Nicotine-dependent Patients Research Articles

Non-Tobacco Nicotine Dependence and Rates of Postoperative Complications in Total Knee Arthroplasty: A Propensity-Matched Comparison.

Tobacco use elevates the incidence of postoperative complications and remains a key modifiable risk factor of perioperative surgical optimization. It remains unclear whether non-tobacco nicotine dependence confers an increased risk of surgical complications. This study evaluates postoperative complications in patients with non-tobacco nicotine dependence for total knee arthroplasty (TKA). We queried the TriNetX health database using Current Procedural Terminology and International Classification of Diseases, 10th Revision (ICD-10) codes and identified two cohorts for evaluation. Cohort A was defined as patients who had a TKA; had a dependence on nicotine; did not have nicotine dependence to cigarettes, chewing tobacco, other tobacco products; and were between the ages of 35 and 90 years. Cohort B was defined as patients who had a TKA but did not have a dependence on nicotine or a personal history of nicotine dependence and were between the ages of 35 and 90 years. This study analyzed a total of 10,594 non-tobacco nicotine-dependent patients and 175,079 non-dependent patients who underwent TKA. In the analysis of propensity-matched cohorts, non-tobacco nicotine-dependent patients demonstrated an increased rate of various postoperative complications within 90 days. Dependent patients saw a significantly increased risk of infection after a procedure (P < 0.001), deep vein thrombosis (P < 0.001), pulmonary embolism (P < 0.001), sepsis (P = 0.0065), and prosthetic joint infection (P = 0.0361) and a higher 3-year revision rate (P = 0.0084). Non-tobacco nicotine dependence demonstrated an increased associated risk of postoperative surgical complications for patients undergoing TKA. Orthopaedic surgeons should consider evaluating non-tobacco nicotine dependence within their surgical optimization protocol. Level III, Prognostic.

Nicotine Dependence and Rates of Postoperative Complications in Achilles Tendon Repair.

Nicotine is a modifiable risk factor that is well demonstrated to cause deleterious effects on tendon healing and overall health. Individuals that have a dependence on nicotine may be at an elevated risk for numerous postoperative complications when compared to nondependent patients. The purpose of this study is to evaluate the complications postoperatively between nicotine- and non-nicotine-dependent Achilles tendon repairs. The global health network database, TriNetX, was used to access and analyze deidentified patient information. Two cohorts were identified for the purposes of this study. Cohort A was defined as patients who had an Achilles tendon repair (Current Procedural Terminology [CPT]: 27650 or CPT: 27654) and had a dependence to nicotine (International Classification of Diseases, Tenth Revision, code: F17). Cohort B was defined as patients who had an Achilles tendon repair but did not have a dependence to nicotine. Data were gathered from health care organizations from August 21, 2000, to August 21, 2023. All postoperative complications were analyzed between 1 and 90 days after the Achilles tendon repair. A total of 2117 nicotine-dependent patients were matched with 18 102 non-nicotine-dependent patients. After propensity matching for age at event, ethnicity, race, sex, and type 2 diabetes mellitus, nicotine-dependent patients who underwent Achilles tendon repair experienced higher associated risk for numerous postoperative complications. When compared to nondependent patients, nicotine-dependent patients had increased risk for wound disruption (risk ratio [RR] 1.55, 95% CI 1.11-2.16) and infection following a procedure (RR 1.64, 95% CI 1.09-2.47) within 90 days post Achilles tendon repair. In this database study using propensity matching, nicotine-dependent patients who underwent Achilles tendon repair were correlated with an increased associated risk for wound disruption and infection after a procedure than their non-nicotine-dependent counterpart. Level III, retrospective cohort study.

Влияют ли возраст и пол на фенотип хронической сердечной недостаточности?

The increase in life expectancy of the Russian population is accompanied by a tendency of aging of patients with coronary heart disease (CHD) and chronic heart failure (CHF). Attention is paid to gender differences in the contributions of individual characteristics to the formation of the heart failure clinical phenotype. The purpose to determine the features of the clinical picture of chronic heart failure in patients with coronary heart disease, taking into account gender and age. Material and methods. 517 patients with CHF and coronary heart disease of both genders were examined. A comparison was made of clinical, laboratory, and instrumental parameters of patients with CHF of different age periods, males and females. Results. Until the age of 60, CHF was predominantly observed in men, in the group older than 75 years in women (p &lt; 0.001). With increasing age, the proportion of nicotine dependent patients decreased, as well as the value of the metabolic index and exercise tolerance. In older patients with CHF, the levels of hemoglobin and triglycerides (TG) in blood decreased. The inverse correlation was found between age and left ventricular ejection fraction (LVEF) and LV end-diastolic size. Among men, tobacco smoking (p = 0.001) and chronic obstructive pulmonary disease (p = 0.001) were found more often. In women, CHF was combined with diabetes mellitus (p &lt; 0.001) and chronic kidney disease (p = 0.001). Female patients differed in levels of general cholesterol, triglyceride and non-high fraction blood cholesterol (p = 0.001, p = 0.023, p = 0.009). Men had more creatinine (p = 0.001) and blood uric acid (p = 0.014). Conclusions. The study identified heart failure with preserved LVEF in 61.5% of men and 74.6% of women; CHF with moderately reduced LVEF — in 15.9% and 18.3%, and CHF with reduced LVEF — in 20.2% and 9.5% (p = 0.003), respectively.

IMPORTANT ASPECTS OF EFFECTIVE TREATMENT OF NICOTINE DEPENDENCE IN PATIENTS WITH DIABETES MELLITUS

Purpose. Increasing the importance and effectiveness of nicotine addiction treatment in patients with diabetes mellitus.Materials and methods. A study of nicotine addiction in patients with type II diabetes mellitus was carried out on the basis of the Department of Endocrinology of the Samara State Medical University Clinics in 2019. The psychological study included 60 men aged 45-60 who are undergoing planned treatment in the endocrinology department for type II diabetes mellitus. Psychological research included: conversation, study of the type of attitude towards illness (TOBOL), study of adherence to treatment (Moriska – Green Compliance Scale). Work with tobacco dependence was carried out according to the WHO recommendations according to the “5 A” principle [14]. Work with patients was carried out in the key of rational, behavioral and gestalt therapy.Results and discussion. In total, 24 group meetings were held – 12 group meetings in each polyclinic group of 26 people. The results obtained showed a decrease in the number of patients with a low level of physical wellbeing, psychological well-being, optimism, self-confidence, and readiness to quit smoking. Along with this, there was an increase in the number of patients with a high level of physical well-being, psychological well-being, optimism), readiness to quit smoking. As for compliance, the overall picture has also improved: there were 39 highly adherent patients among the studied (an increase from 10 % to 75 %), moderately adherent – 13 (a decrease from 73.3 % to 25 %), weakly adherent no (there were 16.7 %).Conclusions. Psychological support of nicotine-dependent patients with diabetes mellitus must necessarily include educational work with patients, work with increasing the level of self-control of the disease and adherence to treatment, with a psychoemotional state. It is optimal to include patients with diabetes mellitus in the group psychotherapeutic process in order to provide mutual assistance and receive effective support in the treatment of tobacco smoking and raise the consciousness of patients in relation to the prevention of complications of diabetes mellitus, and to the disease itself in general.

Impact of Chinese respiratory physicians participating in smoking cessation and mobile health: A randomised feasibility trial.

People who are eager to quit smoking often lack long-term, daily smoking cessation guidance. In addition, advances in mobile communication technology offer promising ways for providing tobacco dependence treatment. However, it is unclear whether the doctor-WeChat network can improve the smoking cessation rate of nicotine-dependent patients. In this prospective single-blind cohort study, 250 smokers were enrolled from May 2018 to October 2018. They were randomly divided into two groups, with or without doctors' active smoking cessation service, and followed up for 6 months. The smoking cessation rate and characteristics of successful smoking cessation groups were compared. The reasons for relapse were also analysed. After smoking cessation for 3 months, the success rate of the group involving active respiratory physicians was 65.0% (80/123), whereas the success rate of the control group was 34.7% (34/98). After 6 months, the success rate of the group involving active respiratory physicians was 55.3% (68/123), while that of the control group was only 11.2% (11/98). There was no difference in the weight change of the participants between the two groups. Subgroup analysis showed that doctors' participation had a greater impact on the success of smoking cessation in men younger than 45 years or unemployed. Doctors in mobile smoking cessation services played a very important role in improving quit rates. Our research provided methodological guidance for further clinical trials and a template for further real-world applications of smoking cessation services.

IMPORTANT ASPECTS OF EFFECTIVE TREATMENT OF NICOTINE DEPENDENCE IN PATIENTS WITH DIABETES MELLITUS

Purpose. Increasing the importance and effectiveness of nicotine addiction treatment in patients with diabetes mellitus. Materials and methods . A study of nicotine addiction in patients with type II diabetes mellitus was carried out on the basis of the Department of Endocrinology of the Samara State Medical University Clinics in 2019. The psychological study included 60 men aged 45-60 who are undergoing planned treatment in the endocrinology department for type II diabetes mellitus. Psychological research included: conversation, study of the type of attitude towards illness (TOBOL), study of adherence to treatment (Moriska – Green Compliance Scale). Work with tobacco dependence was carried out according to the WHO recommendations according to the “5 A” principle [14]. Work with patients was carried out in the key of rational, behavioral and gestalt therapy. Results and discussion . In total, 24 group meetings were held – 12 group meetings in each polyclinic group of 26 people. The results obtained showed a decrease in the number of patients with a low level of physical wellbeing, psychological well-being, optimism, self-confidence, and readiness to quit smoking. Along with this, there was an increase in the number of patients with a high level of physical well-being, psychological well-being, optimism), readiness to quit smoking. As for compliance, the overall picture has also improved: there were 39 highly adherent patients among the studied (an increase from 10 % to 75 %), moderately adherent – 13 (a decrease from 73.3 % to 25 %), weakly adherent no (there were 16.7 %). Conclusions . Psychological support of nicotine-dependent patients with diabetes mellitus must necessarily include educational work with patients, work with increasing the level of self-control of the disease and adherence to treatment, with a psychoemotional state. It is optimal to include patients with diabetes mellitus in the group psychotherapeutic process in order to provide mutual assistance and receive effective support in the treatment of tobacco smoking and raise the consciousness of patients in relation to the prevention of complications of diabetes mellitus, and to the disease itself in general.

A systematic review of the effects of nicotine replacement therapy on agitation among nicotine-dependent psychiatric inpatients

AimsThis systematic review aims to evaluate the effect of nicotine replacement therapies (NRTs) on measures of agitation amongst nicotine-dependent adult psychiatric inpatients.BackgroundSince the introduction of the smoke-free policy for all psychiatric facilities, a psychiatric admission is likely to upset a nicotine-dependent individual's normal routine of nicotine consumption. In addition to the physiological effects of nicotine withdrawal (NW), the interpersonal dynamic which nurse-led guardianship of nicotine products constructs presents stressors to the nicotine dependent patient.Several systematic reviews evaluating changes in objective measures of agitation amongst smoking patients in medical critical care units have found varied results, with some demonstrating worsening agitation with NRT use. We therefore believe that there is sufficient equipoise in the use of NRT to prompt a review of studies amongst psychiatric inpatients.MethodThis review identified English language studies through developed search strategies in PubMed/MEDLINE, EMBASE, PyschINFO, PSYCHLit, Cochrane databases, and Google scholar. The bibliographies of notable papers were explored. Hand searches of five major psychiatric journals were conducted. Peer reviewed studies of any study design were included if they reported primary data of adult psychiatric inpatients. Studies were extracted from 1990 – present, this was felt appropriate as nicotine replacement patches became available in 1992.Search strategies were informed by MeSH search terms and included multiple conceptions of “agitation”, including variations on; agitation, irritability, and arousal to capture the concept from broad academic constructions. The quality of studies was assessed with the Newcastle-Ottawa and Cochrane Collaboration tools.This review follows PRISMA guidelines, and an application for PROSPERO registration has been submitted pending acceptance.ResultTwo studies were identified which matched inclusion criteria. A double-blinded randomised placebo-controlled trial of 40 nicotine-dependent inpatients from Allen et al. reported a significant 23% reduction in Agitated Behaviour Scores at 24 hours following NRT administration on admission compared to their matched placebo controls. Yet a retrospective cross-sectional analysis from Okoli using scores for NW identified more severe withdrawal symptoms including “restlessness” and “anger/irritability” than nicotine-dependent patients not provided with NRT.ConclusionDespite considerable commentary within literature there is presently only one study providing moderate evidence of a positive benefit to measures of agitated behaviour from the use of NRT amongst nicotine-dependent psychiatric inpatients. There is currently very low evidence whether NRT improves or exacerbates the agitation associated with NW amongst nicotine-dependent psychiatric inpatients.

Anksiyete Sensitivitesinin Nikotin Bağımlılığı ve Sigara Bırakma Başarısına Etkileri

Aim: In this study, we aimed to investigate the relationship between the anxiety sensitivity levels and nicotine dependence and smoking cessation outcomes in patients referred to the Smoking Cessation Policlinics.Methods: This retrospective study included 286 patients referred to a smoking cessation policlinic between January 2017 and July 2017. Socio-demographic characteristics, Fagerström Test for Nicotine Dependence (FTDN) scores, depression scores measured by the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Anxiety Sensitivity Index-3 (ASI) scale scores were retrospectively retrieved from patient medical files. All patients were contacted and the instant smoking status of the patients was recorded.Results: Of the participants, 19.5% (n=56) (including those who did not come to follow-up) had quit smoking and were abstinent at least six months after the quitting date. The mean scores of anxiety sensitivity were significantly higher in moderate/high nicotine dependent patients than in mild nicotine dependent patients (p=0.001 and p&amp;lt;0.001, respectively). The mean scores of anxiety sensitivity and all its subscales were significantly higher in current smokers than ex-smokers (p&amp;lt;0.001 for each).Conclusion: It has been determined that anxiety sensitivity may be a severe barrier to smoking cessation success. Therewithal, anxiety sensitivity is significantly associated with high nicotine dependence. It is essential to evaluate the anxiety sensitivity, anxiety, and depression levels from the first days of patients who are planning to stop smoking. High anxiety sensitivity smokers should be carefully monitored, and treatments should be applied to reduce their anxiety sensitivities to increase quit rates

Development features of periodontal tissues inflammatory diseases of nicotine-dependent patients with chronic toxic hepatitis

Introduction. Liver diseases and pathology of the organs of mouth cavity are interconnected. Smoking, usually increases the manifestations of the underlying disease and affects the course. The aim. To investigate the effect of chronic toxic hepatitis of nicotine-dependent patients and of patients without a bad habit on their periodontal status. Materials and methods. During the clinical examination of the oral cavity of 86 patients, the depth and incidence of inflammation of the gum were determined using the number of the Svrakov's number (SN); the conditions of hygiene of the oral cavity were estimated using the Silness-Loe (S-l) index; Periodontal Index (PMA) and Bleeding Index (PBI). General histomorphology was studied on drugs stained with hematoxilin-eosin and by the method of Gerlich and van Gieson. Results. It is established that the indicator of SN had the highest value among patients of group II (2,15±0,13), it was probably (p &lt; 0.05) higher relatively to the group I and comparison group. In the smoking patients with chronic toxic hepatitis, in spinous layer of epithelium was determinanted karyorhexis, karyolysis with the formation of cell debris; basal layer cell proliferation, acanthosis, angiogenesis. We detected damage to collagen and elastic fibers of the periodontal, wich correlated with the intensity and duration of the bad habit. In areas of pronounced alterative changes colonies of bacteria were discovered. Conclusions. Thus, the results obtained in nicotine-dependent patients with chronic toxic hepatitis visualize damaging effect on the epithelium and weakening of the histohematic barrier of the oral cavity and promotes the reproduction and penetrationof pathogenic microflora into the underlying tissues.

Development features of periodontal tissues inflammatory diseases of nicotine-dependent patients with chronic toxic hepatitis

Introduction. Liver diseases and pathology of the organs of mouth cavity are interconnected. Smoking, usually increases the manifestations of the underlying disease and affects the course. The aim. To investigate the effect of chronic toxic hepatitis of nicotine-dependent patients and of patients without a bad habit on their periodontal status. Materials and methods. During the clinical examination of the oral cavity of 86 patients, the depth and incidence of inflammation of the gum were determined using the number of the Svrakov's number (SN); the conditions of hygiene of the oral cavity were estimated using the Silness-Loe (S-l) index; Periodontal Index (PMA) and Bleeding Index (PBI). General histomorphology was studied on drugs stained with hematoxilin-eosin and by the method of Gerlich and van Gieson. Results. It is established that the indicator of SN had the highest value among patients of group II (2,15±0,13), it was probably (p &lt; 0.05) higher relatively to the group I and comparison group. In the smoking patients with chronic toxic hepatitis, in spinous layer of epithelium was determinanted karyorhexis, karyolysis with the formation of cell debris; basal layer cell proliferation, acanthosis, angiogenesis. We detected damage to collagen and elastic fibers of the periodontal, wich correlated with the intensity and duration of the bad habit. In areas of pronounced alterative changes colonies of bacteria were discovered. Conclusions. Thus, the results obtained in nicotine-dependent patients with chronic toxic hepatitis visualize damaging effect on the epithelium and weakening of the histohematic barrier of the oral cavity and promotes the reproduction and penetrationof pathogenic microflora into the underlying tissues.

Pavlovian to Instrumental Transfer Responses Do Not Correlate With Addiction-Like Behavior in Rats.

Pavlovian learning plays a prominent role in the etiology of addiction. The influence of Pavlovian conditioning on the expression of an instrumental response can be studied using the Pavlovian-to-instrumental transfer (PIT) paradigm. This paradigm consists of independent Pavlovian conditioning and instrumental training prior to the combination of both during the test. During this test, the reward is not available, and an increase in the instrumental responding during conditioned stimuli presentation is a measure of PIT. Recent studies have reported a higher PIT in alcohol and nicotine dependent patients, suggesting that enhanced PIT might be a marker for dependence vulnerability. However, these studies did not use standard PIT procedures, and a clear correlation between an enhanced PIT and drug-related and addictive behaviors has so far not been demonstrated. For a systematic evaluation rats were trained in a cocaine addiction model. Addicted-like and non-addicted-like rats were subsequently assessed in the PIT paradigm. In a further experiment, rats were first tested in the PIT paradigm and thereafter subjected to cocaine self-administration (CSA) training. Our results revealed that addicted-like rats did not differ from non-addicted-like in their performance in the PIT test. However, CSA behavior showed a positive correlation with PIT. This data suggests that stronger PIT may predict higher motivational impact of conditioned stimuli on drug self-administration and improved learning of drug-cue association rather than the risk to develop addiction as such.

Prevalence of nicotine dependence and its impact on quality of life and severity of symptoms in schizophrenic patients

Aims and Objectives: The aim of the study is (1) To assess the prevalence of nicotine dependence and its impact on quality of life and severity of symptoms in patients with schizophrenia. (2) To determine the association between ND and clinical symptomatology of schizophrenia. (3) To explore the impact of ND on the quality of life (QOL) of patients with schizophrenia. Materials and Methods: The current study is a cross-sectional study done among 100-male schizophrenic patients conducted in the Department of Psychiatry, Mamata General Hospital, Khammam, Telangana, from July 2017 to December 2017. The tools used are the Fagerstrom test for ND (FTND) was administered to assess ND. The Positive and Negative Syndrome Scale (PANSS) for assessing the clinical symptomatology, and the abbreviated World Health Organization QOL (WHOQOL-BREF) for assessing their QOL. Results: The prevalence of smoking in schizophrenics was 68.75%. Prevalence of ND is higher in illiterates, unemployment, nuclear family, low-socioeconomic status, and hailing from the rural background when compared to that of the nicotine nondependence. Nicotine-dependent were found to be having higher mean scores on the positive subscale and the General Psychopathology Subscale and lower mean scores on negative domain. Within the ND group, correlation testing between the FTND scores and PANSS revealed a negative co-relationship between ND and negative symptoms, whereas the correlation testing between the FTND scores and WHOQOL-BREF scores revealed a negative relationship between ND and psychological, social, and environment domains of QOL. There was a negative correlation between (a) Negative symptoms and all the domain of QOL. (b) General psychopathology and social relationships, environmental among ND. Summary and Conclusion: Nicotine-dependent patients suffer from the higher levels of symptoms and enjoy a worse QOL compared to that of the nondependent patients with schizophrenia. Bearing in mind the innumerable harms of ND, the evaluation and management of ND must become an integral aspect of the evaluation and management of patients with schizophrenia.

Emotion recognition and its relation to prefrontal function and network in heroin plus nicotine dependence: a pilot study.

Many patients with substance use disorders (SUDs) live in a stressful environment, and comorbidity is not uncommon. Understanding the neural mechanisms underlying heroin and nicotine dependences and their relationships to social cognition could facilitate behavioral therapy efficacy. We aimed to provide a translational approach that leads to identifying potential biomarkers for opioid use disorder (OUD) susceptibility during recovery. We examined the clinical characters and the relationships between theory of mind (ToM) and executive functions in three groups: heroin plus nicotine-dependent (HND) patients who had remained heroin abstinent ( months), nicotine-dependent (ND) subjects, and healthy controls (C). The domains included emotion recognition, inhibition, shifting, updating, access, and processing speed. Resting-state functional connectivity (rsFC), ToM task-induced functional connectivity, and brain networks were then explored among 21 matched subjects using functional near-infrared spectroscopy. HND enhanced the severities of anxiety, depression, and hyperactivity. Inhibition domain was impaired in both HND and ND. No impairment in domains of emotion recognition, access, and update was observed. HND demonstrated enhanced rsFC in the medial prefrontal cortex and orbitofrontal cortex (OFC) and decreased ToM-induced connectivity across the PFC. The right superior frontal gyrus in the OFC (oSFG; , , and ) was associated with working memory and emotion recognition in HND. Using a neuroimaging tool, these results supported the prominent reward-deficit-and-stress-surfeit hypothesis in SUDs, especially OUD, after protracted withdrawal. This may provide an insight in identifying potential biomarkers related to a dynamic environment.

Smoking abstinence rate and its associated factors between abrupt and gradual smoking cessation

Objective: To analyze and compare the abstinence rate of smoking quitting methods and its associated factors between abrupt and gradual smoking cessation in smokers with drug-based therapy. Methods: A prospective clinical study was conducted in patients undergoing quitting smoking intervention in Ruijin Hospital smoking cessation clinic between June 2013 and May 2016. All the subjects were randomized in a 1∶1 ratio into the abrupt smoking cessation group (smoking as usual over 3 weeks before a planned quit day, and then stopping smoking abruptly) and the gradual smoking cessation group (gradually reducing tobacco use over 3 weeks before a planned quit day, and then stopping smoking totally). The primary outcome was the complete abstinence rate, and the secondary outcomes included 1-month, 3-month and 6 month 7-day point prevalence of abstinence rates and 3 month sustained abstinence rates. Changes of body weight and drug adverse events were also compared. Results: A total of 314 moderate to severe nicotine-dependent patients were admitted in the study, including 157 patients in the abrupt smoking cessation and 157 patients in the gradual smoking cessation group. Fourteen patients fell off during the follow-up. For the complete abstinence rate, the gradual smoking cessation group was higher than the abrupt smoking cessation group(55.0% vs. 36.9%, χ(2)=9.841, P=0.002) .For 7-d smoking abstinence rate in the 1st, 3rd, 6th month, there was no significant difference between the 2 groups (all P>0.05). As for the 3-month sustained abstinence rate, a higher smoking quitting rate was seen in the gradual smoking cessation group compared to the abrupt smoking cessation group in the 6-month follow-up (17.9% vs.8.7%, χ(2)=5.441, P=0.020). The adverse drug reaction incidence was higher in the abrupt smoking cessation group than the gradual smoking cessation group (Gastrointestinal discomfort: 39.2% vs. 17.7%, χ(2)=12.336, P=0.000; Dreaminess: 40.2% vs. 13.3%, χ(2)=20.172, P=0.000). Conclusions: For moderate to severe nicotine-dependent patients, the gradual smoking cessation could serve to enhance the abstinence rate and mitigate the withdrawal symptoms.

Staff and patient perspectives of a smoke-free health services policy in South Australia: A state-wide implementation

Few jurisdictions have implemented and evaluated a complete smoking ban across all health sites in their jurisdiction, with no designated smoking areas. This article examines staff and patient perceptions and experiences of a mandated smoke-free policy implemented across all government health facilities in South Australia, including mental health sites. An online survey of health staff was conducted prior to policy implementation (n=3098), 3 months post-implementation (n=2673) and 15 months post-implementation (n=2890). Consumer experiences of the policy were assessed via a telephone survey (n=1722; smokers n=254). Staff support for the policy was high across all time points. Two thirds of staff reported having witnessed some policy non-compliance, and self-reported exposure to second-hand smoke was comparable pre-implementation to 15 months post-implementation. Under the policy, 56.3% of smoking patients abstained completely whilst hospitalised and 37.6% cut down the amount that they smoked. Furthermore, 34.7% reported having been offered cessation support during hospitalisation. Whilst the smoke-free policy was viewed positively and had benefits for staff and patients, reports of witnessing some non-compliance were prevalent. While the extent of non-compliance is not known, and the measure used was sensitive, complementary strategies may be needed to reduce exposure to second-hand smoke, particularly at entrances. Health-care staff should be further encouraged to offer support to nicotine-dependent patients to foster compliance and promote abstinence during hospitalisation.

Effects of Intraoperative Dexmedetomidine on Postoperative Pain in Highly Nicotine-Dependent Patients After Thoracic Surgery

To investigate the effects of intraoperative dexmedetomidine on pain in highly nicotine-dependent patients after thoracic surgery.Highly nicotine-dependent men underwent thoracic surgery and received postoperative patient-controlled intravenous analgesia with sufentanil. In dexmedetomidine group (experimental group, n = 46), dexmedetomidine was given at a loading dose of 1 μg/kg for 10 minutes, followed by continuous infusion at 0.5 μg/kg/h until 30 minutes before the end of surgery. The saline group (control group, n = 48) received the same volume of saline. General anesthesia was administered via a combination of inhalation and intravenous anesthetics. If necessary, patients were administered a loading dose of sufentanil by an anesthesiologist immediately after surgery (0 hours). Patient-controlled analgesia was started when the patient's resting numerical rating scale (NRS) score was less than 4. Resting and coughing NRS scores and sufentanil dosage were recorded 0, 1, 4 hours, and every 4 hours until 48 hours after surgery. Dosages of other rescue analgesics were converted to the sufentanil dosage. Surgical data, adverse effects, and degree of satisfaction were obtained.Cumulative sufentanil dosage, resting NRS, and coughing NRS in the first 24 hours after surgery and heart rate were lower in the experimental compared with the control group (P <0.05). No patient experienced sedation or respiratory depression. Frequency of nausea and vomiting and degree of satisfaction were similar in both groups.Intraoperative dexmedetomidine was associated with reduced resting and coughing NRS scores and a sufentanil-sparing effect during the first 24 hours after thoracic surgery.

Investigation of Smoking Cessation Treatment Efficacy Provided in Co-ordination with a Psychiatrist for Nicotine-dependent Patients with Mental Disorders

Investigation of Smoking Cessation Treatment Efficacy Provided in Co-ordination with a Psychiatrist for Nicotine-dependent Patients with Mental Disorders

Effect of Intraoperative and Postoperative Infusion of Dexmedetomidine on the Quality of Postoperative Analgesia in Highly Nicotine-Dependent Patients After Thoracic Surgery: A CONSORT-Prospective, Randomized, Controlled Trial.

Smoking is one of the most common addictions in the world. Nicotine inhalation could increase the risk of cardiorespiratory diseases. However, the solution that improved postoperative analgesia for highly nicotine-dependent patients undergoing thoracic surgery has not been specifically addressed.This CONSORT-prospective, randomized, double-blinded, controlled trial investigated the efficacy of combination of dexmedetomidine and sufentanil for highly nicotine (Fagerstrom test of nicotine dependence ≥6)-dependent patients after thoracic surgery.One hundred seventy-four male patients who underwent thoracic surgery were screened between February 2014 and November 2014, and a total of forty-nine were excluded. One hundred thirty-two highly nicotine-dependent male patients who underwent thoracic surgery and received postoperative patient-controlled intravenous analgesia were divided into 3 groups after surgery in this double-blind, randomized study: sufentanil (0.02 μg/kg/h, Group S), sufentanil plus dexmedetomidine (0.02 μg/kg/h each, Group D1), or sufentanil (0.02 μg/kg/h) plus dexmedetomidine (0.04 μg/kg/h) (Group D2). The patient-controlled analgesia (PCA) program was programmed to deliver a bolus dose of 2 ml, with background infusion of 2 ml/h and a lockout of 5 min, 4-hour limit of 40 ml, as our retrospective study. The primary outcome measure was the cumulative amount of self-administered sufentanil; the secondary outcome measures were pain intensity (numerical rating scale, NRS), level of sedation (LOS), Bruggrmann comfort scale (BCS), functional activity score (FAS), and concerning adverse effects.The amount of self-administered sufentanil were lower in group D2 compared with S and D1 groups during the 72 hours after surgery (P < 0.05), whereas the total dosage and dosage per body weight of sufentanil were significantly lower in D1 group than that of S group only at 4, 8, and 16 hours after surgery (P < 0.05). Compared with S group, the NRS scores at rest at 1, 4, and 8 hours after surgery and with coughing at 4, 8, 16, and 24 hours after surgery were significantly lower in D2 group (P < 0.05). However, compared with D1 group, the NRS scores both at rest and with coughing at 4 and 8 hours after surgery were significantly lower in D2 group (P < 0.05). The NRS scores both at rest and with coughing show that there were no significant differences between D1 group and S group at each time point after surgery (P > 0.05). LOS of group D2 was higher than S and D1 groups at 1 hour after surgery (P < 0.05), BCS of group D2 was higher than S and D1 groups at 4, 8, and 16 hours after surgery (P < 0.05), and FAS of group D2 was higher than S and D1 groups at 48 and 72 hours after surgery (P < 0.05). The number of rescue analgesia during 72 hours after surgery in D2 group was lower than S and D1 groups (P < 0.05). There were no significant differences among the 3 groups in terms of baseline clinical characteristics and postoperative adverse effects except for itching (P > 0.05).Among the tested patient-controlled analgesia options, the addition of dexmedetomidine (0.04 μg/kg/h) and sufentanil (0.02 μg/kg/h) showed better analgesic effect and greater patient satisfaction without other clinically relevant side effects for highly nicotine-dependent patients during the initial 72 hours after thoracic surgery.Trial Registration: chictr.org (ChiCTR-TRC-14004191).

PL.01.01 New targets for the treatment of addiction

I will discuss treatment strategies that are based on pharmacological interventions to reduce craving and relapse in drug and alcohol-dependent patients. I will first provide a historical overview about relapse prevention strategies and will then discuss the current state of the treatment situation in Europe. The presentation will mainly focus on alcohol addiction as major achievements have been made in recent years in the development of anti-relapse drugs and harm reduction in the alcohol field. Thus the development of disulfiram, naltrexone, acamprosate, and nalmefene will be described followed by a discussion of their neurobiological modes of action. This will be followed by a perspective on the introduction of substitution drugs to alcohol addicted patients and the combined use of behavioral and pharmacological interventions such as acceleration of extinction of a drug memory by D-cycloserine or the pharmacological disruption of the reconsolidation of a drug memory. Finally, the use of deep brain stimulation in treatment resistant patients will be discussed. Important conclusions of this lecture are: (i) in Europe there is a paradigmatic shift towards harm reduction in the addiction field, (ii) the substitution concept that is successfully used in opiate and nicotine dependent patients can be also introduced to alcoholic patients, (iii) matching treatment to specific genotypes (e.g. opioid receptor polymorphism) increases treatment success, (iv) a combination of behavioral and pharmacological therapies may be the optimal treatment strategy, and finally (v) the whole organism has to be taken into consideration to provide the best therapy for our patients.

Profile of nicotine use among alcohol dependent patients visiting a tertiary care center in north India.

Background:Use of tobacco among alcohol dependent population is quite frequent. This co-morbidity increases the risk for various diseases. Understanding the pattern of tobacco use with co-morbid alcohol use may help in planning appropriate prevention/treatment strategies. The study aimed at examining the profile and pattern of nicotine use among alcohol dependent patients visiting a tertiary care treatment center in North India.Materials and Methods:Male patients fulfilling diagnostics and statistical manual of mental disorder fourth edition, criteria for nicotine and alcohol diagnostics and statistical dependence, attending the out-patient department of the tertiary care treatment center were recruited after obtaining informed consent. The socio-demographic profile, drug use history, nicotine associated health problems and general health problem were recorded. Motivation to stop tobacco use was assessed qualitatively using the direct questions about their interest and intentions to quit.Results:A total of 150 subjects were included in the study. The mean age of the study sample was 37.6 ± 10.44 years. Tobacco was reported as the gateway drug in 90% of the cases. Exclusive bidi use reported in 42% of the subjects. Mean duration of bidi and co-morbid alcohol use was higher than cigarette or smokeless tobacco use. Self-reported health problems associated with nicotine use and general health was reported by 41% and 39% of the subjects. Unsuccessful past quit attempts was present in 85% cases. More than 90% of subjects remained interested in quitting the tobacco use. An increased liver enzyme (aspartate transaminase, alanine transaminase and gamma-glutamyl transferase) were observed in 43, 32 and 47% of the cases.Conclusion:The results suggest the nicotine and alcohol dependent patients represent a separate population requiring higher attention from the treating physician.