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Greenberg JA, Zwiep TM, Sadek J, Malcolm JC, Mullen KA, McIsaac DI, Musselman RP, Moloo H. Clinical practice guideline: evidence, recommendations and algorithm for the preoperative optimization of anemia, hyperglycemia and smoking. Can J Surg 2021; 64:E491-E509. [PMID: 34598927 PMCID: PMC8526150 DOI: 10.1503/cjs.011519] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2020] [Indexed: 12/13/2022] Open
Abstract
Preoperative optimization has not been explored comprehensively in the surgical literature, as this responsibility has often been divided among surgery, anesthesia and medicine. We developed an evidence-based clinical practice guideline to summarize existing evidence and present diagnostic and treatment algorithms for use by surgeons caring for patients scheduled to undergo major elective surgery. We focus on 3 common comorbid conditions seen across surgical specialties - anemia, hyperglycemia and smoking - as these conditions increase complication rates in patients undergoing major surgery and can be optimized successfully as soon as 6-8 weeks before surgery. With the ability to address these conditions earlier in the patient journey, surgeons can positively affect patient outcomes. The aim of this guideline is to bring optimization in the preoperative period under the existing umbrella of evidence-based surgical care.
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Affiliation(s)
- Joshua A Greenberg
- From the Department of Surgery, The Ottawa Hospital, Ottawa, Ont. (Greenberg, Zwiep, Sadek, Musselman, Moloo); the Department of Medicine, The Ottawa Hospital, Ottawa, Ont. (Saidenberg, Malcolm); the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Saidenberg, McIsaac, Moloo); the University of Ottawa Heart Institute, Ottawa, Ont. (Mullen); and the Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ont. (McIsaac)
| | - Terry M Zwiep
- From the Department of Surgery, The Ottawa Hospital, Ottawa, Ont. (Greenberg, Zwiep, Sadek, Musselman, Moloo); the Department of Medicine, The Ottawa Hospital, Ottawa, Ont. (Saidenberg, Malcolm); the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Saidenberg, McIsaac, Moloo); the University of Ottawa Heart Institute, Ottawa, Ont. (Mullen); and the Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ont. (McIsaac)
| | - Joseph Sadek
- From the Department of Surgery, The Ottawa Hospital, Ottawa, Ont. (Greenberg, Zwiep, Sadek, Musselman, Moloo); the Department of Medicine, The Ottawa Hospital, Ottawa, Ont. (Saidenberg, Malcolm); the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Saidenberg, McIsaac, Moloo); the University of Ottawa Heart Institute, Ottawa, Ont. (Mullen); and the Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ont. (McIsaac)
| | - Janine C Malcolm
- From the Department of Surgery, The Ottawa Hospital, Ottawa, Ont. (Greenberg, Zwiep, Sadek, Musselman, Moloo); the Department of Medicine, The Ottawa Hospital, Ottawa, Ont. (Saidenberg, Malcolm); the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Saidenberg, McIsaac, Moloo); the University of Ottawa Heart Institute, Ottawa, Ont. (Mullen); and the Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ont. (McIsaac)
| | - Kerri A Mullen
- From the Department of Surgery, The Ottawa Hospital, Ottawa, Ont. (Greenberg, Zwiep, Sadek, Musselman, Moloo); the Department of Medicine, The Ottawa Hospital, Ottawa, Ont. (Saidenberg, Malcolm); the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Saidenberg, McIsaac, Moloo); the University of Ottawa Heart Institute, Ottawa, Ont. (Mullen); and the Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ont. (McIsaac)
| | - Daniel I McIsaac
- From the Department of Surgery, The Ottawa Hospital, Ottawa, Ont. (Greenberg, Zwiep, Sadek, Musselman, Moloo); the Department of Medicine, The Ottawa Hospital, Ottawa, Ont. (Saidenberg, Malcolm); the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Saidenberg, McIsaac, Moloo); the University of Ottawa Heart Institute, Ottawa, Ont. (Mullen); and the Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ont. (McIsaac)
| | - Reilly P Musselman
- From the Department of Surgery, The Ottawa Hospital, Ottawa, Ont. (Greenberg, Zwiep, Sadek, Musselman, Moloo); the Department of Medicine, The Ottawa Hospital, Ottawa, Ont. (Saidenberg, Malcolm); the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Saidenberg, McIsaac, Moloo); the University of Ottawa Heart Institute, Ottawa, Ont. (Mullen); and the Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ont. (McIsaac)
| | - Husein Moloo
- From the Department of Surgery, The Ottawa Hospital, Ottawa, Ont. (Greenberg, Zwiep, Sadek, Musselman, Moloo); the Department of Medicine, The Ottawa Hospital, Ottawa, Ont. (Saidenberg, Malcolm); the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Saidenberg, McIsaac, Moloo); the University of Ottawa Heart Institute, Ottawa, Ont. (Mullen); and the Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ont. (McIsaac)
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Vaping, Smoking Cessation, and Harm Reduction? Look Before You Leap. Can J Cardiol 2021; 37:683-685. [PMID: 33838973 DOI: 10.1016/j.cjca.2021.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/03/2021] [Accepted: 02/03/2021] [Indexed: 11/24/2022] Open
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3
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National Trends of Gender Disparity in Canadian Cardiovascular Society Guideline Authors, 2001-2020. CJC Open 2021; 3:S12-S18. [PMID: 34993429 PMCID: PMC8712610 DOI: 10.1016/j.cjco.2021.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/08/2021] [Indexed: 12/14/2022] Open
Abstract
Background The level of representation of women in cardiology remains low compared to that of men, particularly in leadership positions. We evaluated gender disparity in the authorship of Canadian Cardiovascular Society (CCS) guidelines. Methods All CCS guidelines from 2001-2020 were identified. Gender was assessed based on pronoun use in the biographies and social media of the authors. Only primary panel authors were included in our analysis. Stratified analyses were performed based on subspecialties. Results A total of 76 guidelines were identified, with 1172 authors (26% women, 74% men, P < 0.0001), with no significant change in percentage of women authors over 2 decades, (37.1% in 2001, 36.3% in 2020, P = 0.34). Inclusion of women as authors occurred less frequently than inclusion of men in general cardiology guidelines (20.1% vs 79.9%, P < 0.0001) and all subspecialties—heart failure (36.4% vs 63.6%, P < 0.0001), interventional cardiology (12.6% vs 87.4%, P < 0.0001), electrophysiology (20.2% vs 79.8%, P < 0.0001), and pediatric cardiology (41.7% vs 58.3%, P = 0.02). It was less likely for women to be a chair or cochair of a guideline writing committee, compared with men (20.1% vs 79.8%, P < 0.0001). There were 609 unique authors (25.6% women, 74.4% men, P < 0.0001), 542 unique medical doctorate (MD) authors (20.7% women, 79.3% men, P < 0.0001), and 67 unique non-MD authors (65.7% women, 34.3% men, P = 0.0003). Conclusions There is a persistent shortfall in the inclusion of women authors for CCS guidelines, which has not changed over time. Further efforts are required to promote women's inclusion in leadership roles, which may lead to authorship of the guidelines.
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Jaarsma T, Hill L, Bayes-Genis A, La Rocca HPB, Castiello T, Čelutkienė J, Marques-Sule E, Plymen CM, Piper SE, Riegel B, Rutten FH, Ben Gal T, Bauersachs J, Coats AJS, Chioncel O, Lopatin Y, Lund LH, Lainscak M, Moura B, Mullens W, Piepoli MF, Rosano G, Seferovic P, Strömberg A. Self-care of heart failure patients: practical management recommendations from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2020; 23:157-174. [PMID: 32945600 PMCID: PMC8048442 DOI: 10.1002/ejhf.2008] [Citation(s) in RCA: 175] [Impact Index Per Article: 43.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/14/2020] [Accepted: 09/14/2020] [Indexed: 12/21/2022] Open
Abstract
Self-care is essential in the long-term management of chronic heart failure. Heart failure guidelines stress the importance of patient education on treatment adherence, lifestyle changes, symptom monitoring and adequate response to possible deterioration. Self-care is related to medical and person-centred outcomes in patients with heart failure such as better quality of life as well as lower mortality and readmission rates. Although guidelines give general direction for self-care advice, health care professionals working with patients with heart failure need more specific recommendations. The aim of the management recommendations in this paper is to provide practical advice for health professionals delivering care to patients with heart failure. Recommendations for nutrition, physical activity, medication adherence, psychological status, sleep, leisure and travel, smoking, immunization and preventing infections, symptom monitoring, and symptom management are consistent with information from guidelines, expert consensus documents, recent evidence and expert opinion.
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Affiliation(s)
- Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Nursing Science, Julius Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Loreena Hill
- School of Nursing and Midwifery, Queen's University, Belfast, UK
| | - Antoni Bayes-Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; and CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Teresa Castiello
- Department of Cardiology, Croydon Health Service and Department of Cardiovascular Imaging, Kings College London, London, UK
| | - Jelena Čelutkienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | - Carla M Plymen
- Cardiology Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Susan E Piper
- Department of Cardiology, King's College Hospital, London, UK
| | - Barbara Riegel
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Frans H Rutten
- Department of General Practice. Julius Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Tuvia Ben Gal
- Heart Failure Unit, Cardiology department, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | | | - Ovidiu Chioncel
- University of Medicine Carol Davila/Institute of Emergency for Cardiovascular Disease, Bucharest, Romania
| | - Yuri Lopatin
- Department of Cardiology, Cardiology Centre, Volgograd State Medical University, Volgograd, Russia
| | - Lars H Lund
- Department of Medicine Karolinska Institutet and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Mitja Lainscak
- Department of Internal Medicine, General Hospital Murska Sobota, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Brenda Moura
- Hospital das Forças Armadas and Cintesis- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium; and Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Massimo F Piepoli
- Department of Cardiology, G. da Saliceto Hospital, Piacenza, Italy.,Institute of Life Sciences, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Giuseppe Rosano
- Centre for Clinical and Basic Research, IRCCS San Raffaele Roma, Rome, Italy
| | - Petar Seferovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | - Anna Strömberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Cardiology, Linköping University, Linköping, Sweden
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Pipe AL, Reid RD. Smoking Cessation and Cardiac Rehabilitation: A Priority! Can J Cardiol 2018; 34:S247-S251. [DOI: 10.1016/j.cjca.2018.07.416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 07/13/2018] [Accepted: 07/13/2018] [Indexed: 12/11/2022] Open
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Mancini GBJ, Cheng AY, Connelly K, Fitchett D, Goldenberg R, Goodman S, Leiter LA, Lonn E, Paty B, Poirier P, Stone J, Thompson D, Verma S, Woo V, Yale JF. CardioDiabetes: Core Competencies for Cardiovascular Clinicians in a Rapidly Evolving Era of Type 2 Diabetes Management. Can J Cardiol 2018; 34:1350-1361. [DOI: 10.1016/j.cjca.2018.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 07/13/2018] [Accepted: 07/13/2018] [Indexed: 12/18/2022] Open
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Reid RD, Aitken DA, Mullen KA, McDonnell L, Armstrong A, LeBlanc AG, Slovinec-D’Angelo M, Pipe AL. Automated Telephone Follow-up for Smoking Cessation in Smokers With Coronary Heart Disease: A Randomized Controlled Trial. Nicotine Tob Res 2018; 21:1051-1057. [DOI: 10.1093/ntr/nty108] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 05/24/2018] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Smokers with coronary heart disease (CHD) benefit from in-hospital cessation treatment, but relapse is common without ongoing support postdischarge. The purpose of this study was to determine if smoking abstinence would be higher after hospital discharge in smokers who received automated telephone follow-up (ATF) and nurse-counseling, compared with a standard care (SC) control group.
Methods
A total of 440 smokers hospitalized with CHD were randomly assigned to the ATF group (n = 216) or to the SC group (n = 224). Participants in the ATF group received automated phone calls 3, 14, 30, 60, 90, 120, 150, and 180 days after hospital discharge. The ATF system posed questions concerning smoking status, confidence in staying smoke-free, and need for assistance. If flagged by the ATF system, a nurse-counselor provided additional counseling by phone. Self-reported continuous smoking abstinence was assessed 26 and 52 weeks postdischarge using intention-to-treat analysis. The main outcome measure was continuous abstinence for weeks 1–26 postdischarge.
Results
Participants in the ATF group achieved higher abstinence rates for weeks 1–26 than those in the SC group (odds ratio [OR] = 1.53, 95% confidence interval [CI] = 1.01 to 2.33). There was no significant difference between groups in abstinence rates for weeks 27–52 (OR = 1.37; 95% CI = 0.89 to 2.09).
Conclusions
ATF-mediated follow-up helped smokers with CHD achieve abstinence during the intervention period. There was a trend toward clinically important improvements for weeks 27–52; but between-group differences for this time point did not achieve statistical significance.
Clinical Trial Number
NCT00449852.
Implications
Automated telephone follow-up exerts its effect by reinforcing participants’ efforts to be smoke-free and by proactively linking people requiring assistance to individualized support (eg, telephone counseling). This study shows that automated telephone follow-up can assist smokers with CHD in remaining smoke-free; however, the success of automated telephone follow-up is limited to the treatment period and abstinence rates after the treatment period were not statistically different from among those receiving standard care. Extended treatment via automated telephone follow-up may provide a solution to extend cessation assistance beyond hospital discharge.
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Affiliation(s)
- Robert D Reid
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Debbie A Aitken
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Kerri-Anne Mullen
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Lisa McDonnell
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Ashley Armstrong
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Allana G LeBlanc
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Monika Slovinec-D’Angelo
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Andrew L Pipe
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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Minaker LM, Tait H, Ong M, Nguyen N. Slim cigarette smoking prevalence among Canadian youth smokers: Implications for federal standardized packaging legislation. Canadian Journal of Public Health 2018; 108:e565-e570. [PMID: 29356665 DOI: 10.17269/cjph.108.6197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 10/08/2017] [Accepted: 09/10/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Tobacco companies market to females and young people through slim cigarette design features and packaging. This study assessed the prevalence and perceptions of slim cigarette smoking in grades 9-12 student smokers across Canada using multiple data sources. METHODS Data from three cycles of the Youth Smoking Survey (2008/2009 to 2012/2013) and one cycle of the Cancer Risk Assessment in Youth Survey (2015) were used. The prevalence and perceptions of slim cigarette smoking among current smokers were compared by sex and grade. RESULTS In all surveys, the rate of slim cigarette use was higher among females than males; however, this difference was not statistically significant. In the two most recent surveys, grades 9-10 students had a significantly higher prevalence of use compared with grades 11-12 students. The majority of students (59.8% of females and 53.3% of males) responded, "I don't know" to the survey item seeking to determine perceptions of harm of slim cigarettes compared with regular cigarettes. CONCLUSION Slim cigarette use among Canadian grades 9-12 students represents a small but growing problem. Youths' uncertainty around the harms associated with slim cigarette use and the effect of slim cigarette packaging and design on harm perceptions indicate the need for product design regulations and further education in Canada.
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Affiliation(s)
- Leia M Minaker
- School of Planning, Faculty of Environment, University of Waterloo, Waterloo, ON; Propel Centre for Population Health Impact, University of Waterloo, Waterloo, ON.
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Ikonomidis I, Marinou M, Vlastos D, Kourea K, Andreadou I, Liarakos N, Triantafyllidi H, Pavlidis G, Tsougos E, Parissis J, Lekakis J. Effects of varenicline and nicotine replacement therapy on arterial elasticity, endothelial glycocalyx and oxidative stress during a 3-month smoking cessation program. Atherosclerosis 2017; 262:123-130. [DOI: 10.1016/j.atherosclerosis.2017.05.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 05/08/2017] [Accepted: 05/11/2017] [Indexed: 10/19/2022]
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Alabousi M, Abdullah P, Alter DA, Booth GL, Hogg W, Ko DT, Manuel DG, Farkouh ME, Tu JV, Udell JA. Cardiovascular Risk Factor Management Performance in Canada and the United States: A Systematic Review. Can J Cardiol 2017; 33:393-404. [DOI: 10.1016/j.cjca.2016.07.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 07/03/2016] [Accepted: 07/06/2016] [Indexed: 01/13/2023] Open
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Teo KK, Dokainish H. Effective Management of Cardiovascular Risk Factors-Are We Doing Enough? Can J Cardiol 2016; 33:300-302. [PMID: 27956041 DOI: 10.1016/j.cjca.2016.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/03/2016] [Accepted: 10/05/2016] [Indexed: 10/20/2022] Open
Affiliation(s)
- Koon K Teo
- Population Health Research Institute, McMaster University-Hamilton Health Sciences, Hamilton, Ontario, Canada.
| | - Hisham Dokainish
- Population Health Research Institute, McMaster University-Hamilton Health Sciences, Hamilton, Ontario, Canada
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Grainger Gasser A, Welch C, Arora M, Greenland R, Bhatti L, Sanda L, Moodie R, Bianco E. Reducing Cardiovascular Mortality Through Tobacco Control: A World Heart Federation Roadmap. Glob Heart 2016. [PMID: 26213299 DOI: 10.1016/j.gheart.2015.04.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
| | | | - Monika Arora
- Public Health Foundation of India, New Delhi, India
| | | | | | | | - Rob Moodie
- University of Melbourne, Melbourne, Victoria, Australia
| | - Eduardo Bianco
- Framework Convention Alliance (FCA), and The Center for Research on the Tobacco Epidemic (CIET), Montevideo, Uruguay
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Fitchett DH, Goodman SG, Leiter LA, Lin P, Welsh R, Stone J, Grégoire J, Mcfarlane P, Langer A. Secondary Prevention Beyond Hospital Discharge for Acute Coronary Syndrome: Evidence-Based Recommendations. Can J Cardiol 2016; 32:S15-34. [PMID: 27342696 DOI: 10.1016/j.cjca.2016.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 02/20/2016] [Accepted: 03/01/2016] [Indexed: 12/21/2022] Open
Abstract
In the past 3 decades, a better understanding of the pathophysiology of cardiovascular disease has resulted in innovations in the treatment and prevention of its clinical manifestations such as death, myocardial infarction, or stroke. After an acute coronary syndrome there are short- and long-term risks of subsequent cardiovascular events. This leads to opportunities to initiate strategies to reduce complications resulting from myocardial injury (cardiac protection) and to prevent recurrent acute coronary events (vascular protection). The results from clinical trials inform best practice and guidelines for patient management. Despite clear and consistent guidelines, an important number of patients are not receiving these treatments. Moreover, many others do not receive treatment that follows the strategy proven in the clinical trial and this is associated with a significant loss of opportunities to improve outcomes. The Canadian Heart Research Centre has therefore assembled a panel of experts to provide a review of available data and distill it to specific evidence-based recommendations that can be used by specialists and primary care physicians as a platform for secondary prevention. The therapeutic recommendations are conveniently divided into vascular protection (dual antiplatelet therapy, lipid-lowering, and renin angiotensin system inhibition) which should be considered in all patients; cardiac protection (addition of β-blocker therapy) in patients with left ventricular dysfunction including consideration for management of heart failure; and continuing management of risk factors and comorbid conditions on the basis of the specific patient profile. These recommendations are intended as a decision support tool and a quick reference for Canadian physicians.
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Affiliation(s)
- David H Fitchett
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
| | - Shaun G Goodman
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Heart Research Centre, University of Alberta, Edmonton, Alberta, Canada; Vigour Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Lawrence A Leiter
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Peter Lin
- Canadian Heart Research Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Robert Welsh
- Vigour Centre, University of Alberta, Edmonton, Alberta, Canada
| | - James Stone
- University of Calgary, Calgary, Alberta, Canada
| | - Jean Grégoire
- Montreal Heart Centre, University of Montreal, Montreal, Quebec, Canada
| | - Philip Mcfarlane
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Anatoly Langer
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Heart Research Centre, University of Alberta, Edmonton, Alberta, Canada
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Youth retail tobacco access in Canada: regional variation, perceptions, and predictors from YSS 2010/2011. Addict Behav 2015; 51:1-6. [PMID: 26183442 DOI: 10.1016/j.addbeh.2015.06.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 06/17/2015] [Accepted: 06/30/2015] [Indexed: 11/23/2022]
Abstract
PURPOSE Retail tobacco access is an important determinant of youth smoking prevalence. This study examines perceptions of ease in obtaining cigarettes and how prevalence of self-reported retail tobacco access among youth smokers varies by province in Canada. Additionally, relevant retail experiences, such as being asked for identification by a store clerk, are described. METHODS Data from grades 9-12 students who participated in the 2010/2011 Youth Smoking Survey, a nationally generalizable sample of Canadian students (n=31396) were used to examine retail tobacco access and related experiences. Logistic regression models were used to examine differences in retail tobacco access and retail tobacco experiences by sociodemographic and regional characteristics. RESULTS 79% of students who never smoked thought it would be easy to get cigarettes. About one-quarter of smokers reported usually buying cigarettes from stores, and the percent of student smokers usually buying cigarettes in stores ranged from 16% in British Columbia to 36% in Quebec. Compared to grade 9 students, grade 12 students had higher odds of report being asked for identification (OR=6.3, 95% CI 1.9-21.5). CONCLUSIONS Retail tobacco access appears to be a significant source of cigarette access among Canadian youth. Retail tobacco access varies significantly by province, which suggests provincial policies should be strengthened.
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Hammal F, Ezekowitz JA, Norris CM, Wild TC, Finegan BA. Smoking status and survival: impact on mortality of continuing to smoke one year after the angiographic diagnosis of coronary artery disease, a prospective cohort study. BMC Cardiovasc Disord 2014; 14:133. [PMID: 25274407 PMCID: PMC4190449 DOI: 10.1186/1471-2261-14-133] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 09/22/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Smoking is an undertreated risk factor for coronary artery disease (CAD) and is associated with adverse outcomes after myocardial infarction. Aims of our study were to determine if management of CAD by medical therapy (MT) alone or with coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) influence smoking status at one year following angiography and if a change in smoking status at one year influences long term survival. METHODS Prospective cohort study using the APPROACH registry. Two cohorts were examined: (1) 11,334 patients who returned a one year follow-up questionnaire; (2) 4,246 patients propensity-matched based on their post-angiography treatment - MT or revascularization (RV). Multivariate modeling and survival analysis were used. RESULTS In the propensity-matched cohort, quit rates at one year were greater among CABG patients (68%) than PCI (37%) or MT patients (47%). Smokers in the RV group, who self-reported quitting at one year, had a significantly reduced mortality compared to those who continued to smoke. CONCLUSIONS CABG patients were more likely to quit smoking than those treated with MT alone or PCI. Quitting smoking was associated with improved long-term survival; smoking remains a key risk factor for mortality in patients with CAD. These data underscore the importance of nicotine addiction management in patients with CAD and the need to emphasize cessation particularly in those patients undergoing MT or PCI.
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Affiliation(s)
| | | | | | | | - Barry A Finegan
- Department of Anesthesiology & Pain Medicine, University of Alberta, 8-120 Clinical Sciences Building, Edmonton, Alberta T6G2G3, Canada.
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Pipe AL. Network meta-analysis demonstrates the safety of pharmacotherapy for smoking cessation in cardiovascular patients. EVIDENCE-BASED MEDICINE 2014; 19:193. [PMID: 24917603 DOI: 10.1136/eb-2014-110030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Andrew L Pipe
- Heart Institute, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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Mancini GJ, Gosselin G, Chow B, Kostuk W, Stone J, Yvorchuk KJ, Abramson BL, Cartier R, Huckell V, Tardif JC, Connelly K, Ducas J, Farkouh ME, Gupta M, Juneau M, O’Neill B, Raggi P, Teo K, Verma S, Zimmermann R. Canadian Cardiovascular Society Guidelines for the Diagnosis and Management of Stable Ischemic Heart Disease. Can J Cardiol 2014; 30:837-49. [DOI: 10.1016/j.cjca.2014.05.013] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 05/22/2014] [Accepted: 05/23/2014] [Indexed: 02/05/2023] Open
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Mullen KA, Coyle D, Manuel D, Nguyen HV, Pham B, Pipe AL, Reid RD. Economic evaluation of a hospital-initiated intervention for smokers with chronic disease, in Ontario, Canada. Tob Control 2014; 24:489-96. [PMID: 24935442 PMCID: PMC4552906 DOI: 10.1136/tobaccocontrol-2013-051483] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 05/23/2014] [Indexed: 11/06/2022]
Abstract
Introduction Cigarette smoking causes many chronic diseases that are costly and result in frequent hospitalisation. Hospital-initiated smoking cessation interventions increase the likelihood that patients will become smoke-free. We modelled the cost-effectiveness of the Ottawa Model for Smoking Cessation (OMSC), an intervention that includes in-hospital counselling, pharmacotherapy and posthospital follow-up, compared to usual care among smokers hospitalised with acute myocardial infarction (AMI), unstable angina (UA), heart failure (HF), and chronic obstructive pulmonary disease (COPD). Methods We completed a cost-effectiveness analysis based on a decision-analytic model to assess smokers hospitalised in Ontario, Canada for AMI, UA, HF, and COPD, their risk of continuing to smoke and the effects of quitting on re-hospitalisation and mortality over a 1-year period. We calculated short-term and long-term cost-effectiveness ratios. Our primary outcome was 1-year cost per quality-adjusted life year (QALY) gained. Results From the hospital payer's perspective, delivery of the OMSC can be considered cost effective with 1-year cost per QALY gained of $C1386, and lifetime cost per QALY gained of $C68. In the first year, we calculated that provision of the OMSC to 15 326 smokers would generate 4689 quitters, and would prevent 116 rehospitalisations, 923 hospital days, and 119 deaths. Results were robust within numerous sensitivity analyses. Discussion The OMSC appears to be cost-effective from the hospital payer perspective. Important consideration is the relatively low intervention cost compared to the reduction in costs related to readmissions for illnesses associated with continued smoking.
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Affiliation(s)
- Kerri-Anne Mullen
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Douglas Coyle
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Douglas Manuel
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Hai V Nguyen
- Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Ba' Pham
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Andrew L Pipe
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Robert D Reid
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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Yu Y, Rajan SS, Essien EJ, Yang M, Abughosh S. The relationship between obesity and prescription of smoking cessation medications. Popul Health Manag 2014; 17:172-9. [PMID: 24784163 DOI: 10.1089/pop.2013.0059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The objective of this study was to examine the differences in prescription of smoking cessation medications among smokers with different body mass index (BMI) classifications. A retrospective cross-sectional study was conducted using National Ambulatory Medical Care Survey data (2006-2010). Self-reported current smokers aged 18 years and older were included in the study. The outcome of interest was receiving a prescription for a Food and Drug Administration-approved smoking cessation medication. Multivariate logistic regression was performed to assess the association between the outcome variable and the main independent variable (BMI classification), controlling for other covariates. The results showed that overweight, obese, and severely obese smokers were less likely to be prescribed a smoking cessation medication as compared to normal weight smokers. Although 5.11% of normal weight smokers were prescribed a smoking cessation medication, only 3.70% of overweight smokers, 3.41% of obese smokers, and 2.50% of severely obese smokers were prescribed a smoking cessation medication. In addition, older smokers, whites, smokers visiting primary care providers, smokers receiving tobacco counseling, and nondiabetic smokers were more likely to be prescribed a smoking cessation medication. Lower prescription of smoking cessation medications among overweight, obese, and severely obese smokers might be driven by patients' health concerns and behavioral factors or providers' treatment preferences or biases. The disparity in smoking cessation medication prescription among smokers with different BMI classifications raises quality of care and health care concerns for overweight, obese, and severely obese smokers.
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Affiliation(s)
- Yuping Yu
- 1 Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston , Houston, Texas
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Perrotta L, Xhaferi B, Chiostri M, Pieragnoli P, Ricciardi G, Di Biase L, Natale A, Ricceri I, Biria M, Lakkireddy D, Valleggi A, Emdin M, Michelotti F, Mascioli G, Pandozi A, Santini M, Padeletti L. Effects of smoking in patients treated with cardiac resynchronization therapy. Intern Emerg Med 2014; 9:311-8. [PMID: 23250544 DOI: 10.1007/s11739-012-0891-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 12/03/2012] [Indexed: 11/28/2022]
Abstract
Smoking is associated with increased morbidity and mortality in cardiac patients. However, data on the prognostic impact of smoking in heart failure (HF) patients on cardiac resynchronization therapy with defibrillator (CRT-D) are absent. We investigated the effects of smoking on all-cause mortality and on a composite endpoint (all-cause death/appropriate device therapy), appropriate and inappropriate device therapy, in 649 patients with HF who underwent CRT-D between January 2003 and October 2011 in 6 Centers (4 in Italy and 2 in USA). 68 patients were current smokers, 396 previous-smokers (patients who had smoked in the past but who had quit before the CRT-D implant), and 185 had never smoked. The risk of each endpoint by smoking status was evaluated with both Kaplan-Meier and Cox proportional-hazard analysis. After adjusting for age, left ventricular ejection fraction, QRS width and ischemic etiology, both current and previous smoking were independent predictors of all-cause death [HR = 5.07 (95 % CI 2.68-9.58), p < 0.001 and HR = 2.43 (95 % CI 1.38-4.29), p = 0.002, respectively) and of composite endpoint [HR = 1.63 (1.04-2.56); p = 0.033 and HR = 1.46 (1.04-2.04) p = 0.027]. In addition, current smokers had a significantly higher rate of inappropriate device therapy compared to never smokers [HR = 21.74 (4.53-104.25), p = 0.005]. Our study indicates that in patients with HF who received a CRT-D device, current and previous smoking increase the event rate per person-time of death and of appropriate and inappropriate ICD therapy more than other known negative prognostic factors such as age, left ventricular dysfunction, prolonged QRS duration and ischemic etiology.
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Affiliation(s)
- Laura Perrotta
- University of Florence, Viale Morgagni 85, 50134, Florence, Italy,
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Chou LP, Chang HF, Kao C, Lin W, Huang CL. Smoking cessation in Taiwanese male smokers with coronary artery disease: influencing factors and policy implications. Int Nurs Rev 2013; 60:244-50. [PMID: 23692009 DOI: 10.1111/inr.12004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To investigate factors affecting smoking cessation in male smokers with coronary artery disease. DESIGN A descriptive, correlation, cross-sectional study was conducted. METHODS Data were collected using a questionnaire constructed by a literature review of research on smoking cessation in male smokers including demographics and smoking background, as well as psychological, interpersonal and environmental factors. A total of 130 male patients with coronary artery disease were recruited from the cardiac clinic at a regional hospital in Taiwan from August to December 2008. The response rate was 93% (n = 121). Descriptive statistics, chi-square, t-tests and logistic regression analysis were conducted. RESULTS During the survey, 64.5% of the respondents reported that they had stopped smoking after a coronary event. Five factors were significantly associated with smoking cessation after diagnosis of coronary artery disease: age, the severity of heart diagnoses, antismoking norms (perceived that smoking was against the social norms), nicotine dependence level, and contrary views of smoking (perceived negative expectancy of smoking). Multivariate analysis revealed antismoking norms to be the most important predictor (AOR = 4.27; P < .05) after adjusting age. CONCLUSION The study highlights the need to develop smoking cessation interventions that specifically counsel patients with coronary artery disease about these information, such as the disease risk and development, health consequences of smoking, and dependence therapy. Additionally, government support for tobacco control programmes in hospitals and elsewhere is designed to have a beneficial effect on patients' smoking behaviours primarily by increasing antismoking norms.
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Affiliation(s)
- L-P Chou
- Department of Medicine, Sin-Lau Christian Hospital, Tainan, Taiwan
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Smoking and vascular risk: are all forms of smoking harmful to all types of vascular disease? Public Health 2013; 127:435-41. [DOI: 10.1016/j.puhe.2012.12.021] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 04/02/2012] [Accepted: 12/21/2012] [Indexed: 11/21/2022]
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Strobel L, Schneider NK, Krampe H, Beißbarth T, Pukrop T, Anders S, West R, Aveyard P, Raupach T. German medical students lack knowledge of how to treat smoking and problem drinking. Addiction 2012; 107:1878-82. [PMID: 22551065 DOI: 10.1111/j.1360-0443.2012.03907.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
AIM To assess the extent of undergraduate medical training on alcohol use disorders (AUD) and smoking, and medical students' perceived knowledge regarding consequences of, and treatment options for, these disorders compared with other chronic conditions. DESIGN Cross-sectional survey assessing teaching and perceived knowledge of health consequences and treatment options for AUD and smoking compared with diabetes and hypertension. SETTING Medical schools in Germany. PARTICIPANTS Twenty-five of 36 medical school offices (response rate 69.4%) and 19 526 of 39 358 students from 27 medical schools (response rate 49.6%). MEASUREMENT Medical schools were asked to provide information on curricular coverage of the four conditions. Students reported their year of study and perceived knowledge about the consequences of all four disorders and perceived knowledge of treatment options. FINDINGS Courses time-tabled approximately half as many teaching hours on AUD and tobacco as on diabetes or hypertension. Final-year students reported high levels of knowledge of consequences of all four conditions and how to treat diabetes and hypertension, but only 20% believed they knew how to treat alcohol use disorders or smoking. CONCLUSIONS Curriculum coverage in German medical schools of alcohol use disorders and smoking is half that of diabetes and hypertension, and in the final year of their undergraduate training most students reported inadequate knowledge of how to intervene to address them.
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Affiliation(s)
- Lisa Strobel
- Department of Cardiology and Pneumology, University Hospital Göttingen, Göttingen, Germany, German
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Raupach T, Falk J, Vangeli E, Schiekirka S, Rustler C, Grassi MC, Pipe A, West R. Structured smoking cessation training for health professionals on cardiology wards: a prospective study. Eur J Prev Cardiol 2012; 21:915-22. [PMID: 23008136 DOI: 10.1177/2047487312462803] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Smoking is a major cardiovascular risk factor, and smoking cessation is imperative for patients hospitalized with a cardiovascular event. This study aimed to evaluate a systems-based approach to helping hospitalized smokers quit and to identify implementation barriers. DESIGN Prospective intervention study followed by qualitative analysis of staff interviews. METHODS The prospective intervention study assessed the effects of implementing standard operating procedures (SOPs) for the provision of counselling and pharmacotherapy to smokers admitted to cardiology wards on counselling frequency. In addition, a qualitative analysis of staff interviews was undertaken to examine determinants of physician and nurse behaviour; this sought to understand barriers in terms of motivation, capability, and/or opportunity. RESULTS A total of 150 smoking patients were included in the study (75 before and 75 after SOP implementation). Before the implementation of SOPs, the proportion of patients reporting to have received cessation counselling from physicians and nurses was 6.7% and 1.3%, respectively. Following SOP implementation, these proportions increased to 38.7% (p < 0.001) and 2.7% (p = 0.56), respectively. Qualitative analysis revealed that lack of motivation, e.g. role incongruence, appeared to be a major barrier. CONCLUSIONS Introduction of a set of standard operating procedures for smoking cessation advice was effective with physicians but not nurses. Analysis of barriers to implementation highlighted lack of motivation rather than capability or opportunity as a major factor that would need to be addressed.
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Affiliation(s)
- Tobias Raupach
- University Medical Centre Göttingen, Göttingen, Germany University College London, London, UK
| | - Jan Falk
- University Medical Centre Göttingen, Göttingen, Germany
| | | | | | - Christa Rustler
- Deutsches Netz Rauchfreier Krankenhäuser & Gesundheitseinrichtungen e.V., Berlin, Germany
| | | | - Andrew Pipe
- University of Ottawa Heart Institute, Ottowa, Canada
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