Applying the ‘Cognitive Bias Modification’ concept to smoking cessation – A Systematic Review

Abstract. Background: In recent years, new neurocognitive explanatory approaches such as dual-process theories offer significant progress in understanding long-term relapse in substance use disorders. Based on such explanatory concepts stemming from basic research, novel methods of intervention have been deduced which focus on directly changing cognitive biases. The efficacy of these Cognitive Bias Modification (CBM) concepts has been evaluated in a growing number of studies in the context of different substance use and addictive disorders. By now, there are also first findings for using CBM in the context of smoking. Objectives: To evaluate the empirical evidence, whether CBM qualifies i) for reducing attentional or approach bias towards smoking-related cues, ii) for effectively reducing the high relapse rates in smoking cessation, iii) for the reduction of smoking behaviour and iv) craving. Methods: The systematic evidence search has been carried out in clinical databases (Cochrane Library, PsycArticles, PSYNDEX, PsycINFO, Medline) as well as via manual reverse search. Finally, 12 studies have been identified which met the inclusion criteria (RCT, CBM interventions for smokers; outcomes: change in attentional or approach bias, craving, number of cigarettes smoked, abstinence). Results: Despite the heterogeneity of the studies in terms of sample selection, realisation of interventions and methodological aspects, the findings collectively indicate that different forms and ‘dosages’ of CBM interventions can influence attentional or approach bias in smokers. Also, positive effects on craving and motivation to quit could be detected. Effects on smoking behaviour are inconsistent and often statistically non-significant. First online applications showed encouraging results. Discussion: The results concerning the efficacy of CBM in smoking cessation are still rudimentary and inconsistent. However, a large portion of the studies was not conducted under naturalistic conditions, but rather in laboratories with non-treatment seekers or participants partially motivated to quit. Despite these limitations, the findings can be evaluated as encouraging. The results suggest that CBM will be implemented in routine care as an adjunct intervention within a behavioural therapy-oriented cessation programme. However, specific studies which assess the efficacy of CBM as a component for relapse prevention in smoking cessation intervention in routine care are still lacking.

Esophageal manometry and 24-hour pH testing in the management of gastroesophageal reflux patients

BACKGROUND

With rising interest in gastroesophageal reflux disease, an evaluation of the importance of manometry (M) and 24-hour pH testing (pH) for decisions regarding these patients is appropriate.

METHODS

Two gastroenterologists and two surgeons were presented with history and physical examination, endoscopy, histology, and esophagram data ("DATA") from 100 patients and asked to make a treatment decision. After some time, either pH or M was added to DATA, and a further decision requested. Finally, DATA plus pH plus M was presented, and a decision was requested. Decisions were evaluated for changes in medical therapy, changes between medical and surgical therapy, and changes in type of surgery offered.

RESULTS

Overall, 43% (173 of 400) of decisions were altered by the addition of both M and pH to DATA, with 28.5% (114 of 400) of decisions changed from medical therapy to surgery or vice versa by the addition of both tests to DATA. The addition of M alone changed decisions more often than pH alone especially with regard to the type of surgery offered (P <0.05).

CONCLUSIONS

Together, M and pH alter clinical decisions and often alter the decision regarding surgery. Both tests appear important, but M more frequently alters overall management decisions and the type of surgery offered. Despite the need for cost containment, these clinical tools are essential to important decisions regarding the care of patients with gastroesophageal reflux disease.

Antibody-mediated activation of genetically defective Escherichia coli beta-galactosidases by monoclonal antibodies produced by somatic cell hybrids

Six hybridomas producing monoclonal antibodies against Escherichia coli beta-galactosidase (beta-D-galactoside galoctohydrolase, EC 3.2.1.23) have been derived from two separate somatic cell fusions. Three of these antibodies can activate defective enzymes produced by strains of E. coli carrying Z-gene point mutations. In antigen excess, one monoclonal antibody shows similar enzyme binding and mutant-activating capacity. Characteristically, the former reaction has a 200-fold higher equilibrium constant. These data provide direct evidence that the enzyme-activation reaction is a single-hit event in which one antibody site favors the correct conformation of one active center of the enzyme. Because each "activating" hybridoma is able to activate several but not all point mutant enzymes tested, it appears that the correction of the genetic defect is produced by binding key sites of the protein three-dimensional structure rather than the sites affected by the mutation.