***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: OBJECTIVES To assess general practitioners ' and practice nurses ' self reported behaviour , attitudes , and knowledge in relation to smoking cessation . DESIGN AND SETTING Two postal surveys of r and om national sample s of 303 GPs ( survey 1 ) and 459 practice nurses ( survey 2 ) covering Engl and and Wales ; effective response rates were 75 % and 96 % , respectively . RESULTS Survey 1 found that 96 % of GPs accepted that intervening against smoking was part of their role and almost all ( 99 % ) said that they recorded smoking status when patients registered ; 57 % reported that they routinely up date d their records on smoking status , 50 % said they advised smokers to stop during most or all consultations , and 76 % said they advised smokers to cut down if they can not stop . A large majority ( 83 % ) said they either recommended or prescribed nicotine replacement therapy ( NRT ) . Although most GPs ( 86 % ) thought that NRTs were effective , only a minority thought they were worth the cost ( 47 % ) or should be on National Health Service ( NHS ) prescription ( 32 % ) . There was little evidence that previous training in smoking cessation was associated with more activity , more positive attitudes , or greater knowledge . Survey 2 found that almost all practice nurses ( 99 % ) agreed that intervening against smoking was part of their role and 95 % said they advised patients to stop at least occasionally ; 71 % said they advised smokers to stop at most or all consultations . A majority ( 74 % ) said that they recommended NRT to their patients . As with the GPs most practice nurses thought that nicotine replacement was effective ( 79 % ) , but fewer ( 42 % ) thought the cost was justified , and only about half ( 53 % ) thought it should be available on NHS prescription . Nurses who said they had been trained in smoking cessation engaged in more activity relating to smoking cessation , had more positive attitudes , and were more knowledgeable . CONCLUSION GPs and practice nurses accepted that intervening with smoking was an important part of their role and a large majority reported that they intervened at least with some smokers . This represents a promising baseline from which to proceed in terms of implementation of the new smoking cessation guidelines , but it is hoped that improvements can be made in terms of the frequency of updating records and intervening , and acceptance of the cost-effectiveness of NRT as a life preserving intervention The efficacy of physician anti-smoking intervention with 289 patients in a family practice setting was assessed . The design included two treatment conditions , physician advice and physician advice plus the offer of nicotine chewing gum ( NCG ) prescription . A no-advice group permitted assessment of the effects of repeated testing . The NCG group had higher rates of abstinence at all follow-up points , but the difference approached statistical significance at 3 months only ( p less than .10 ) . Comparison of those who actually used NCG to all other groups revealed significantly more users were abstinent at 1- and 3-month follow-up . A similar pattern occurred for proportion attempting cessation and smoking reduction . A dose-response relationship of gum use to outcome was identified . Long-term users ( greater than 20 days ) had 86 % abstinence at 3 months versus 18 % for short-term users . Thus , NCG does appear to have a role in family practice for promoting short-term cessation 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 PURPOSE Guidelines encourage primary care clinicians to document smoking status when obtaining patients ’ blood pressure , temperature , and pulse rate ( vital signs ) , but whether this practice promotes cessation counseling is unclear . We examined whether the vital sign intervention influences patient-reported frequency and intensity of tobacco cessation counseling . METHODS This study was a cluster-r and omized , controlled trial conducted in the Virginia Ambulatory Care Outcomes Research Network ( ACORN ) . At intervention practice s , nurses and medical assistants were instructed to assess the tobacco use status of every adult patient  and record it with the traditional vital signs . Control practice s did not use any systematic tobacco screening or identification system . Outcomes were the proportion of smokers reporting clinician counseling of any kind and the frequency of 2 counseling subcomponents :  simple quit advice and more intensive discussion .  RESULTS A total of 6,729 adult patients ( 1,149 smokers ) at 18 primary care practice s completed exit question naires during a 6-month comparison period . Among 561 smokers at intervention practice s , 61.9 % reported receiving any counseling , compared with 53.4 % of the 588 smokers at control practice s , for a difference of 8.6 % ( P = .04 ) . The effect was largely restricted to simple advice , which was reported by 59.9 % of intervention patients and 51.5 % of control patients ( P=.04 ) . There was no significant increase in more extensive discussion , with 32.5 % and 29.3 % of patients at intervention and control practice s , respectively , reporting this type of counseling ( P=.18 ) . CONCLUSIONS The vital sign intervention promotes tobacco counseling at primary care practice s through a modest increase in simple advice to quit . When implemented as a st and -alone intervention , it does not appear to increase intensive counseling BACKGROUND AND OBJECTIVE GPs are an important source of smoking cessation advice . This research examined whether a model encouraging GP referral of patients who smoke to a specialist service  would be acceptable and effective for increased smoking cessation when compared with a model of in- practice management . METHODS The study design was cluster r and omized controlled trial . Practice s were r and omized to one of two interventions , at a rate of 1:2 : ( i ) st and ard in- practice GP management or ( ii ) referral to a quitline service . The main outcome measures were sustained abstinence of > or=1 month duration at 3-month follow-up and > or=10 months duration at 12 months , using intention to treat analysis . RESULTS At 3-month follow-up , patients in the referral condition were twice as likely to report sustained abstinence than those in the in- practice condition [ 12.3 % compared with 6.9 % ; odds ratio ( OR ) = 1.92 ( 95 % confidence interval ( CI ) 1.17 - 3.13 ] . At 12-month follow-up , patients in the referral condition had nearly three times the odds of sustained abstinence [ 6.5 % compared with 2.6 % ; OR = 2.86 ( 95 % CI 0.94 - 8.71 ) ] . The intervention effect was mediated by the amount of help received outside the practice . CONCLUSIONS This research provided evidence that GPs referring smokers to an evidence -based quitline service results in increased cessation . The benefit is largely due to patients in the referral condition receiving more external help than patients in the in- practice condition , as they received equivalent practice -based help . Where suitable services exist , we recommend that referral become the normative strategy for management of smoking cessation in general practice to complement any practice -based help provided The results are reported from a multicentered , r and omized clinical trial of a physician-delivered smoking cessation intervention package . All physicians attended a four-hour training session during which the rationale s for the different aspects of the intervention were discussed , including a detailed description of the proper use of nicotine-bearing chewing gum .  Patients were r and omized to receive an offer of a prescription of 2 mg of nicotine chewing gum in addition to the basic intervention ( n = 111 ) or the basic intervention alone ( n = 112 ) . The basic intervention included advice , setting a date for quitting , self-help material s , and the offer of supportive follow-up visits . Receptionists were instructed to recruit the first two smokers attending the practice each day . One-year smoking cessation was vali date d by cotinine saliva analysis . The vali date d three-month sustained abstinence rates at one year were 8.1 percent and 9.8 percent in the gum and no-gum groups , respectively . The 95 percent confidence interval about this difference was -9.3 percent to 6.4 percent . There is no evidence from this study that the offer of 2 mg of nicotine-bearing gum enhances smoking cessation rates when added to a comprehensive intervention offered to all smokers in primary care . Until larger trials are completed , however , the possibility that this dose of nicotine gum may produce small beneficial effects can not be excluded BACKGROUND This project examined tobacco policies and delivery of cessation services in nonprofit HMOs that collectively provide comprehensive medical care to more than 8 million members . METHODS Three annual surveys with health plan managers showed that all of these health plans had written tobacco control guidelines that became more comprehensive over the span of this study . We also surveyed a r and om sample of 4207 current smokers who had attended a primary care visit in the past year ( 399 - 528 at each of nine health plans ) . RESULTS Of these smokers , 71 % reported advice to quit , 56 % were asked about their willingness to quit , 49 % were provided some assistance in quitting  ( mostly self-help material or information about classes or counseling ) , and 9 % were offered some kind of follow-up .  Smokers receiving assistance in quitting reported higher satisfaction with their care . CONCLUSIONS In general , health plans with the most comprehensive policies also showed higher rates of implementing tobacco treatment programs in primary care . Compared with tobacco control efforts of a decade or more ago , considerable progress has been made . However , there is still room for improvement in the proportion of smokers who receive the most effective forms of assistance in quitting The purpose of this study was to examine the effectiveness of different practice -based approaches to assist patients of primary care physicians to quit smoking and sustain cessation .  Forty-four nonsmoking general practitioners volunteered for the study . After a period of training , they r and omized 923 smoking clients , unselected for motivation toward quitting , to four different intervention groups : ( i ) minimal intervention , consisting of one single counselling session and a brief h and out on quitting techniques ; ( ii ) repeated counselling including reinforcing sessions at Months 1 , 3 , 6 , and 9 ; ( iii ) repeated counselling and use of nicotine gum ; and ( iv ) repeated counselling and spirometry . Biochemically vali date d smoking status was assessed at six and 12 months after recruitment . The proportion of verified quitters at 12 months was 4.8 percent among subjects r and omized to the minimal intervention group , compared to 5.5 percent , 7.5 percent , and 6.5 percent among those r and omized to the three repeated-counselling groups . In no treatment group was the outcome significantly different from that for one-time counselling at the ( P<0.05 ) level . Lack of power , contamination , and low attendance at reinforcing sessions should be taken into account in interpreting the results Objective : To compare the characteristics of smokers who do and do not receive  smoking cessation treatment in primary care . Design : Prospect i ve cohort study using practice s registered with the pilot Q RESEARCH data base . Setting : 156 550 patients aged 18 years and over from 39 general practice s located within four strategic health authorities , representing the former Trent Region , UK . Subjects : Patients registered with practice s between 1 April 2001 and 31 March 2003 aged 18 years and over who were identified as smokers before the two year study period . Outcome : Prescription for smoking cessation treatment ( nicotine replacement therapy ( NRT ) or bupropion )  in the two year study period . Variables : Age , sex , deprivation score , co-morbidity . Results : Of the 29 492 patients recorded as current smokers at the start of the study period 1892 ( 6.4 % ) were given prescriptions for  smoking cessation treatment during the subsequent two years . Of these , 1378 ( 72.8 % ) were given NRT alone , 406 ( 21.5 % ) bupropion alone , and 108 ( 5.7 
    Output:
    
There was evidence that medical advice increased the success of quit attempts and inconclusive evidence that offering assistance increased their success .
CONCLUSIONS Physicians may be more effective in promoting attempts to stop smoking by offering assistance to all smokers than by advising smokers to quit and offering assistance only to those who express an interest in doing so