***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Sustained-release bupropion hydrochloride and nortriptyline hydrochloride have been shown to be efficacious in the treatment of cigarette smoking . It is not known whether psychological intervention increases the efficacy of these antidepressants . This study compared both drugs with placebo . It also examined the efficacy of these 2 drugs and placebo with and without psychological intervention . METHODS This was a 2 ( medical management vs psychological intervention ) x 3 ( bupropion vs nortriptyline vs placebo ) r and omized trial . Participants were 220 cigarette smokers . Outcome measures were biologically verified abstinence from cigarettes at weeks 12 , 24 , 36 , and 52 . RESULTS Psychological intervention produced higher 7-day point-prevalence rates of biochemically verified abstinence than did medical management alone . With the use of point-prevalence abstinence , both nortriptyline and bupropion were more efficacious than placebo . On rates of 1-year continuous abstinence , the 2 drugs did not differ from each other or from placebo . Psychological intervention did not differ from medical management alone on rates of 1-year continuous abstinence . CONCLUSIONS Both nortriptyline and bupropion are efficacious in producing abstinence in cigarette smokers . Similarly , psychological intervention produces better abstinence rates than simple medical management . Both drugs , and psychological intervention , have limited efficacy in producing sustained abstinence . The data also suggest that combined psychological intervention and antidepressant drug treatment may not be more effective than antidepressant drug treatment alone Background Tobacco use is a major risk factor for recurrent stroke . The provision of cost-free quit smoking medications has been shown to be efficacious in increasing smoking abstinence in the general population . Objective The objective of this pilot study was to assess the feasibility and obtain preliminary data on the effectiveness of providing cost-free quit smoking pharmacotherapy and counselling to smokers identified in a stroke prevention clinic . Trial design Cluster r and omised controlled trial . Methods All patients seen at the Ottawa Hospital Stroke Prevention Clinic who smoked more five or more cigarettes per day , were ready to quit smoking in the next 30 days , and were willing to use pharmacotherapy were invited to participate in the study . All participants were advised to quit smoking and treated using a st and ardised protocol including counselling and pharmacotherapy . Participants were r and omly assigned to either a prescription only usual care group or an experimental group who received a 4-week supply of cost-free quit smoking medications and a prescription for medication renewal . All patients received follow-up counselling . The primary outcome was biochemically vali date d quit rates at 26 weeks . The research coordinator conducting outcome assessment was blind to group allocation . Results Of 219 smokers screened , 73 were eligible , 28 consented and were r and omised , and 25 completed the 26-week follow-up assessment . All 28 patients r and omised were included in the analysis . The biochemically vali date d 7-day point prevalence abstinence rate in the experimental group compared to the usual care group was 26.6 % vs 15.4 % ( adjusted OR 2.00 , 95 % CI 0.33 to 13.26 ; p=0.20 ) . Conclusions It would be feasible to definitively evaluate this intervention in a large multi-site trial . Trial registration number http:// Clinical Trials.gov # UOHI2010 - 1 BACKGROUND An increase in the number of dentists conducting tobacco-use cessation treatment is needed . The authors assessed the effects of high-intensity training ( HIT ) or low-intensity training ( LIT ) and reimbursement on general dentists ' tobacco-use-related attitudes and treatment behaviors . METHODS The authors r and omly selected 265 dentists in three states and assigned them to one of five groups : HIT workshop groups with and without tobacco-use cessation counseling reimbursement , LIT mailed self- study groups with and without reimbursement or a control group . Outcomes at follow-up were dentists ' self-reported tobacco-use-related attitudes and behaviors and patients ' reports of dentists ' behaviors . RESULTS Significantly more dentists in the intervention groups reported having positive attitudes and behaviors at follow-up than did dentists in the control group . Dentists in the HIT groups , however , reported assessing patients ' willingness to quit and assisting them with the quitting process significantly more often than did dentists in the LIT groups . Significantly more patients of dentists in the intervention groups who used tobacco reported receiving advice and assistance from their dentists than did patients of dentists in the control group . Adding reimbursement to HIT or LIT conditions did not provide additional intervention effect . CONCLUSION Dentists trained by means of a workshop or self- study program used components of a recommended guideline more frequently and felt more positive toward tobacco-use cessation counseling than did dentists in the control group . CLINICAL IMPLICATION S Although the workshop training was more successful than the self- study training , the latter 's reach among dentists could have a more significant public health impact . The effect of reimbursement needs further study INTRODUCTION Although the majority of smokers are ambivalent about quitting , few treatments specifically target smokers lacking motivation to quit in the near future . Most existing interventions are instead predicated on the belief that active treatments should only be distributed to smokers interested in quitting , a largely untested assumption . METHODS In the current clinical trial ( N = 157 ) , motivated smokers wanting to quit in the next 30 days were given a 2-week nicotine replacement therapy ( NRT ) sample and a referral to a quitline ( Group MNQ ) , while unmotivated smokers were r and omized to receive the same treatment ( Group UNQ ) or a quitline referral only ( Group UQ ) . Participants were tracked via telephone for 3 months to assess quitting behaviors and smoking reduction . RESULTS Groups significantly differed across all comparisons with regard to incidence of any quit attempt ( MNQ : 77 % , UNQ : 40 % , UQ : 18 % , p < .05 ) and any 24-hr quit attempts ( 62 % , 32 % , 16 % , p < .05 ) . Clinical ly meaningful differences emerged in the rates of floating ( 19 % , 17 % , 6 % ) and point prevalence abstinence ( 17 % , 15 % , 5 % ) . Compared to participants in Group UQ ( 11 % ) , a greater proportion of participants in Group MNQ ( 48 % , p = .01 ) and Group UNQ ( 31 % , p = .01 ) reduced their daily cigarette consumption by at least half . Proxy measures of cessation readiness ( e.g. , motivation ) favored participants receiving active forms of treatment . CONCLUSIONS Providing NRT sample s engaged both motivated and unmotivated smokers into the quitting process and produced positive changes in smoking outcomes . This suggests that motivation should not be considered a necessary precondition to receiving treatment Smoking  cessation treatment is now integrated into many health-care systems and a major research effort is under way to improve current success rates . Until now results from r and omized clinical trials have been reported in many different ways , leading to problems of interpretation . We propose six st and ard criteria comprising the ' Russell St and ard ' ( RS ) . These criteria are applicable to trials of cessation aids where participants have a defined target quit date and there is face-to-face contact with research ers or clinic staff , as follows . ( 1 ) Follow-up for 6 months ( RS6 ) or 12 months ( RS12 ) from the target quit date or the end of a predefined ' grace period ' ; ( 2 ) self-report of smoking abstinence over the whole follow-up period allowing up to five cigarettes in total ; ( 3 ) biochemical verification of abstinence at least at the 6-month or 12-month follow-up point ; ( 4 ) use of an ' intention-to-treat ' approach in which data from all r and omized smokers are included in the analysis unless they have died or moved to an untraceable address ( participants who are included in the analysis are counted as smokers if their smoking status at the final follow-up can not be determined ) ; ( 5 ) following-up ' protocol violators ' and using their true smoking status in the analysis ; and ( 6 ) collecting follow-up data blind to smokers ' allocation to trial group . We believe that these criteria provide the best compromise between practicability and surrogacy for long-term cessation and will enable meaningful comparison between studies . There may be good reasons why other outcome criteria would also be reported , and studies that involve interventions with special groups or where there is no design ated target quit date or face to face contact would need to adapt these criteria accordingly This pilot study suggests that changes in prescribing policy for nicotine replacement patches should be made only when evidence of cost-effectiveness can be adduced from a r and omized controlled trial AIMS We studied whether reimbursement for smoking cessation treatment ( SCT ) can increase prolonged abstinence from smoking up to 2 years . SETTING , PARTICIPANTS AND DESIGN : From the general population , we recruited smokers and assigned them r and omly to a control group ( n = 634 ) or an intervention group ( n = 632 ) . For 6 months , participants in the intervention group could apply for reimbursement and received information regarding the reimbursed SCT . Participants in the control group received no reimbursement or information . MEASUREMENTS In this follow-up study , prolonged abstinence from smoking was defined as reported being abstinent from at least 7 days before the end of reimbursement until the follow-up assessment 6 months or 2 years later . FINDINGS At 6 months after the end of reimbursement , 18 participants in the control group ( 2.8 % ) and 35 participants ( 5.5 % ) in the intervention group reported sustained abstinence for at least 6 months [ odds ratio ( OR ) = 2.0 , 95 % confidence interval ( CI ) 1.1 - 3.6 ] . Two years after the reimbursement period , 10 participants in the control group ( 1.6 % ) and 27 participants in the intervention group ( 4.3 % ) still reported sustained abstinence ( OR = 4.1 , 95 % CI 1.7 - 10.2 ) . The overall effectiveness of SCT  increased with reimbursement and was 22 % in the intervention group and 8 % in the control group after 2 years . CONCLUSIONS Reimbursement may be an effective strategy to increase the prolonged abstinence rate even after 2 years OBJECTIVE To assess the impact and costs of coverage for tobacco dependence treatment benefits with no patient cost sharing for smokers with employer sponsored coverage in two large independent practice association ( IPA ) model health maintenance organisations ( HMOs ) in California , USA . METHODS A r and omised experimental design was used . 1204 eligible smokers were r and omly assigned either to the control group , which received a self-help kit ( video and pamphlet ) , or to the treatment group , which received the self-help kit and fully covered benefits for over the counter ( OTC ) nicotine replacement therapy ( NRT ) gum and patch , and participation in a group behavioural cessation programme with no patient cost sharing . RESULTS The quit rates after one year of follow up were 18 % in the treatment group and 13 % in the control group ( adjusted odd ratio ( OR ) 1.6 , 95 % confidence interval ( CI ) 1.1 to 2.4 ) , controlling for health plan , sociodemographics , baseline smoking characteristics , and use of bupropion . Rates of quit attempts ( adjusted OR 1.4 , 95 % CI 1.1 to 1.8 ) and use of nicotine gum or patch ( adjusted OR 2.3 , 95 % CI 1.6 to 3.2 ) were also higher in the treatment group . The annual cost of the benefit per user who quit ranged from $ 1495 to $ 965 or from $ 0.73 to $ 0.47 per HMO member per month . CONCLUSIONS Full coverage of a tobacco dependence treatment benefit implemented in two IPA model HMOs in California has been shown to be an effective and relatively low cost strategy for significantly increasing quit rates , quit attempts , and use of nicotine gum and patch in adult smokers Physician use of clinical practice guidelines ( CPGs ) is disappointingly low in the United States . Much emphasis historically has been placed on the individual clinician to implement use of guidelines in practice . Recently , the Public Health Service issued an up date d set of smoking cessation guidelines that include recommendations not only for patients and physicians , but also for health care administrators , insurers , and purchasers . A r and om sample of Missouri family physicians and general internists was used to determine , for the first time empirically , whether physicians receiving external support for guideline implementation were more likely to adopt and adhere to guidelines in practice . Fewer than 20 percent of physicians receive system support consistent with the up date d guideline for smoking cessation . Only 32 percent of physicians who are unaware of the guidelines receive any of the recommended external support , while nearly 60 percent of physicians who adhere to the guidelines in practice are receiving some form of external support . Thus , the fundamental issue that requires national attention is that successful guideline implementation is highly dependent on administrative supports from health care organizations and insurers OBJECTIVES Tobacco use adversely affects oral health . Clinical guidelines recommend that oral health professionals promote tobacco abstinence and provide patients who use tobacco with brief  tobacco use  cessation counselling . Research shows that these guidelines are seldom 
    Output:
    
Full financial interventions directed at smokers when compared to no financial interventions increase the proportion of smokers who attempt to quit , use smoking cessation treatments , and succeed in quitting .
The absolute differences are small but the costs per additional quitter are low to moderate .
We did not detect an effect on smoking cessation from financial incentives directed at healthcare providers .