A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy.

BACKGROUND: E-cigarettes are commonly used in attempts to stop smoking, but evidence is limited regarding their effectiveness as compared with that of nicotine products approved as smoking-cessation treatments. METHODS: We randomly assigned adults attending U.K. National Health Service stop-smoking services to either nicotine-replacement products of their choice, including product combinations, provided for up to 3 months, or an e-cigarette starter pack (a second-generation refillable e-cigarette with one bottle of nicotine e-liquid [18 mg per milliliter]), with a recommendation to purchase further e-liquids of the flavor and strength of their choice. Treatment included weekly behavioral support for at least 4 weeks. The primary outcome was sustained abstinence for 1 year, which was validated biochemically at the final visit. Participants who were lost to follow-up or did not provide biochemical validation were considered to not be abstinent. Secondary outcomes included participant-reported treatment usage and respiratory symptoms. RESULTS: A total of 886 participants underwent randomization. The 1-year abstinence rate was 18.0% in the e-cigarette group, as compared with 9.9% in the nicotine-replacement group (relative risk, 1.83; 95% confidence interval [CI], 1.30 to 2.58; P<0.001). Among participants with 1-year abstinence, those in the e-cigarette group were more likely than those in the nicotine-replacement group to use their assigned product at 52 weeks (80% [63 of 79 participants] vs. 9% [4 of 44 participants]). Overall, throat or mouth irritation was reported more frequently in the e-cigarette group (65.3%, vs. 51.2% in the nicotine-replacement group) and nausea more frequently in the nicotine-replacement group (37.9%, vs. 31.3% in the e-cigarette group). The e-cigarette group reported greater declines in the incidence of cough and phlegm production from baseline to 52 weeks than did the nicotine-replacement group (relative risk for cough, 0.8; 95% CI, 0.6 to 0.9; relative risk for phlegm, 0.7; 95% CI, 0.6 to 0.9). There were no significant between-group differences in the incidence of wheezing or shortness of breath. CONCLUSIONS: E-cigarettes were more effective for smoking cessation than nicotine-replacement therapy, when both products were accompanied by behavioral support. (Funded by the National Institute for Health Research and Cancer Research UK; Current Controlled Trials number, ISRCTN60477608 .).

Effects of singing groups on staff well-being: a feasibility study.

AIMS: To determine the feasibility of recruiting and retaining staff 'singing for well-being' groups over three months and the acceptability of the proposed intervention and data collection methods, and to explore the potential effects of singing groups on staff well-being. METHOD: This was a feasibility study that used a two-group wait-list crossover design. Standardised measures of well-being, engagement, burnout and organisational commitment were used, alongside participant feedback. Questionnaires were given to participants at baseline, three months and six months, with the mean group scores for the measures used calculated at each point. FINDINGS: Participant recruitment did not meet the target set, and only half of the participants returned pre-intervention and post-intervention questionnaires. Acceptability of the programme was high and, despite limited data, positive effects emerged in relation to emotional and work-related well-being. Participant comments about the singing programme and facilitator were universally favourable. CONCLUSION: This feasibility study suggests there may be several benefits of staff singing groups, in terms of improving the well-being of participants. However, proceeding to a full research trial would require additional time and resources to maximise recruitment.

Outcomes post-discharge from an early intervention in psychosis service.

AIM: To investigate the effectiveness of an early intervention in psychosis (EIP) service on engagement and hospital bed usage, post-discharge. A secondary aim was to identify if there was a subgroup of patients with 'poor outcomes'. METHOD: A naturalistic study comparing engagement and hospital bed day usage of individuals who received treatment from an EIP service (n = 75) with those who presented before the service was established (n = 113). RESULTS: The EIP service demonstrated better engagement with service users in year 5 (P = 0.001). No significant differences were observed on hospital bed day usage. When 'poor outcome' cases were removed, a trend towards lower bed usage in EIP services emerged (P = 0.139). CONCLUSION: EIP services improve engagement with service users. There was not a significant reduction in hospital bed usage. However, advantages could be masked by a relatively small number of individuals with 'poor outcomes'.