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Richman PB, Dinowitz S, Nashed AH, et al. The emergency department as a potential site for smoking cessation intervention: A randomized, controlled trial. Acad Emerg Med 2000; 7:348-353.
There was no difference in the smoking cessation rates between ED patients who received written materials and those who were counseled by ED physicians, found this study from Morristown (NJ) Memorial Hospital. In the study, 152 patients were enrolled in the control group that received a "Stop Smoking" pamphlet, or the intervention group that received the pamphlet and scripted counseling, which included a referral to a smoking cessation program at the hospital. Here are the study’s key findings:
• None of the patients in the intervention group contacted or attended the smoking cessation program during the study period.
• The control and intervention groups had the same smoking cessation rate (10%) after three months.
However, the results should not discourage future efforts to use the ED as a venue to promote smoking cessation, say the researchers. "Rather, it should serve as an impetus for improving/modifying the intervention model that we constructed for this investigation," they wrote. They suggest the following:
• Refer patients to programs that have costs subsidized in cases of need or are available at no cost to the patient.
• Use multiple smoking cessation program sites to give patients more options.
Grierson R, Green R, Sitar DS, et al. Gastric lavage for liquid poisons. Ann Emerg Med 2000; 25:435-439.
Gastric lavage is not likely to improve outcomes because of its unreliable performance and modest extent, says this study from the University of Manitoba in Winnepeg, Canada. The study looked at whether gastric lavage reduces the absorption of ingested liquids. Although gastric lavage is no longer a standard treatment for toxic ingestions, there was minimal data on the use of this technique for the ingestion of liquids.
Ten volunteers ingested a solution of acetaminophen in water, and underwent gastric lavage one hour later. There was a 20% reduction in acetaminophen bioavailability, but that was not likely to be clinically significant, the researchers note.
Activated charcoal is a less risky alternative, say the researchers, who note that adverse effects from gastric lavage include aspiration pneumonia, arrhythmias, and cardiac arrest and occur in 3% of cases. "We do not recommend gastric lavage for the treatment of toxic ingestions of liquids," they conclude.
There are many identifiable factors that contribute to patients being excluded from thrombolytic therapy because of a delay in seeking treatment, says this research from the University of Maryland School of Nursing in Baltimore, which summarized published data on this topic. Here are some of the factors identified that cause patients to delay seeking treatment:
• Gender. Women experiencing an acute myocardial infarction (AMI) wait longer than men in seeking treatment. Denial was a common response of women experiencing the onset of symptoms of an AMI.
• Educational level. Patients with fewer years of education waited longer to seek treatment.
• Income. Patients with an annual income of less than $20,000 wait longer to seek treatment than those with an annual income over $60,000.
• Age. Older patients wait longer than younger patients to seek treatment. This might be due to the fact that older patients are more likely than younger patients to have a history of medical conditions that might mask an AMI.
Understanding the reasons why patients delay treatment is essential, say the researchers. "With this understanding, more appropriate public education can be undertaken about the signs and symptoms of AMI and when to dial for an ambulance," they wrote.
Also, specific populations known to delay seeking treatment (the elderly, women, and African-Americans) can be targeted for educational efforts.