| Journals Watch
2001 This section features a constantly updated list of recently published articles relevant to nurse prescribing. Abstracts of the papers are included and incorporate an expert's opinion about the article. Users are encouraged to submit their views about published papers through the feedback section. Please note: In this section of the website we aim to cover articles on areas where nurses do prescribe. However, not all the treatments or appliances mentioned are prescribable by nurses. For that reason, nurses should check the up-to-date versions of the Nurse Prescribing Formulary and Drug tariff if they are in any doubt. Lifestyle
and smoking Editorial: Newly available treatments for nicotine addiction. BMJ 2001; 322:1076-1077 Summary: This article summarizes the evidence on the effectiveness of NRT, bupropion and behavioural support. The effectiveness of NRT seems to increase with more intensive behavioural support and counselling, with up to 20% of smokers stopping with NRT and support from specialist counsellors. Bupropion has not been tested without intensive behavioural support but published sustained one-year abstinence rates in trials average about 20%. Side effects from NRT usually arise from the irritant effect of nicotine. Bupropion may cause seizures in about 1 in 1000 users in the dose used for smoking cessation but otherwise the common side effects are relatively minor. NRT and bupropion are only suitable for smokers on 10-15 a day or more who want to stop and are ready to try. They should be referred to the specialist smoking cessation services, but if they cannot attend for some reason a prescription for NRT is still worth offering. These services should be running in all authorities and should be convenient for most smokers. Although prescribing budgets have been increased to allow for more prescriptions of NRT and bupropion, the money has not been ring-fenced; ring-fencing of the money for the specialist services will be removed after April 2002. It is essential that these services continue. back Website: www.bmj.com
Sowter E. Help patients quit. Practice Nurse 2001; 22(5); 44-46 Summary: This article looks at the use of nicotine replacament therapy (NRT) products and bupropion in helping people to give up smoking. It is based on one of the Treatment Notes series from the Consumers Association and concludes that for people who want to stop, both NRT and bupropion can give valuable support by reducing the withdrawal effects that most people experience. NRT works by providing nicotine without the need to smoke. The six forms of NRT available in the UK are: chewing gum, skin patches, nasal spray, inhaler devices, tablet dissolved under the tongue and lozenge dissolved in the mouth. Trial results suggest that using an NRT product nearly doubles the chance of successfully giving up smoking compared with placebo but evidence on which, if any, products are most effective is more sparse. Some trials have suggested that using patches together with gum or nasal spray may help although none of the NRT manufacturers recommends combining products. Smokers should consult a GP or pharmacist about using such combinations if they are not being helped by using one treatment. The article stresses that taking NRT over a long period is less harmful than continuing to smoke as it is the other chemicals in tobacco that cause many of the serious illnesses linked to smoking. Bupropion (Zyban) is only available on prescription and is thought to act on the part of the brain involved in nicotine addiction. The available evidence (less than for NRT) suggests that in people motivated to stop, taking bupropion can make them twice as likely to succeeed as placebo. In the trials, smokers received additional support or advice and the efficacy of NRT or buprion without this is less clear. There is evidence that about 20% will remain abstinent for a year if helped by a clinic plus NRT compared with 6% for NRT alone. Smokers should be urged to seek this sort of support from smokers' clinics or advisers. back
Miles K et al. Patient group directions in nurse-led sexual health clinics. Nursing Standard 2001; 16(7): 33-34 Summary: Fewer prescriptions were needed from doctors following the introduction of patient group directions (PGDs) at a nurse-led sexual health clinic in London, saving time for nurses, doctors and patients, according to the audit described in this article. Three PGDs were approved, for the supply of clotrimazole cream and pessaries for vulvovaginal candidiasis and for metronidazole for bacterial vaginosis. In 11 weeks, data were collected for 408 patients and reviewed. The number of prescriptions required from a doctor dropped from 35.4% to 16.9% of the nurses' caseload following the introduction of the PGDs. Although documentation was found to be appropriate, the results suggested that the PGDs for clotrimazole cream and pessaries may have been used inappropriately. Nurses were supplying treatment in the absence of positive microscopy diagnosis. It is accepted practice at the clinic to treat women presenting with symptoms and signs of candidiasis with negative microscopy results once other causes are ruled out. The PGD did not therefore reflect locally accepted practice and its eligibility criteria have now been redefined. This highlights the need for early review of new PGDs to ensure safe and accountable practice. back Website: www.nursing-standard.co.uk
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