91-0.98). CONCLUSIONS A single question that assesses smoking at 7 days provides excellent concordance with the more detailed TLFB. The single question appears adequate to assess self-reported tobacco use in clinical trials of smoking cessation.
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Affiliation(s)
- Steven L. Bernstein
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Health Policy, Yale School of Public Health, New Haven, Connecticut, USA
| | - June Rosner
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Benjamin Toll
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut, USA
- Medical University of South Carolina, Charleston, South Carolina, USA
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Bernstein SL, Rosner J, Toll B. A Multicomponent Intervention Including Texting to Promote Tobacco Abstinence in Emergency Department Smokers: A Pilot Study. Acad Emerg Med 2016; 23:803-8. [PMID: 27146116 PMCID: PMC4938754 DOI: 10.1111/acem.12990] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 04/14/2016] [Accepted: 04/14/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Emergency department (ED) patients commonly smoke. Current treatment approaches use motivational interviewing, which is effective, but resource-intensive. Mobile health approaches may be more feasible and generalizable. OBJECTIVE The objective was to assess the feasibility of an ED-initiated program of tobacco dependence treatment that employs text messaging. METHODS Smokers age 18 or older were randomized to intervention or control arms. Control subjects received a brochure describing the state smokers' quitline. Intervention subjects received the brochure, 4 weeks of nicotine patches and gum (with the initial dose administered in the ED), a referral to the quitline, and enrollment in SmokefreeTXT, a free SMS-messaging service. SmokefreeTXT delivered 28 days of messages, two to five messages/day. Some messages ask subjects to provide data on mood or craving. Follow-up was conducted by phone call. RESULTS Sixty subjects were enrolled in May 2014. Of all subjects, 33 (55%) were nonwhite; 78% were insured by Medicaid. All intervention subjects used the texting program, with 24/30 (80%) using the program for all 28 days. At 1 month, 14/30 subjects (47%) in the intervention arm reported abstinence versus 3/30 (10%) in the control arm (p = 0.003). At 3 months, the abstinence rates in the intervention and control arms were, respectively, 9/30 (30%) and 4/30 (13%; p = 0.21). Subjects responding to more assessments of mood or craving were more likely to report abstinence at 1 month. CONCLUSION A texting program, combined with pharmacotherapy and a quitline referral, is feasible and may promote tobacco abstinence in ED smokers. A larger trial is planned to assess these results.
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Affiliation(s)
- Steven L Bernstein
- Department of Emergency Medicine
- Yale School of Medicine, the Yale Cancer Center
- Department of Health Policy, Yale School of Public Health, New Haven, CT
| | | | - Benjamin Toll
- Department of Psychiatry
- Yale School of Medicine, the Yale Cancer Center
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
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Bernstein SL, Rosner JM, Toll B. Cell Phone Ownership and Service Plans Among Low-Income Smokers: The Hidden Cost of Quitlines. Nicotine Tob Res 2016; 18:1791-3. [PMID: 26920647 DOI: 10.1093/ntr/ntw042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 02/17/2016] [Indexed: 11/14/2022]
Abstract
BACKGROUND Quitlines (QLs) are free, effective sources of treatment for tobacco dependence. Although the QL number is toll-free, the use of cell phones as the sole source of telephony may impose an unintended cost, in terms of cell minutes. OBJECTIVES To quantify the use of cell-only telephony among self-pay or Medicaid smokers, assess their calling plans, and estimate the impact of a typical course of QL counseling. METHODS A survey of smokers age at least 18 years visiting an American urban emergency department from April to July, 2013. RESULTS Seven-hundred seventy-three smokers were surveyed, of whom 563 (72.8%) were low-income, defined as having Medicaid or no insurance. All low-income smokers had at least one phone: 48 (8.5%) reported land-lines only, 159 (28.2%) land-lines and cells, and 356 (63.2%) cells only. Of the cell phone owners, monthly calling plans provided unlimited minutes for 339/515 (65.8%), at most 250 minutes for 124 (24.1%), and more than 250 minutes for 52 (10.0%). Another recent trial found that QL users make a median of 1 call lasting 28 minutes, with the 75th and 90th percentiles of calls and minutes at 3 and 4 calls, and 48 and 73.6 minutes, respectively. Thus, robust use of QL services could consume 11%-29% of a low-income smoker's typical 250 monthly cell minutes. CONCLUSION Among low-income smokers, cell phones are often the sole telephone. Robust use of the QL may impose a substantial burden on low-income smokers' calling plans, and therefore deter use of the QL. Exempting calls to QLs from counting against smokers' plans may help promote QL utilization. IMPLICATIONS Low-income individuals have high rates of smoking, and are more likely to own only cell phones, not landlines, for telephone access. Because cell phone calling plans often have limited numbers of monthly minutes, cell-only individuals may have to spend a substantial proportion of their monthly minutes on QL services. This may act as a deterrent to using an otherwise free, effective means of treatment for tobacco dependence. Exempting QLs from monthly calling plans may improve access for low-income smokers.
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Affiliation(s)
- Steven L Bernstein
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT; Yale Comprehensive Cancer Center, Yale School of Medicine, New Haven, CT; Department of Health Policy, Yale School of Public Health, New Haven, CT;
| | - June-Marie Rosner
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Benjamin Toll
- Yale Comprehensive Cancer Center, Yale School of Medicine, New Haven, CT; Department of Psychiatry, Yale School of Medicine, New Haven, CT; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
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Bernstein SL, Rosner J, DeWitt M, Hsiao A, Dziura J, Toll B. Design and implementation of decision support for tobacco dependence treatment in an inpatient electronic medical record. Implement Sci 2015; 10 Suppl 1:A1-I1. [PMID: 26329822 PMCID: PMC4934000 DOI: 10.1186/1748-5908-10-s1-a1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Bernstein SL, D'Onofrio G, Rosner J, O'Malley S, Makuch R, Busch S, Pantalon MV, Toll B. Successful Tobacco Dependence Treatment in Low-Income Emergency Department Patients: A Randomized Trial. Ann Emerg Med 2015; 66:140-7. [PMID: 25920384 PMCID: PMC4819432 DOI: 10.1016/j.annemergmed.2015.03.030] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 03/18/2015] [Accepted: 03/25/2015] [Indexed: 10/23/2022]
Abstract
STUDY OBJECTIVE Tobacco use is common among emergency department (ED) patients, many of whom have low income. Our objective is to study the efficacy of an intervention incorporating motivational interviewing, nicotine replacement, and quitline referral for adult smokers in an ED. METHODS This was a 2-arm randomized clinical trial conducted from October 2010 to December 2012 in a northeastern urban US ED with 90,000 visits per year. Eligible subjects were aged 18 years or older, smoked, and were self-pay or had Medicaid insurance. Intervention subjects received a motivational interview by a trained research assistant, 6 weeks' worth of nicotine patches and gum initiated in the ED, a faxed referral to the state smokers' quitline, a booster call, and a brochure. Control subjects received the brochure, which provided quitline information. The primary outcome was biochemically confirmed tobacco abstinence at 3 months. Secondary endpoints included quitline use. RESULTS Of 778 enrolled subjects, 774 (99.5%) were alive at 3 months. The prevalence of biochemically confirmed abstinence was 12.2% (47/386) in the intervention arm versus 4.9% (19/388) in the control arm, for a difference in quit rates of 7.3% (95% confidence interval 3.2% to 11.5%). In multivariable logistic modeling controlling for age, sex, and race or ethnicity, study subjects remained more likely to be abstinent than controls (odds ratio 2.72; 95% confidence interval 1.55 to 4.75). CONCLUSION An intensive intervention improved tobacco abstinence rates in low-income ED smokers. Because approximately 20 million smokers, many of whom have low income, visit US EDs annually, these results suggest that ED-initiated treatment may be an effective technique to treat this group of smokers.
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Affiliation(s)
- Steven L Bernstein
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT; Yale Cancer Center, New Haven, CT.
| | - Gail D'Onofrio
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - June Rosner
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | | | | | | | - Michael V Pantalon
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Benjamin Toll
- Department of Psychiatry, Yale School of Medicine, New Haven, CT; Yale Cancer Center, New Haven, CT
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Land SR, Warren GW, Moinpour C, Ostroff JS, Crafts J, Folz J, Gulley JL, Szabo E, Chollette V, Brandon TH, Duffy S, Hatsukami DK, Dresler CM, Gritz ER, Schnoll R, Sarna L, Rigotti N, Buckner JC, Mitchell SA, Toll B. Standardizing measurement of tobacco use in cancer clinical trials. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.9550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Stephanie R Land
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | | | | | | | | | | | - James L. Gulley
- National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | | | | | | | | | | | - Ellen R. Gritz
- The University of Texas MD Anderson Cancer Center, Houston, TX
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Pommerenke A, Alberg A, Brandon TH, Croghan I, Cummings MK, Dresler C, Gritz ER, Herbst R, Leischow S, Marshall JR, Toll B, Warren G. Abstract 5049: Physician preferences in tobacco cessation support for cancer patients: A survey of physicians at National Cancer Institute Designated Cancer Centers. Cancer Res 2014. [DOI: 10.1158/1538-7445.am2014-5049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose: The purpose of this study was to evaluate oncologists' preferences for methods to increase delivery of tobacco cessation support to cancer patients.
Methods: An email list of 6844 physicians at NCI Designated Cancer Centers was generated using publically available online resources. An online survey was conducted in the fall of 2013 to assess tobacco assessment and cessation practices by physicians, barriers to providing cessation support, and methods to improve access to cessation services for cancer patients. Results of this survey are compared to similar survey findings by the American Society of Clinical Oncology (ASCO) and the International Association for the Study of Lung Cancer (IASLC).
Results: Of 6844 electronically delivered survey invitations, we received 887 responses (13%). Consistent with previously published ASCO and IASLC surveys, 90% of physicians agreed that tobacco use by patients affects cancer treatment outcomes (vs. 87-92% in ASCO/IASLC), 90% of respondents reported that they ask patients about their tobacco use (vs. 90% in ASCO/IASLC), and 83% routinely advise tobacco users to quit (vs. 80-82% in ASCO/IASLC). However, only 37% of respondents regularly discussed medications, and 35% actively treated patients (vs. 39-44% in ASCO/IASLC). Most (71%) responding oncologists preferred cessation support be provided at the initial patient consult, and few (11%) were concerned about the use of tobacco cessation medications. Lack of time and lack of available resources were the dominant barriers to the administration of tobacco cessation support to cancer patients by oncologists. Only 10% of oncologists believed they were adequately trained to counsel patients on smoking cessation, but 55% reported that training for someone else in their clinic would increase tobacco cessation support. When asked what provider they prefer to administer cessation support to cancer patients, 16% reported a primary care physician, 18% reported a mid-level (nurse practitioner or physician assistant), 50% reported any other clinical staff, and only 1% preferred to personally provide cessation support. Whereas most (58%) oncologists preferred to have dedicated cessation services within their institution, 38% reported they would use dedicated services either within, or outside their institution.
Conclusions: Most oncologists at NCI Designated Cancer Centers recognize the importance of tobacco cessation, but prefer to have tobacco cessation support for cancer patients provided by another trained professional.
Citation Format: Alix Pommerenke, Anthony Alberg, Thomas H. Brandon, Ivana Croghan, Michael K. Cummings, Carolyn Dresler, Ellen R. Gritz, Roy Herbst, Scott Leischow, James R. Marshall, Benjamin Toll, Graham Warren. Physician preferences in tobacco cessation support for cancer patients: A survey of physicians at National Cancer Institute Designated Cancer Centers. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 5049. doi:10.1158/1538-7445.AM2014-5049
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Affiliation(s)
| | | | | | | | | | - Carolyn Dresler
- 4International Association for the Study of Lung Cancer, Aurora, CO
| | | | | | | | | | | | - Graham Warren
- 1Medical University of South Carolina, Charleston, SC
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Land SR, Toll B, Warren GW, Brandon TH, Mitchell SA, Dresler CM, Gritz ER, Schnoll R, Sarna L, Moinpour C, Ostroff JS, Khuri FR, Buckner JC, Cummings KM, Herbst RS, Shields PG, Duffy S, Rigotti N, Prindiville SA, Abrams JS. Standardizing measurement of tobacco use in cancer clinical trials. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e17658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Ellen R. Gritz
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Linda Sarna
- University of California, Los Angeles, Los Angeles, CA
| | | | | | | | | | | | - Roy S. Herbst
- Department of Medical Oncology, Yale University School of Medicine, New Haven, CT
| | | | | | | | | | - Jeffrey S. Abrams
- National Cancer Institute at the National Institutes of Health, Bethesda, MD
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Pommerenke AW, Alberg A, Gritz ER, Cummings KM, Brandon TH, Croghan IT, Dresler C, Herbst RS, Leischow S, Marshall JR, Toll B, Warren GW. Addressing findings from the 2014 Surgeon General’s Report: Physician preference for supporting tobacco cessation in cancer patients. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e17508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Ellen R. Gritz
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | - Carolyn Dresler
- International Association for the Study of Lung Cancer, Denver, CO
| | - Roy S. Herbst
- Department of Medical Oncology, Yale University School of Medicine, New Haven, CT
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Abstract
INTRODUCTION Couples in which both members smoke (dual-smoker couples) have not been the explicit target of cessation interventions. Quit rates are lower and relapse rates are higher among individuals in dual-smoker couples. A potentially effective strategy to motivate dual-smoker couples to quit is to convey messages that highlight how the positive outcomes of quitting (gain frame) or the negative outcomes of continued smoking (loss frame) affect the couple rather than the individual smoker. We explored whether dual-smoker couples' smoking behaviors (e.g., amount smoked) and desire to quit would differ as a function of message frame (gain vs. loss) or outcome focus (individual vs. couple). METHODS Dual-smoker couples (N = 40) completed a baseline survey and were then randomized to review gain- or loss-framed messages that varied whether the outcomes influenced the individual or the couple. Main outcomes were desire to quit after reading messages and smoking behaviors at a 1-month follow-up. RESULTS Couple-focused messages produced the strongest desire to quit and decreased amount of cigarettes smoked at follow-up. The latter effect was mediated by desire to quit. Loss-framed messages produced inconsistent effects on desire to quit. There were no significant interactions between outcome focus and message framing. CONCLUSIONS Findings suggest that messages emphasizing how smoking affects both partners can motivate cessation among dual-smoker couples. Contrary to findings showing that gain-framed messages motivate cessation targeting individual smokers, results suggest that loss-framed messages may be more persuasive than gain-framed messages when the target of the outcome involves significant others.
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Mazure CM, Toll B, McKee SA, Wu R, O’Malley SS. Menstrual cycle phase at quit date and smoking abstinence at 6 weeks in an open label trial of bupropion. Drug Alcohol Depend 2011; 114:68-72. [PMID: 20832955 PMCID: PMC3016455 DOI: 10.1016/j.drugalcdep.2010.07.024] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Revised: 07/12/2010] [Accepted: 07/13/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Quit attempts may have different outcomes based on menstrual cycle phase on quit day. This is the first preliminary study examining whether smoking cessation outcomes vary by menstrual cycle phase of quit date in women receiving a 6-week open trial of sustained release (SR) bupropion. METHODS Thirty-three treatment-seeking premenopausal women were studied. Abstinence outcomes were compared for women quitting during the luteal versus follicular phase. RESULTS Women receiving bupropion SR whose self-selected quit date occurred in the luteal phase had significantly higher rates of point prevalence abstinence during the final week of a 6-week post-quit treatment period than women quitting in the follicular phase (62.5% versus 29.4%; p<0.05). A similar, but non-significant, pattern of findings was demonstrated for continuous abstinence during the treatment phase and for point prevalence abstinence at 3-month follow-up. CONCLUSIONS Women receiving bupropion SR were significantly more likely to be abstinent at treatment completion if quitting occurred during the luteal phase. This is consistent with recent findings of outcome related to cycle phase at quit date in the absence of pharmacotherapy, and differs from findings utilizing nicotine replacement. Results add to emerging data suggesting that smoking cessation interventions with varying mechanisms of action may result in different outcomes for premenopausal women based on gonadal hormones at quit date.
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Affiliation(s)
- Carolyn M. Mazure
- Yale University School of Medicine, Department of Psychiatry,Yale University, Department of Psychology,Women’s Health Research at Yale
| | - Benjamin Toll
- Yale University School of Medicine, Department of Psychiatry,Yale Cancer Center
| | - Sherry A. McKee
- Yale University School of Medicine, Department of Psychiatry
| | - Ran Wu
- Yale University School of Medicine, Department of Psychiatry
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Epperson CN, Toll B, Wu R, Amin Z, Czarkowski KA, Jatlow P, Mazure CM, O’Malley SS. Exploring the impact of gender and reproductive status on outcomes in a randomized clinical trial of naltrexone augmentation of nicotine patch. Drug Alcohol Depend 2010; 112:1-8. [PMID: 20561758 PMCID: PMC2946976 DOI: 10.1016/j.drugalcdep.2010.04.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Revised: 04/14/2010] [Accepted: 04/15/2010] [Indexed: 10/19/2022]
Abstract
In a series of exploratory analyses, we examined the roles of gender, reproductive status and negative affect on smoking abstinence in subjects participating in a large (n=385) 6-week randomized clinical trial (RCT) of nicotine patch therapy, with varying doses of oral naltrexone (0mg, 25mg, 50mg, 100mg) treatment. Negative affect was assessed daily during the first post-quit week via telephone interactive voice response (IVR). Weight and adverse events were recorded weekly. In the intent to treat sample, the effects of dose on continuous abstinence were non-significant in the overall model for men and women. In the 295 study completers, there was a significant effect of dose on continuous abstinence in women only (F=8.53, p=0.04). In the 100mg group, 71% of women were continuously abstinent compared to 41% in the placebo group (p<0.05). Women in the active naltrexone groups gained less weight (F=2.91, df=3, p=0.04). Women in the 100mg vs. placebo group were less adherent with medication (F=3.19, p<0.05). These effects were not significant in men. Naltrexone treatment condition (100mg vs. placebo, p=0.02, odds ratio (OR)=0.28), gender (OR=0.55 p=0.09), and IVR ratings of negative affect (OR 1.02, p=0.04) predicted abstinence at Week 1 in study completers. Menstrual cycle status on quit day had a modest affect on abstinence. These data suggest that naltrexone dose, gender, and negative affect play a role in smoking abstinence, particularly in the early stages of treatment. When used in conjunction with nicotine replacement therapy, naltrexone dose may be important in women.
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Affiliation(s)
- C. Neill Epperson
- University of Pennsylvania School of Medicine Department of Psychiatry, Philadelphia, PA 19104 USA,University of Pennsylvania School of Medicine Department of Obstetrics and Gynecology; Philadelphia, PA 19104 USA
| | - Benjamin Toll
- Yale University School of Medicine Department of Psychiatry, New Haven, CT 06520 USA
| | - Ran Wu
- Yale University School of Medicine Department of Psychiatry, New Haven, CT 06520 USA
| | - Zenab Amin
- Yale University School of Medicine Department of Psychiatry, New Haven, CT 06520 USA
| | - Kathryn A. Czarkowski
- University of Pennsylvania School of Medicine Department of Psychiatry, Philadelphia, PA 19104 USA
| | - Peter Jatlow
- Yale University School of Medicine Department of Laboratory Medicine; New Haven, CT 06520 USA
| | - Carolyn M. Mazure
- Yale University School of Medicine Department of Psychiatry, New Haven, CT 06520 USA,Yale University, Department of Psychology, New Haven, CT 06520 USA,Yale University, Women’s Health Research at Yale; New Haven, CT 06520 USA
| | - Stephanie S. O’Malley
- Yale University School of Medicine Department of Psychiatry, New Haven, CT 06520 USA,Yale University, Department of Psychology, New Haven, CT 06520 USA
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Shafer DE, Toll B, Schuman RF, Nelson BL, Mond JJ, Lees A. Activation of soluble polysaccharides with 1-cyano-4-dimethylaminopyridinium tetrafluoroborate (CDAP) for use in protein-polysaccharide conjugate vaccines and immunological reagents. II. Selective crosslinking of proteins to CDAP-activated polysaccharides. Vaccine 2000; 18:1273-81. [PMID: 10649629 DOI: 10.1016/s0264-410x(99)00370-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Covalently linking protein to polysaccharides converts the anti-polysaccharide immune response from a T-cell independent response to one which is T-cell dependent. The organic cyanylating reagent 1-cyano-4-dimethylaminopyridinium tetrafluoroborate (CDAP) (Vaccine 14:190, 1996) has been used to activate polysaccharides, which can then be reacted with spacer reagents or directly with protein. We wished to explore ways in which proteins could be linked to CDAP-activated polysaccharides to conjugate in a more controlled and selective fashion. To this end, we examined the reaction of nucleophilic amino acids with CDAP-activated polysaccharides under basic and acidic conditions. We found that lysine, cysteine and histidine but not methionine, serine or tyrosine conjugated to CDAP-activated dextran. We also examined the reaction of various spacer reagents with CDAP-activated dextran as a function of pH. The addition of hexanediamine was highly pH dependent and maximal at pH 9.3. In contrast, the addition of adipic dihydrazide, which has a pKa of ca 2.5 was essentially independent of pH. By performing the conjugation reaction at pH 5, we were able to selectively couple hydrazides even in the presence of high concentrations of amines. Proteins derivatized with limited numbers of hydrazides could be conjugated to CDAP-activated polysaccharides at pH5, where the native protein was not reactive. Proteins could be derivatized with hydrazides on carboxyls using adipic dihydrazide and a water soluble carbodiimide or on amines using a mild two-step reaction. Tetanus toxoid-pneumococcal type 14 conjugates produced by coupling hydrazide-derivatized tetanus toxoid under acidic conditions induced anti-polysaccharide antibodies at titers comparable to that stimulated by conjugates produced using a basic coupling pH. Our data suggest that crosslinking was occurring only with the limited number of hydrazides on the protein and that we achieved limited and selective crosslinking between the protein and CDAP-activated polysaccharide. This work also demonstrates that CDAP-mediated conjugation to polysaccharides can be applied even to very pH sensitive proteins and polysaccharides.
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Affiliation(s)
- D E Shafer
- Virion Systems, Inc., Rockville, MD 20850, USA
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Eneroth CM, Andreasson L, Beran M, Biörklund A, Carlsöö B, Modalsli B, Olofsson J, Paavolainen M, Toll B. Preoperative facial paralysis in malignant parotid tumours. ORL J Otorhinolaryngol Relat Spec 1977; 39:272-7. [PMID: 206863 DOI: 10.1159/000275367] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Preoperative paralysis of the facial nerve was found in 145 of 1,029 patients with malignant parotid tumours (14%) treated at nine university clinics in Scandinavia. The incidence of facial paralysis varied between the different clinics. A parellelism between the incidence of the facial paralysis and the impairment of the prognosis of the different tumour types is shown. The presence of preoperative facial nerve paralysis in malignant parotid tumours implies a very poor prognosis but the situation is not as hopeless as has been suggested and therefore one must rely on very radical surgery.
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