***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: INTRODUCTION Advice can have a small but clinical ly important effect in promoting smoking cessation . Where studied , the rate of delivery has been found to be low . Training has been found to increases this rates , but there is little research on effectiveness in terms of smoking cessation rates . This study aim ed to assess the effectiveness and cost-effectiveness of an health professionals educational program to increase long-term rates of nicotine abstinence in smoking out patients . METHODS We conducted a pragmatic cluster-r and omized , controlled trial in 35 primary health care centers in Spain . Participants were all 830 health professionals who attended 5,970 smokers during recruiting period . After that we measured continuous abstinence 6 months after the intervention and biochemically vali date d ( saliva cotinine test ) 1 year following intervention . Cost-effectiveness was measured in terms of cost per life year gained . RESULTS After 6 months , the rate of continuous abstinence was significantly higher in the intervention group ( 2.1 % vs. 0.3 % , p > .0001 ) with an odds ratio of 6.5 ( 95 % CI = 3.3 - 12.7 ) . After 1 year , biochemical validation was performed on 31 of the 67 patients previously registered as abstinent . All of them were abstinent and belonged to intervention group . The incremental cost per life year gained after 6 months was € 969 . CONCLUSIONS A primary care training program on smoking cessation based on scientific evidence , behavioral theory , and active learning methods increases long-term continuous nicotine abstinence rate among out patients in a significant way . These may be relevant for planning training of professionals , clinical assistance , and public health programs PURPOSE Dental hygienists report a lack of confidence in initiating Tobacco Dependence Counseling ( TDC ) with their patients who smoke . The purpose of this study was to determine if the confidence of dental hygiene students in providing TDC can be increased by St and ardized Patient ( SP ) training , and if that confidence can be sustained over time . METHODS This 2-parallel group r and omized design was used to compare the confidence of students receiving SP training to stu dents with no SP training .  After a classroom lecture , all subjects ( n=27 ) received a baseline test of knowledge and confidence . Subjects were r and omly assigned to test and control groups with equivalent mean knowledge scores . The test group subjects participated in a SP TDC session . Both groups gained parallel experience to treating patients who were smokers and giving TDC in clinical scenarios during the 6 month time period . One week end-training and 6 month post-training assessment s were administered to both groups . ANCOVA compared mean confidence scores . RESULTS End-training scores at 1 week showed a statistically significant increase ( p=0.002 ) in overall mean confidence following SP training for individuals in the test group . The 6 month follow-up test results showed a slight decline in confidence scores among subjects in the test group and an overall gain in confidence for control group participants . However , overall confidence scores were comparable for the groups . CONCLUSION SP training improved dental hygiene students ' initial confidence in providing TDC and was sustained , but not to a significant degree . Clinical experience alone increased confidence . Further studies may help determine how the initial confidence gained by SP training can be sustained and what the role of clinical experience plays in overall confidence in providing TDC 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 OBJECTIVE Family physicians ( FPs ) are cornerstone for tobacco control . It was aim ed to compare the effect of training on their smoking cessation practice , knowledge level and attitudes towards smoking and tobacco control . METHODS AND MATERIAL S The cross-sectional and multi-centered study was carried out using structured survey modified WHO based question naire . It was delivered to 1500 FPs r and omly selected among approximately 23000 family physicians across the country . The study survey was self-reported by FPs , assessing their knowledge , attitudes , status of post-graduate training , and practice about tobacco control . Participants were assigned into two groups as non-trainee groups ( Group 1 ) and post-graduate trainee ( Group 2 ) . RESULTS The mean age was 38.4 ± 7.1 years-old . The percentage of male and female FPs in the study was 53.1 % and 46.9 % . The ratio of family physicians who participated in training program Group 2 ) was 26.5 % ( n = 327 ) . The ratio of female FPs who participated the SCP training course was significantly higher than that of male FPs ( 27.3 % versus 22.5 % , p = 0.035 ) . There was no significant difference for smoking status between groups ( p = 0.686 ) . When the number FPs whose consulted by the smokers over ≥ 5 a week was compared , the ratio of FPs was significantly higher in group 2 than group 1 ( p < 0.001 ) , but overall ratio of FPs ( 2.8 % ) who consulted within a week smokers was considerably lower Statements of Competence and confidence items stated by all FPs were 24.2 % and 32.2 % , respectively . Physicians who had attended post-graduate training on SCP were more competent and confident , compared to non-trained FPs ( p = 0.002 and p = 0.001 ) . CONCLUSION Post-graduate training on tobacco control improved self-confidence and competence of FPs . With post-graduate training , significant improvement was seen in practical skills of physicians . A continuing training program should be introduced to FPs , to engage them for smoking cessation practice The use of st and ardized patients ( SPs ) shows promise in tobacco cessation treatment ( TCT ) training by providing a simulated clinical environment for dental students to practice counseling skills with individuals trained to portray patients . The purpose of this study was to determine if there was a difference in attitudes , perceptions , and knowledge between dental students who received a lecture and practice sessions with SPs  and those who received a lecture only . Dental students in an introductory clinical course at one dental school were invited to participate in the study by completing a pre and post question naire . The pre question naire was administered to all students prior to a tobacco cessation lecture . Students were group-r and omized to either the intervention or control group . The intervention group completed the post question naire after the lecture and practice sessions with SPs , and the control group completed it after the lecture only . Of ninety-eight students who attended the lecture and were invited to participate in the study , a total of ninety-four from the two groups ( 96 percent ) provided two linkable question naires for analysis . In the results , training with lecture and SPs increased the students ' underst and ing of barriers , subjective norms , perceived skills , self-efficacy , and intentions to provide TCT more than those in the lecture only ; however , it did not significantly increase their attitudes and knowledge . These findings suggest that using SPs is a valuable educational method to promote the provision of TCT by dental students and graduates OBJECTIVE Few continuing education programs to train behavioral health professionals to deliver tobacco treatment services have been described and evaluated . METHODS The effectiveness of two-day training on changing practice was examined by review of clinical charts from 20 clinicians who attended in 2012 . Ten medical records were r and omly selected for review from each clinician 's outpatient practice at a large behavioral health system . Five charts from smokers seen within six months before and after training were review ed per clinician , for a total of 200 . Records were electronically search ed on " cigarette , " " nicotine , " " tobacco , " " quit , " " smoking , " and " smoke . " RESULTS were compared via chi square tests ( all p<.05 ) . RESULTS Almost half of the smokers indicated that they were interested in quitting , although baseline rates of tobacco use treatment were very low . Documentation of tobacco use significantly increased between baseline and posttraining , both on the problem list ( 35 % versus 74 % ) and treatment plan ( 20 % versus 60 % ) . Also posttraining , clinicians advised significantly more out patients to quit ( 9 % versus 36 % ) or referred them to individual or group counseling . Discussion of nicotine replacement was documented more frequently in charts ( 10 % versus 31 % ) , and prescriptions for tobacco treatment medications increased significantly in the posttraining period , although overall prescribing remained low . The proportion of patients making quit attempts also significantly increased in the posttraining period ( 10 % versus 39 % ) , suggesting that providers were delivering more tobacco treatment than was reflected in charts . CONCLUSIONS An intensive training program for behavioral health professionals increased tobacco treatment and patient quit attempts . Strategies beyond training may be needed to enhance prescribing by these practitioners BACKGROUND Health professionals have a proven , positive impact on patients ' ability to quit smoking , yet few integrate cessation counseling into routine practice .The aim of this study was to evaluate the impact of continuing education training on physicians ' and pharmacists ' cessation counseling . METHODS A group-r and omized trial of health care providers ( 87 physicians and 83 pharmacists ) from 16 Texas communities compared smoking cessation training ( intervention group ) with skin cancer prevention training ( control group ) .  Pretraining , posttraining , and extended follow-up surveys were collected from providers . Perceived ability , confidence , and intention ( ACI ) to address smoking with patients were assessed with a composite ACI index . Patient exit interviews ( at baseline , 1452 patients completed interviews ; after 12 months , 1303 completed interviews ) assessed counseling practice s. RESULTS There was a significant increase in the percentage of physicians with a high ACI index in the intervention group from pretraining to posttraining ( 27 % to 73 % ; P < .001 ) vs the control group ( 27 % to 34 % ; P = .42 ) and for pharmacists ( 4 % to 60 % ; P < .001 ) vs the control group ( 10 % to 14 % ; P = .99 ) . Similar results were seen from pretraining to extended follow-up . At baseline , fewer pharmacy patients reported being asked about smoking compared with patients seen by physicians ( 7 % vs 33 % ; P = .001 ) . There was an increase in assisting patients to quit ( 6 % to 36 % ; P = .002 ) by physicians ( baseline vs 12 months ) in the intervention group , but not in the control group . CONCLUSIONS Training led to significant and lasting improvement in counseling among physicians . Low levels of counseling were seen among pharmacists 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 implemented successfully . This study aim ed to evaluate two interventions to enhance tobacco use prevention and cessation ( TUPAC ) counselling among oral health professionals in Finl and . METHODS We used a cluster-r and omized community trial to test educational and fee-for-service interventions in enhancing TUPAC counselling among a sample of dentists ( n=73 ) and dental hygienists ( n=22 ) in Finl and .  Educational intervention consisted of 1 day of training , including lectures , interactive sessions , multimedia demonstrations and a role play session with st and ard patient cases . Fee-for-service intervention consisted of monetary compensation for providing tobacco use prevention or cessation counselling . TUPAC counselling procedures provided were reported and measured using an electronic dental records system . In data analysis , intent-to-treat principles were followed at both individual and cluster levels . Descriptive analysis included chi-square and t-tests . A general linear model for repeated measures was used to compare the outcome measures by intervention group . RESULTS Of 95 providers , 73 participated ( 76.8 % ) . In preventive counselling , there was no statistically significant time effect or group-by-time interaction . In cessation counselling , statistically significant group-by-time interaction was found after a 6-month follow-up ( F=2 
    Output:
    
Implication s This systematic review summarizes existing tobacco-related curriculum components ( content , intensity , competency evaluation , and barriers ) and training interventions for health-care professionals worldwide and demonstrates that they are associated with positive health-care professional outcomes ( knowledge , attitudes , behaviors , and skills ) and client outcomes ( quit attempts and smoking abstinence )