Public Release: 

Task force releases recommendations for smoking cessation

American College of Physicians

1. Task Force recommends behavioral interventions and medication to help smokers quit

Clinicians should ask all adults and pregnant women about smoking and advise quitting with proven interventions to those who smoke

Free recommendation statement: http://www.annals.org/article.aspx?doi=10.7326/M15-2023

Free evidence review: http://www.annals.org/article.aspx?doi=10.7326/M15-0171

URLs go live when the embargo lifts

The U.S. Preventive Services Task Force recommends counseling and pharmaceutical interventions to help adults and pregnant women quit smoking. Clinicians should ask all adult patients about smoking and encourage those who do smoke to quit with appropriate cessation aids. Task Force recommendations were informed by a systematic review of published evidence on smoking cessation interventions, including behavioral interventions and medications. The full recommendations and the evidence review are published in Annals of Internal Medicine.

For nonpregnant adults, the Task Force recommends behavioral therapy or the use of medications that have been approved for smoking cessation by the U.S. Food and Drug Administration, including nicotine replacement therapy. For nonpregnant adults, these cessation aids may be used alone or in combination. The Task Force recommends behavioral interventions only for pregnant women.

There was not enough evidence for the Task Force to assess the benefits and harms of the use of e-cigarettes for smoking cessation in adults, or the use of smoking cessation medications, including nicotine replacement therapy, in pregnant women.

Note: For an embargoed PDF, please Cara Graeff. To speak to a member of the Task Force, please contact Nicole Raisch at newsroom@uspstf.net or 202-572-2044. To speak with the lead author of the evidence review, Dr. Carrie Patnode, please contact Jonathan Fine at Jonathan.D.Fine@kpchr.org or 503-335-6602.

2. Pill shown to improve asthma control and reduce exacerbations in placebo trials

Abstract: http://www.annals.org/article.aspx?doi=10.7326/M15-1059

URL goes live when the embargo lifts

A systematic review of published research suggests that taking a leukotriene-receptor antagonist (LTRAs) tablet significantly improves asthma control and reduces the risk for an exacerbation in adults and adolescents with asthma. The evidence review is published in Annals of Internal Medicine.

Asthma is one of the most common chronic diseases. Successful long-term management may include the use of inhaled corticosteroids, the current gold standard of maintenance treatment. LTRAs offer an advantage over inhaled medications because they can be taken in pill form once or twice a day and are not associated with the adverse effects that come with long-term corticosteroid use.

Researchers conducted a systematic review of randomized, controlled trials that compared the efficacy and safety of LTRAs with placebo in adults and adolescents with asthma. The data suggest that administration of LTRAs significantly reduced the risk for an exacerbation. In trials where LTRAs were used alone (monotherapy), LTRAs significantly improved asthma control compared with placebo, whereas only some measures of asthma control were significantly improved in trials of LTRAs used as add-on therapy to inhaled corticosteroids. The authors caution that it is not clear from the research which patients would benefit most from treatment with LTRAs and more research is needed.

Note: For an embargoed PDF, please Cara Graeff. The lead author, Dr. Michael Miligkos, can be reached through Maria Anastasiou at +30 2421074709. The author's direct email address is mmiligkos@med.uth.gr.

3. How clean is that duodenoscope, really?

Abstract: http://www.annals.org/article.aspx?doi=10.7326/M15-1719

URL goes live when the embargo lifts

According to a commentary published in Annals of Internal Medicine, patients preparing for endoscopic retrograde cholangiopancreatography (ERCP) may want to ask their physicians about the cleanliness of their duodenoscopes (specialized endoscopes used for ERCP procedures).

Recently, the recognition of "superbug infections" from agents transmitted by duodenoscopes has prompted investigation and development of action plans by the U.S. Food and Drug Administration, the Centers for Disease Control and Prevention, and professional medical societies. A review of data on endoscope-related infections, exposures, or device contaminations contained 146 reports linked to duodenoscopes, which included 13 deaths. To date, at least 6 duodenoscope-related outbreaks of multidrug-resistant bacteria have been reported in the United States and a recent study reported that 1.9 percent of duodenoscope cultures were positive for pathogenic bacteria despite strict adherence to manufacturers' reprocessing and high-level disinfection guidelines.

While new guidelines on duodenoscope cleaning are being developed, patients should be informed that the absolute risk for infection from an endoscopic procedure is low, as is the risk for infection from a duodenoscope contaminated by a multi-drug-resistant organism. Physicians should stay current on guidelines and strive to establish an environment of open information exchange with patients about what is being done to maximize their safety.

Note: For an embargoed PDF, please Cara Graeff. The lead author, Dr. Jeffrey Tokar, can be reached through Amy Merves at Amy.Merves@fccc.edu or 215-728-7784.

Also in this issue:

Medicare Chronic Care Management Payments and Financial Returns to Primary Care Practices: A Modeling Study
Sanjay Basu, MD, PhD; Russell S. Phillips, MD; Asaf Bitton, MD, MPH; Zirui Song, MD, PhD; and Bruce E. Landon, MD, MBA, MSc
Original Research
Abstract: http://www.annals.org/article.aspx?doi=10.7326/M14-2677

Medicare's Chronic Care Management: Will It Help Primary Care Survive?
Fitzhugh C. Pannill III, MD, FACP
Editorial
Abstract: http://www.annals.org/article.aspx?doi=10.7326/M15-1992

The Blind Spot in the Patient Protection and Affordable Care Act's Cost-Control Policies
Erin C. Fuse Brown, JD, MPH
Ideas and Opinions
Abstract: http://www.annals.org/article.aspx?doi=10.7326/M15-1386

Health Policy Basics: Implementation of the International Classification of Disease, Tenth Revision, Clinical Modification
Brian Outland, RHIT, CCS-P, CPC-O; Mary M. Newman, MD; and Margo J. William, MHA, CMPE
Medicine and Public Issues
Abstract: http://www.annals.org/article.aspx?doi=10.7326/M15-1933

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