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PURPOSE: To identify the best screening protocol to prevent neonatal group B streptococcal (GBS) sepsis through literature review. DATA SOURCES: Selected research articles, texts, and Internet sources. CONCLUSIONS: Centers for Disease Control and Prevention (CDC), American Academy of Pediatrics (AAP), American College of Obstetricians and Gynecologists (ACOG), and American College of Nurse Midwives (ACNM) have issued guidelines describing methods to identify pregnant women at risk of intrapartum transmission of GBS to their babies. Studies have been conducted to discover the superiority of one prevention method over the other but no consensus has been reached. IMPLICATIONS FOR PRACTICE: Before widely used prevention methods, approximately 8,000 babies each year became infected with GBS; of those, 400 died and many survivors suffered life-long sequelae. Adoption of an appropriate protocol can prevent transmission of GBS from a colonized mother to her infant. Clinicians should implement either universal culture-based or risk factor-based screening guidelines for prenatal diagnosis and intrapartum prophylaxis of GBS disease. [ABSTRACT FROM AUTHOR]

PURPOSE: To describe the incidence, assessment, and management of intimate partner violence (IPV) from a cultural perspective emphasizing the values, strengths, and health care needs of African-American women. DATA SOURCES: Review of the published scientific literature, U.S. Bureau of Justice Statistics and the National Crime Victimization Survey (NCVS) supplemented with hypothetical cases. CONCLUSIONS: Violence is a social and public health emergency affecting over 10% of the population during their lives and 22% of women who are physically assaulted by an intimate. Roughly 3 million to 4.4 million women report being battered annually, although this is a low estimate. Neither gender nor age nor sexual orientation protects one from IPV. Violent crime causes 2.2 million known injuries with a huge cost in hospital days and other expenses. IMPLICATIONS FOR PRACTICE: Women often hesitate to report violence; health care professionals detect as few as 5% of battered women. Women suffer for months and years before accurate diagnosis. Clinicians need to be vigilant in case finding, education, prevention, and treatment. Cultural differences in values and beliefs, and behavioral norms influence evaluation, treatment, and referral. [ABSTRACT FROM AUTHOR]

PURPOSE: To review the epidemiology and clinical features of migraine and to discuss the use of the 5-HT1B/1D agonists (triptans) in the treatment of moderate to severe migraine. DATA SOURCES: A Medline search was conducted for relevant recent articles on migraine and the efficacy and safety of the triptans. CONCLUSIONS: With the advent of a standardized classification system for headache to simplify migraine diagnosis, new approaches to treatment, and effective new therapies, such as the triptans, many patients have obtained significant relief from the pain and disability associated with migraine. IMPLICATIONS FOR PRACTICE: The key to successful migraine management is to provide the most effective treatment at the earliest possible time. Under the step-care approach to migraine management, the mildest and most conservative treatment was recommended as a first step, without regard for the degree of the patient's pain or disability. This approach has been replaced by stratified care, in which migraine management is based on the severity of the patient's pain and disability. Under the stratified approach, patients with moderate or severe migraine would be prescribed effective migraine-specific drugs, such as the triptans, as first-line therapy. [ABSTRACT FROM AUTHOR]

PURPOSE: To describe herpes zoster ophthalmicus in relation to the anatomy, pathophysiology, course, diagnostic considerations, and management for the primary care provider. DATA SOURCES: Actual case study supplemented with an extensive review of current scientific and psychosocial literature. CONCLUSIONS: Herpes zoster ophthalmicus (HZO) is an extension of a herpes zoster (HZ) infection involving the fifth cranial (trigeminal) nerve, which results from the reactivation of a latent varicella virus among individuals who had contracted a varicella infection sometime within their lifespan. IMPLICATIONS FOR PRACTICE: Due to the vague presenting symptomology of HZO, many patients may be misdiagnosed lessening the chance for prompt diagnosis and therapeutic intervention. Educational awareness, listening to psychosocial concerns of the patients, and immediate referral can decrease potential chronic side effects of the disorder. [ABSTRACT FROM AUTHOR]

PURPOSE: To inform the nurse practitioner of the common causes of chronic cough, to educate how each cause can be identified, and to suggest treatment options for the most common causes. DATA SOURCE: Selected research and review articles from professional journals. CONCLUSION: Chronic cough is a common presenting complaint in the primary care setting. Although at first the symptom may seem simple, the etiology, diagnosis, and treatment of chronic cough can be challenging. Furthermore, without proper identification of the cause, effective treatment most likely will not be obtained. IMPLICATIONS FOR PRACTICE: By familiarizing oneself with this topic, nurse practitioners will feel confident in treating chronic cough. [ABSTRACT FROM AUTHOR]

PURPOSE: To review the literature related to health promotion during the perimenopausal years and suggest methods for integrating those changes into the lifestyles of women in primary care. DATA SOURCES: Selected scientific literature and guidelines for exercise programs. CONCLUSIONS: The transition into perimenopause presents an opportunity for addressing health promotion issues, such as diet and exercise. As a woman senses perimenopausal changes, health awareness emerges. Such personal insight motivates the woman to implement lifestyle changes. IMPLICATIONS FOR PRACTICE: Considering the average women will spend approximately one third of her life past menopause, a concerted effort is needed to ensure her well-being. Diet and exercise represent two modifiable areas of concern for perimenopausal women. Dietary selections of phytoestrogens, calcium, fiber and fat along with exercises plans are relatively simple interventions to begin the process of change. [ABSTRACT FROM AUTHOR]

PurposeTo provide an overview of current diagnostic protocols of Alzheimer's disease (AD), screening techniques, tests, and a review of standard and new treatments.Data SourcesSelected articles from the scientific literature, online sources, and standard texts were examined.ConclusionsStandard tools, such as the Geriatric Depression Scale, the Mini Mental State Evaluation, and the 7-Minute Screen, are useful in the primary care setting for screening elderly patients. Other tools, such as the Clinical Dementia Rating (CDR) and the Global Deterioration Scale, are useful for staging and monitoring progression of disease and response to treatment. Clinical diagnostic testing is still in developmental stages, but the hope is to have a reliable and objective diagnostic tool in order to diagnose AD in the earliest stages.Implications for PracticeThe diagnosis and treatment of AD is becoming a more frequent challenge in the primary care office. Clinicians must keep abreast of the rapid changes in new technologies in order to make informed diagnostic and therapeutic decisions. [ABSTRACT FROM AUTHOR]

PURPOSE: To describe the components of the female athlete triad, including definitions and clinical criteria for diagnosis, methods of screening, and treatment options. DATA SOURCES: Selected scientific literature; standard diagnostic guidelines. CONCLUSIONS: The female athlete triad is a cascading event consisting of disordered eating, amenorrhea, and osteoporosis. This disorder can occur in any sport but is seen most often in events that emphasize thinness and appearance such as gymnastics, ballet, and diving. It can often go unrecognized and result in irreversible bone loss and possible death. IMPLICATIONS FOR PRACTICE: Primary care nurse practitioners (NPs) may be the first health care professionals encountering these females; they need to recognize the risk factors and institute a multidisciplinary approach to treatment. The treatment team should be composed of the patient, the NP, a dietitian, a psychologist, psychiatrist, or psychiatric nurse specialist, and the patient's family, coaches, and trainers. [ABSTRACT FROM AUTHOR]

PURPOSE: To determine if patients recovering from open heart surgery were able to read and understand written discharge instructions and further to analyze the level of difficulty of standard discharge instructions and consent forms for open heart surgery. DATA SOURCES: After screening for visual acuity and efficiency, literacy was assessed with the Rapid Estimate of Adult Literacy in Medicine test (REALM) and comprehension was tested by a post-test of five questions based on the discharge instructions. Flesch-Kincaid scores were calculated on four sets of standard written discharge instructions and consent forms. CONCLUSIONS: Results from the study indicated that the REALM test was more accurate than the reported grade level and that reading skills are needed to understand and comprehend information needed for post-operative care. The study further substantiated that health care facilities are not providing written instructional material that is within the reading level of the patient. IMPLICATIONS FOR PRACTICE: Illiteracy can have a major impact in the health care system. Low reading skills can disempower and can prove to be costly for patients who are requiring health care services. Further investigation is needed on the impact of patients' reading skills on the health care system. [ABSTRACT FROM AUTHOR]

PURPOSE: To describe the growing problem of allergic rhinitis (AR) and the latest recommendations on its diagnosis and management for the nurse practitioner (NP) in primary care settings. DATA SOURCES: Recent clinical research, review articles and consensus guidelines, and the author's clinical experience. CONCLUSIONS: The prevalence of AR is increasing, possibly due to increased airborne pollutants, poor ventilation, and rising levels of indoor allergens. Allergic disease is systemic and rarely involves a single symptom. Treatments include reducing exposure to allergens as well as pharmacotherapy. IMPLICATIONS FOR PRACTICE: Patient education is crucial for successful management and includes understanding the allergic basis of symptoms, reducing allergen exposure, understanding proper use of medications, and reassessing the plan on a regular basis. [ABSTRACT FROM AUTHOR]

PurposeTo define the esophageal motor disorders of achalasia and esophageal spasms and describe their presentation in the clinical setting.Data SourcesSelected research-based articles, textbooks, and expert opinion. A case study is presented.ConclusionsThe presentation of esophageal motor disorders may not be clear, particularly when the presenting symptom is chest pain. Determining whether the pain is cardiac or digestive in origin is crucial.Implications for PracticeProgressive dysphagia for both solids and liquids is the major symptom of achalasia; other symptoms include regurgitation, chest pain, and nocturnal cough. Diffuse esophageal spasm typically causes substernal chest pain with nonprogressive dysphagia and odynophagia for both liquids and solids. Dysphagia related to esophageal motility is characterized by a sensation of swallowed food 'sticking' in the throat or chest; there is no problem initiating the act of swallowing. [ABSTRACT FROM AUTHOR]

PurposeTo review the pathophysiology, clinical presentation, and management options for antiphospholipid antibody syndrome (APS), a potentially life-threatening coagulation disorder.Data SourcesSelected scientific literature, consensus guidelines, and expert opinion.ConclusionsClinical features that should alert the clinician to consider APS include recurrent fetal loss, arterial or venous thrombosis, thrombocytopenia and livedo reticularis. One should be suspicious of this diagnosis in a younger patient, one with an autoimmune disease, or family history of autoimmune disease. To confirm the diagnosis one needs both clinical and laboratory abnormalities.Implications for PracticeThe signs and symptoms of APS are varied and could be confused with many disorders. The primary care provider needs to be aware of this syndrome in order to include it in the differential diagnosis and appropriately recognize and refer the patient in a timely manner. [ABSTRACT FROM AUTHOR]

PurposeTo review the functions of sleep and describe an appropriate sleep assessment for the identification of sleep disorders for nurse practitioners (NP) in primary care. Guidelines for management and referral are included.Data SourcesSelected scientific literature, national consensus guidelines, and the author's experience.ConclusionsThe incidence of sleep deprivation in the United States is generally unacknowledged by the public as well as health care professionals. Unfortunately, the catastrophic and debilitating consequences that result from alterations in sleep are usually noted after significant physical and emotional damage have occurred.Implications for PracticeAn assessment of sleep hygiene and the physical, emotional, or lifestyle changes that alter sleep patterns should be a part of the NP's routine encounter with patients. Referral is indicated for suspicion of obstructive sleep apnea, narcolepsy, restless leg syndrome, complex motor activity, or if the condition fads to respond to therapeutic management. [ABSTRACT FROM AUTHOR]

PurposeTo describe the assessment, diagnosis, appropriate testing, and available treatment options for Peyronie's disease.Data sourcesSelected articles from the medical literature, standard textbooks and online resources.ConclusionsClinical hallmarks of the disease include palpable, fibrotic plaques, temporary painful, penile curvature during erection and decreased rigidity of the penis.Implications for practiceTreatment options range from watchful waiting to surgery. Several promising medications, including vitamin E, are being investigated. [ABSTRACT FROM AUTHOR]

PurposeTo describe the etiology, clinical manifestations, differential diagnosis, and treatment of chronic bacterial and chronic abacterial prostatitis (CBP and CAP respectively) in the primary care setting.Data SourcesSelected research, clinical guidelines, and research-based articles in the scientific literature.ConclusionsMost cases of CBP can be appropriately diagnosed and treated in the primary care office. In the case of a diagnosis of CAP, initial therapy can be started by the nurse practitioner (NP) with referral to a urologist for refractory cases.Implications for PracticeComplete eradication of pathogens in CBP is not always possible. Assisting patients to carefully follow their treatment regimens, including completion of all antibiotic therapy, will reduce the frequency and severity of symptoms. Successful management of chronic prostatitis symptoms can result in an improved quality of life and an increased ability to perform activities of daily living for patients. Chronic abacterial prostatitis may require referral to a urologist or mental health professional for co-management of symptoms. [ABSTRACT FROM AUTHOR]

PurposeTo describe the assessment and management of chronic wounds and detail current recommendations for optimal wound care practices.Data SourcesSelected scientific literature, clinical practice guidelines, and the authors' clinical experience.ConclusionsMultiple factors play a role in the problems associated with chronic wounds. Wound care is costly in regards to medical care, as well as costly in terms of the hardship placed on the patient, family, and staff. Too often, wound care practices are based on rituals rather than research.Implications for PracticeThe assessment and management of chronic wounds needs to be individualized according to a thorough assessment of the wound, the patient's lifestyle, and the caregiver's knowledge and skill for managing the wound. It is also important to know what wound care products are available and the types of wounds appropriate for their use. [ABSTRACT FROM AUTHOR]

PurposeTo review the presentation, treatment, and prevention of Lyme disease in primary care.Data SourcesSelected articles from the scientific literature and the Centers for Disease Control.ConclusionsLyme disease is a tick-borne, multisystem inflammatory disease with worldwide distribution caused by the spirochete Borrelia burgdorferi. Lyme disease is initially characterized by a spreading, annular erythema migrans skin rash and can disseminate to the musculoskeletal, neurologic, or cardiovascular system. Stages of the disease present with varying clinical manifestations.Implications for PracticeTreatment of Lyme disease with appropriate antimicrobial therapy should be prompt in order to avoid debilitating outcomes. Awareness of the many presentations of Lyme disease in endemic areas may facilitate a timely diagnosis and appropriate treatment. [ABSTRACT FROM AUTHOR]

PURPOSETo provide nurse practitioners (NPs) with a basic understanding of clinical presentation, transmission, diagnosis, pharmacological treatment, and post-exposure prophylaxis of inhalational anthrax.DATA SOURCESSelected research and clinical articles and government guidelines.CONCLUSIONSInhalational anthrax has an incubation period of I to 6 days and is very difficult to diagnose early. The chest radiograph consistently reveals a widened mediastinum and pleural effusion without infiltrates. Mortality for inhalational anthrax is high, despite aggressive treatment after onset of symptoms. Delays in diagnosis contribute to the high mortality rate.IMPLICATIONS FOR PRACTICEThe potential use of aerosolized anthrax as a biological warfare weapon has renewed interest in inhalational anthrax. Primary care providers are cornerstones in the defense against biological weapons because they may be the first to recognize and report suspicious cases. [ABSTRACT FROM AUTHOR]

PURPOSETo review the options for effectively screening for cervical cancer, including human papilloma virus (HPV) identification, cytologic screening, colposcopy, or a combination approach. Current pathophysiology, diagnostic criteria, treatment approaches, and patient preparation and education related to cervical cancer screening and prevention are also included.DATA SOURCESComprehensive review of current literature, including research and review articles.CONCLUSIONBecause the Papanicolau (Pap) smear is a screening tool, not a diagnostic tool, further studies must be done to identify the actual nature of discovered abnormalities. Of particular concern is the classification of atypical squamous cells of undetermined significance (ASCUS), which may simply indicate inflammation, or may be the first indicator of serious pathology. Following ASCUS Pap smears with HPV screening will allow for a clarification of the best approach to treatment. A screening algorithm supported by a review of the literature is proposed.IMPLICATIONS FOR PRACTICECervical cancer is a preventable disease caused by certain forms of HPV Current screening protocols are based on the use of the Pap smear; and in areas where this test is routine and available, morbidity and mortality rates have dropped dramatically. Many women throughout the world and in underserved regions of the U. S. do not have adequate access to routine screening with Pap smear technology. As long as women continue to die needlessly of cervical cancer, more comprehensive and accessible screening methods must be explored. (Cutting the unnecessary worldwide and in the U.S.) [ABSTRACT FROM AUTHOR]

Purpose: To examine the effect of hormone replacement therapy (HRT) on adverse cardiac events in postmenopausal women.Data Sources: A systematic review of all available scientific literature (513 articles) on the cardioprotective benefits of HRT, including research reports, meta-analyses, and commentaries.Conclusions: Epidemiological studies have consistently suggested that HRT administered to postmenopausal women significantly lowers the risks of cardiovascular events. However, the claimed benefits might have been exaggerated. The results of the only large randomized clinical trial did not show similar benefits as those reported from observational studies. Research findings about cardiovascular protection of HRT remain inconclusive.Implications for Practice: While waiting for more definitive data, it is appropriate to consider other options that have been proven safe and effective in the prevention of cardiovascular disease. [ABSTRACT FROM AUTHOR]

PURPOSE: To provide clinicians in primary care settings with guidelines on evaluation, diagnosis, and management of post-traumatic stress disorder (PTSD).DATA SOURCES: Research-based articles in the medical and psychiatric literature, review articles, and diagnostic criteria.CONCLUSIONS: PTSD is a disorder where psychological and physiological reactions are closely related. Populations at risk include survivors of motor vehicle accidents, natural and man-made disasters, torture, and childhood sexual abuse, as well as combat veterans.IMPLICATIONS FOR PRACTICE: Patients with a history of recent trauma should be targeted for early screening and intervention. Effective treatment of PTSD is a three-stage process consisting of stabilization of symptoms, processing of traumatic perceptions, and integration of trauma into the patient's world- and self-view. [ABSTRACT FROM AUTHOR]

PURPOSE: To review the specific mechanism of action of biologic response modifiers and help clinicians place these new drugs in the context of established therapies for rheumatoid arthritis (RA).DATA SOURCES: Review of scientific literature, including all the clinical trials for these drugs.CONCLUSIONS: Biologic response modifiers target key inflammatory events involved in joint destruction. They have the potential to revolutionize the management of RA.IMPLICATIONS FOR PRACTICE: Referral to a rheumatologist should be strongly considered as soon as the diagnosis of RA is made. Early referral to a specialist has been associated with improved health status for patients with RA due to early and aggressive therapy with these new agents. [ABSTRACT FROM AUTHOR]

Fatigue, though a common complaint, presents a challenge to nurse practitioners who must evaluate its significance in the primary care setting. Fatigue is described as a multidimensional phenomenon and is classified as physiologic, acute, or chronic. A distinction is made between chronic fatigue and chronic fatigue syndrome (CFS). The use of the Piper Fatigue Scale is suggested in order to objectively quantify this symptom in clinical practice. In this article, the Habit and Lifestyle Form for the Evaluation of Fatigue is presented as a way to assist the provider in considering simple and obvious causes of fatigue that may otherwise be overlooked. Finally, an algorithm for the evaluation of fatigue is presented. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance is not a new concept. For over half a century, health care providers have been faced with this problem. The overuse and misuse of antimicrobial therapy by health care providers has contributed largely to the problem, but several other factors have also been associated with antimicrobial resistance. This article reviews current literature regarding antimicrobial resistance in an effort to educate health care providers to make judicious decisions in the treatment of bacterial infections and stem the rise of antibiotic resistance by carefully scrutinizing prescribing practices. Contributing factors to antimicrobial resistance and recommendations for the control of antimicrobial resistance will be reviewed. Treatment recommendations for common health ailments (i.e., acute otitis media, rhinitis, sinusitis, and pharyngitis) are provided. [ABSTRACT FROM AUTHOR]

Neurocysticercosis is the most common parasitic infection of the central nervous system (CNS). Infection occurs following oral ingestion of eggs of the porcine tapeworm, Taenia solium. Eggs migrate to distal tissue sites via the bloodstream, and develop into larval cysts. When cyst growth disrupts normal function of the CNS, patients most commonly present with new onset seizures or hydrocephalus. Neuroimaging with computed tomography (CT) scan and magnetic resonance imaging (MRI) is used to diagnose neurocysticercosis. Treatment regimens are based on cyst location and developmental stage, and include supportive care, supportive care combined with pharmacologic therapy, and surgical intervention. [ABSTRACT FROM AUTHOR]

The article discusses various reports published within the issue, including one by dela Cruz and Galang on illness beliefs and practices of an underserved and minority population and another by Bellar, Jarosz, and Bellar on the biology of weight regulation and obesity.

The article offers information on the American Academy of Nurse Practitioners Certification Program (AANPCP). AANPCP started in 1993, certifying adult and family nurse practitioners. In 2007, gerontology nurses were added in the program. Certification is considered as a significant part of nursing practice since it denotes the readiness of a nurse to practice in primary care. The changes implemented in the 2009 AANPCP are also explained.

PURPOSE: To review the pathophysiology of asthma, present a case study, and provide management strategies for treating this common, yet complex disorder in children and adults. DATA SOURCES: Selected clinical guidelines, clinical articles, and research studies. CONCLUSIONS: Asthma is a chronic inflammatory airway disorder with acute exacerbations that currently affects approximately 14 million-15 million children and adults in the United States. Costs for asthma are staggering and nurse practitioners (NPs) are frequently presented with management decisions for the acute treatment and chronic management of this disorder. Disparities exist with the occurrence of asthma between race and gender. Additionally, there is an increased incidence in acute exacerbations resulting from poor long-term control and follow-up care among the socioeconomically disadvantaged. IMPLICATIONS FOR PRACTICE: Standards of care, along with new and emerging treatment strategies, guide NPs in providing the most comprehensive care to those affected with this chronic disorder. Knowledge about the pathophysiology of asthma and correlated to the case presentation enhances understanding treatment strategies for NPs who are often faced with providing care for patients with this chronic disorder that may sometimes present in an acute exacerbation. [ABSTRACT FROM AUTHOR]

PURPOSE: To describe the clinical syndrome called dementia with Lewy bodies (DLB) and highlight its common and unique characteristics with respect to diagnosis and management. DATA SOURCES: Review of the scientific literature including psychiatric literature, reports of clinical trials, and clinical practice guidelines. CONCLUSIONS: DLB is a clinical and histopathologic disease, which is second only to Alzheimer's disease (AD) as a cause of dementia in older adults. The clinical syndrome of DLB includes cognitive and motor deterioration reminiscent of symptoms associated with AD and Parkinson's disease (PD) respectively. IMPLICATIONS FOR PRACTICE: The late life intersection of cognitive and motor symptoms can present significant challenges in the primary care setting. Recognizing key features of common neurodegenerative disorders is essential to accurately diagnosing and appropriately treating the growing population of older adults who suffer from AD, PD, and DLB. [ABSTRACT FROM AUTHOR]

PURPOSE: To describe the classical features of Marfan's syndrome to help nurse practitioners (NPs) diagnose it in the early stages of progression and perhaps prevent many of its deleterious effects. DATA SOURCES: Selected research-based articles in the scientific literature and classic medical texts. CONCLUSIONS: The cause of Marfan's syndrome is unknown, but studies have linked it with a disorder of chromosome 15. It is a degenerative connective tissue disorder that affects the musculoskeletal, ocular, integumentary, respiratory, and neurologic systems. The most lethal effect is on the cardiovascular system causing dissecting aortic aneurysms. IMPLICATIONS FOR PRACTICE: Early diagnosis is essential for a positive course of management. Marfan's syndrome can have fatal consequences and is often underdiagnosed and misdiagnosed. [ABSTRACT FROM AUTHOR]

PurposeTo review the literature on and discuss the role of the primary care provider in assessing and managing overweight children before they become obese.Data SourcesSelected research, national guidelines and recommendations, and the professional experience of the authors.ConclusionsThe focus of primary care involves early detection and family interventions that are designed for lifestyle modifications, specifically for improved nutrition and an increase in regular physical activity, to achieve optimal child health. Early identification and management of children who exceed a healthy weight for height, gender, and age will prevent the increasing incidence of pediatric obesity. Early prevention and management of pediatric overweight and obesity will also decrease the potential for associated medical and psychosocial problems.Implications For PracticePediatric obesity has risen dramatically in the United States during the last two decades; it is a significant child health problem that is preventable and largely under-diagnosed and under-treated. It is essential to discuss prevention of obesity with parents at every well-child visit; treatment should be initiated when patterns of weight gain exceed established percentiles for increasing height for age and gender. [ABSTRACT FROM AUTHOR]

PURPOSE: To review the literature on model smoking cessation programs and provide an overview of the practice guidelines for intensive smoking cessation groups.DATA SOURCES: Selected evidence-based literature and AHCPR/AHRQ clinical practice guidelines.CONCLUSIONS: Smoking is the leading cause of preventable death in our global society and is expected to kill more people than any other disease within 20 years. Data support that most smokers want to quit and are more likely to succeed with a combination of behavioral and pharmacological support.IMPLICATIONS FOR PRACTICE: Smoking cessation must be a priority in the delivery of patient care. Intensive interventions are more effective than brief interventions and should be available for all smokers. [ABSTRACT FROM AUTHOR]