Advice Session Research Articles

One year effectiveness of an individualised smoking cessation intervention at the workplace: a randomised controlled trial

Aims: To assess the effectiveness of a smoking cessation intervention at the workplace. The intervention was adapted to smokers‘ tobacco dependence, and included minimal structured counselling at the first visit...

Short-term treatment for alcohol-related problems: four-session guided self-change versus one session of advice—a randomized, controlled trial

The aim of this study was to compare two short-term treatments for alcohol-related problems. The study was performed at an outpatient clinic for substance misuse, and subjects (65 men and 28 women) were recruited through advertisements in the local newspaper. The subjects were randomized to either a four-session guided self-change group or a one-session advice group. Alcohol consumption, degree of alcohol dependence, negative consequences of drinking, and health-related quality of life were measured or assessed, respectively, by using the timeline follow-back technique, the Short Alcohol Dependence Data (SADD) questionnaire, The Drinker Inventory of Consequences questionnaire, and the Nottingham Health Profile questionnaire. Biological markers for high alcohol consumption [carbohydrate-deficient transferrin (CDT) and gamma-glutamyl transferase (γ-GT) levels] were analyzed. All assessments were made at baseline and at 9- and 23-month follow-up periods after treatment. Self-reported alcohol consumption was significantly reduced ( P < .0001) in both treatment groups at the 23-month follow-up period, as were measures of alcohol dependence, negative consequences of drinking, and health-related quality of life, whereas no corresponding reduction was found in CDT or γ-GT values. No statistically significant differences in self-reported alcohol consumption were found between the two groups. Patient satisfaction was significantly higher with the four-session guided self-change treatment than with the one session of advice. This finding seems to indicate that individuals, although suffering from alcohol-related problems of relatively low severity, appreciate more time with a therapist.

Short- and long-term smoking cessation for three levels of intensity of behavioral treatment.

Efficacy and costs of 3 levels of medical-behavioral treatment intensity in conjunction with nicotine replacement therapy (NRT) were compared in 240 one-pack-a-day smokers: (a) a low-intensity (LI) group that received 8 weeks of NRT (n = 80) and 1 advice and education (A&E) session with a nurse practitioner (NP); (b) a moderate-intensity (MI) group that was provided NRT and 4 A&E sessions with an NP (n = 80); and (c) a high-intensity (HI) group that received treatment combining NRT, 4 A&E sessions, and 12 weeks of individualized cognitive-behavioral therapy (n = 80). Biochemically confirmed abstinence rates at 9, 26, and 52 weeks posttreatment initiation were highest for the HI (45%, 37%, 35%) group, followed by the LI (35%, 30%, and 27%) and MI (27%, 12%, 12%) groups. Group differences approached statistical significance at 9 weeks and were statistically significant at both 26 and 52 weeks. The cost of LI treatment was $308, that of MI was $338, and the HI treatment cost was $582.

Cognitive therapy versus dietary counselling in the outpatient treatment of anorexia nervosa: effects of the treatment phase

Objective Cognitive therapy (CT) has been used in anorexia nervosa, but little is known about its effectiveness. A randomized controlled trial was undertaken comparing dietary advice (DA) with cognitive therapy in the outpatient treatment of AN. Method Thirty-five patients were randomly allocated to either cognitive therapy (n=25) or dietary advice (n=10). There were no significant differences in the groups pre-treatment. Twenty sessions of cognitive therapy or dietary advice were offered. Results At 6 months 23 cognitive therapy patients remained engaged whereas all the dietary advice controls dropped out. Cognitive therapy patients showed significant changes in Body Mass Index (p=0.001), Eating Disorder Inventory Scores (p=0.035), Beck Depression Inventory Scores (p<0.0001) and Locus of Control of Behaviour Scores (p=0.017). Conclusions Significant improvements were observed in patients allocated to cognitive therapy, but not in those allocated to dietary advice on an intention to treat analysis. Cognitive therapy has advantages of promoting engagement and facilitating recovery. Copyright © 1999 John Wiley & Sons, Ltd and Eating Disorders Association.

Cognitive therapy versus dietary counselling in the outpatient treatment of anorexia nervosa: effects of the treatment phase

Objective: Cognitive therapy (CT) has been used in anorexia nervosa, but little is known about its effectiveness, A randomized controlled trial was undertaken comparing dietary advice (DA) with cognitive therapy in the outpatient treatment of AN.Method: Thirty-five patients were randomly allocated to either cognitive therapy (n = 25) or dietary advice (n = 10). There were no significant differences in the groups pre-treatment. Twenty sessions of cognitive therapy or dietary advice were offered.Results: At 6 months 23 cognitive therapy patients remained engaged whereas all the dietary advice controls dropped out. Cognitive therapy patients showed significant changes in Body Mass Index (p = 0.001). Eating Disorder Inventory Scores (p = 0.035). Beck Depression Inventory Scores (p < 0.0001) and Locus of. Control of Behaviour Scores (p = 0.017),Conclusions: Significant improvements were observed in patients allocated to cognitive therapy, but not in those allocated to dietary advice on an intention to treat analysis. Cognitive therapy has advantages of promoting engagement and facilitating recovery. Copyright (C) 1999 John Wiley & Sons, Ltd and Eating Disorders Association.

Providing welfare rights advice in primary care.

To evaluate the introduction of dedicated open access welfare rights advice sessions in a general practice setting. A retrospective study of 416 client visits over a 11 month period from August 1995. A prospective questionnaire survey of 34 attendees over a three month period from April 1996. Semi-structured interviews with 11 involved primary care staff. An inner city health centre. Social characteristics of clients attending; problems presented; benefit uptake; views from the health centre staff and welfare rights advisers and comments on future development. A total of 270 new clients used the service during the study period with 146 repeat visits (35%). Of the new clients, 158 out of 270 (59%) reported that they were disabled and 50% of the 158 had specific disability based welfare rights enquiries. 15% of new clients (40 out of 270) were found to be owed money by the current benefit system. Of these, 24 clients obtained one-off payments totalling ł15,863 and 16 clients obtained regular payments totalling ł539 a week. 58% of interviewed clients had not previously accessed any welfare rights advisory services. The welfare rights service was considered by the primary health care team to be a very useful contribution in a highly deprived area. The advice service increased the uptake of social security benefits in 15% of all new attendees. An open access service may not have been the most efficient method of delivering such advice. However, the high proportion of new clients who reported having a disability suggested that a health centre setting may be particularly accessible for those reporting disability. Further work is required to explore these findings and the most effective and efficient method of delivering the service in a deprived inner city setting.

Providing welfare rights advice in primary care

Objective: To evaluate the introduction of dedicated open access welfare rights advice sessions in a general practice setting. Design: A retrospective study of 416 client visits over a 11 month period from August 1995. A prospective questionnaire survey of 34 attendees over a three month period from April 1996. Semi-structured interviews with 11 involved primary care staff. Setting: An inner city health centre. Outcomes: Social characteristics of clients attending; problems presented; benefit uptake; views from the health centre staff and welfare rights advisers and comments on future development. Results: A total of 270 new clients used the service during the study period with 146 repeat visits (35%). Of the new clients, 158 out of 270 (59%) reported that they were disabled and 50% of the 158 had specific disability based welfare rights enquiries. 15% of new clients (40 out of 270) were found to be owed money by the current benefit system. Of these, 24 clients obtained one-off payments totalling £15 863 and 16 clients obtained regular payments totalling £539 a week. 58% of interviewed clients had not previously accessed any welfare rights advisory services. The welfare rights service was considered by the primary health care team to be a very useful contribution in a highly deprived area. Conclusions: The advice service increased the uptake of social security benefits in 15% of all new attendees. An open access service may not have been the most efficient method of delivering such advice. However, the high proportion of new clients who reported having a disability suggested that a health centre setting may be particularly accessible for those reporting disability. Further work is required to explore these findings and the most effective and efficient method of delivering the service in a deprived inner city setting.

Prenatal care and sea fish

Objectives: To evaluate the effects of a prenatal nutritional counselling programme about the benefits of increasing dietary intake of sea fish. Study design: A hospital and parity matched observational comparison study. Four-hundred ninety-nine pregnant women, attending selected clinics for antenatal care, before 20 weeks gestation, were offered a 20-min nutritional advice session. They were encouraged to increase the intake of oily sea fish and reduce intake of food rich in transfatty acid. For each woman interviewed a corresponding control was established. Main results: The mean birth weight was slightly higher in the study group (3349 g vs. 3284 g) and the difference persisted after adjusting for gestational age (85 g/week vs. 83 g/week). The rate of delivery before 37 weeks was lower in the study group (7.3% versus 9.5%). The mean neonatal head circumference was greater in the study group (34.7 cm vs. 34.4 cm). Conclusion: The effect of advice to increase intake of oily fish warrants further study.

An evaluation of exercise regimes for patients with osteoarthritis of the knee: a single-blind randomized controlled trial

Osteoarthritis (OA) of the knee is a major public health problem in the United Kingdom and various forms of physiotherapy are used in the treatment of this condition despite the lack of studies evaluating its efficacy. The purpose of this study was to compare the efficacy of two different forms of physiotherapy exercise management with a control group. Twenty-seven patients with OA knee were recruited from routine orthopaedic clinics and were on the waiting-list for physiotherapy. Patients were randomly allocated to three groups. Group 1 ( n = 9) consisted of a control group; Group 2 ( n = 8) consisted of supervised sessions of exercises; Group 3 ( n = 10) consisted of an advice and instruction session plus a functional home exercise regime. Parameters measured were: pain; range of motion; quadriceps strength; knee joint swelling; exercise tolerance. Results were analysed using a Kruskal-Wallis analysis of variance and a Mann-Whitney U-test with the significance level set at p &lt;0.05. The results showed no significant difference ( p &gt;0.05) between any of the outcome measures of the three groups. This study concludes that patients with OA knee can be helped most economically by one session of advice and a functional home exercise regime. This can be done in a group setting under supervision of one physiotherapist.

Profile of young people's advice clinic in reproductive health, 1988-93

For an unprepared sexually active teenager the 1990s present a minefield of potential problems in addition to the most obvious problems of unplanned pregnancy and sexually transmitted disease. Promoting the importance of a healthy sexual and reproductive life to young people requires openness, better sex education, realistic discussion of related issues, and provision of contraception, as well as support if things go wrong. The Woodhouse Park Clinic in south Manchester opened in October 1988 with the aim of providing weekly advice sessions to young people up to the age of 18. Advice is given on topics such as substance misuse and smoking as well as on family planning. Attendance has steadily increased over the years; from April to June 1993 the average number of attenders per session was 39, one third of whom were young men.

Behaviour therapy versus doctor's anti‐smoking advice in diabetic patients

To evaluate the efficacy of a structured behaviour therapy programme on smoking cessation in diabetic patients. Prospective, randomized, controlled intervention study. University out-patient diabetes clinic. A total of 794 consecutive insulin-treated smoking diabetic patients were invited to participate in a smoking cessation programme. Eighty-nine patients agreed to participate and were randomized in two groups. Forty-four patients were randomized to a structured extensive behaviour therapy anti-smoking intervention and 45 patients to a control group that received a single unstructured anti-smoking advice session given by a physician. After 6 months, nine patients were confirmed not to be smoking (i.e. urine cotinine concentration below 20 ng ml-1, 2 [5%] in the behaviour therapy intervention group and 7 [16%] in the control group. In diabetic patients an extensive behaviour therapy intervention for smoking cessation is no more successful than an unstructured physician's advice.

Superior outcome of females over males after brief treatment for the reduction of heavy drinking: replication and report of therapist effects

The procedures and findings of a previous study were replicated. Sixty-one men and 35 women were randomized to one of three treatments: Manual: three sessions of instructions in use of a manual describing a step-by-step method for attaining abstinence or moderate drinking. three sessions of advice using a pamphlet summarizing the contents of the manual. Therapist: application of the step-by-step method in an indefinite number of sessions. At 3-month follow-up, the number of Moderate drinkers was again significantly higher among women than men in the GUIDELINES (77% versus 24%) and Manual conditions (75% versus 33%), but not in the Therapist condition (50% versus 53%). Again, at 1-year more women than men were Moderate drinkers in all conditions (69% versus 31% overall). Changes from baseline in GGT, MCV, and the Digit Symbol Test corroborated the clients' reports of drinking. In this study the more experienced therapists had significantly lower rates of client dropout than the less experienced. Clinical and research implications of the findings are discussed.

Specialist versus general practitioner treatment of problem drinkers

The efficacy of specialist versus general practitioner (GP) treatment of problem drinkers was assessed in a randomised controlled trial. 40 problem drinkers referred consecutively to a specialist alcohol clinic by their GP were, after assessment, randomly allocated to either GP or specialist clinic treatment groups. All subjects received intitial advice and counselling in the clinic about their drinking. The specialist clinic group received continued care from the clinic including, if necessary, admission to hospital. Patients in the GP group were returned to the care of the G P who was contacted and supported by the specialist. After 6 months of follow-up, there were significant reductions in alcohol consumption and alcohol-related problems in both groups. No significant difference was found between the two groups with respect to the main outcome measures. No differential treatment effect was found with the more severely dependent drinkers. The findings show that after an initial detailed assessment and advice session, the treatment provided by GPs is at least as effective as that from a specialist clinic with respect to improvements in drinking behaviour and alcohol-related problems. After initial assessment and advice, specialist clinics should encourage GPs to become more involved in the subsequent care of problem drinkers. Such a practice should be based on the individual patient's needs and the adequacy of support offered to GPs.