Comparing Smoking Cessation Interventions among Underserved Patients Referred for Lung Cancer Screening: A Pragmatic Trial Protocol.

Smoking burdens are greatest among underserved patients. Lung cancer screening (LCS) reduces mortality among individuals at risk for smoking-associated lung cancer. Although LCS programs must offer smoking cessation support, the interventions that best promote cessation among underserved patients in this setting are unknown. This stakeholder-engaged, pragmatic randomized clinical trial will compare the effectiveness of four interventions promoting smoking cessation among underserved patients referred for LCS. By using an additive study design, all four arms provide standard "ask-advise-refer" care. Arm 2 adds free or subsidized pharmacologic cessation aids, arm 3 adds financial incentives up to $600 for cessation, and arm 4 adds a mobile device-delivered episodic future thinking tool to promote attention to long-term health goals. We hypothesize that smoking abstinence rates will be higher with the addition of each intervention when compared with arm 1. We will enroll 3,200 adults with LCS orders at four U.S. health systems. Eligible patients include those who smoke at least one cigarette daily and self-identify as a member of an underserved group (i.e., is Black or Latinx, is a rural resident, completed a high school education or less, and/or has a household income <200% of the federal poverty line). The primary outcome is biochemically confirmed smoking abstinence sustained through 6 months. Secondary outcomes include abstinence sustained through 12 months, other smoking-related clinical outcomes, and patient-reported outcomes. This pragmatic randomized clinical trial will identify the most effective smoking cessation strategies that LCS programs can implement to reduce smoking burdens affecting underserved populations. Clinical trial registered with clinicaltrials.gov (NCT04798664). Date of registration: March 12, 2021. Date of trial launch: May 17, 2021.

Ultrasound Measurement of the Cross-Sectional Area of the Median Nerve: The Effect of Teaching on Measurement Accuracy.

BACKGROUND: The purpose of this study was to determine the effect of concise instruction and guidance on the accuracy of measuring the cross-sectional area of the median nerve at the carpal tunnel inlet. METHODS: Seven orthopedic residents and 5 hand fellows obtained serial measurements of the median nerve at the carpal tunnel inlet using a 15-6 MHz ultrasound (US) probe. After a 5-minute teaching session, all participants repeated measurements. A single cadaveric specimen was used. Measurements were compared with the measurement of a fellowship-trained hand surgeon with extensive experience in US diagnosis of carpal tunnel syndrome. This was considered the reference standard. RESULTS: The rate of participants selecting the correct structure to measure on US was 36% before instruction and 97% after. Discarding the measurements of the incorrect structure, the average measurement was 4.8 mm2 before instruction and 5.2 mm2 after. The standard measurement was 6 mm2. The average deviation from the standard measurement -.2 mm2 before instruction and -0.8 mm2 after. The percent of measurements (of the correct structure) that fell within 1 mm2 of the standard measurement increased from 62% to 74%. Participant self-reported confidence in performing measurements elevated from 2.4/10 before instruction to 6.5/10 after. CONCLUSIONS: US of the median nerve cross-sectional area can be efficiently taught and results in measurements consistent with that of an experienced operator.