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Watters DA, Scott DA, Sammour T, Harris B, Ludbrook GL. If the peri-operative patient pathway was right, what would it look like? ANZ J Surg 2024. [PMID: 39104302 DOI: 10.1111/ans.19179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 07/17/2024] [Accepted: 07/17/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND Patients undergoing surgery deserve the best possible peri-operative outcomes. Each stage of the peri-operative patient journey offers opportunities to improve care delivery, with shorter lengths of stay, less complications, reduced costs and better value. METHODS These opportunities were identified through narrative review of the literature, with consultation and consensus at the hidden pandemic (of postoperative complications) summit 2, July 2023 in Adelaide, Australia RESULTS: Before surgery: Some patients who receive timely alternative treatments may not need surgery at all. The period of waiting after listing should be a time of preparation. Risk assessment at the time of surgical listing facilitates recognition of need for comorbidity optimisation and identifies those who will most benefit from prehabilitation, particularly frail and deconditioned patients. DURING SURGERY During the surgical admission, ERAS programs result in less postoperative complications, shorter length of stay and better patient experience but require agreement between clinicians, and coordinated monitoring of delivery of the elements in the ERAS bundle of care. AFTER SURGERY At-risk patients need to have the appropriate levels of monitoring for cardiovascular instability, renal impairment or respiratory dysfunction, to facilitate timely, proactive management if they develop. Access to allied health in the early postoperative period is also critical for promoting mobility, and earlier discharge, particularly after joint surgery. Where appropriate, provision of rehabilitation services at home improves patient experience and adds value. The peri-operative patient journey begins and ends with primary care so there is a need for clear communication, documentation, around sharing of responsibility between practitioners at each stage. CONCLUSION Identifying and mitigating risk to reduce complications and length of stay in hospital will improve outcomes for patients and deliver the best value for the health system.
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Affiliation(s)
- David Allan Watters
- School of Medicine, Deakin University, Geelong, Victoria, Australia
- University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
- Safer Care Victoria, Melbourne, Victoria, Australia
| | - David A Scott
- Safer Care Victoria, Melbourne, Victoria, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
- Department of Anaesthesia and Acute Pain Medicine, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Tarik Sammour
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Ben Harris
- Department of Policy and Research, Private HealthCare Australia, Melbourne, Victoria, Australia
| | - Guy Lawrence Ludbrook
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Department of Anaesthesia, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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2
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Mestdag M, Degey S, Deflandre E. [Perioperative smoking cessation (conventional smoking and e-cigarettes) in 2023. A narrative review of the literature]. Rev Mal Respir 2024; 41:237-247. [PMID: 38429192 DOI: 10.1016/j.rmr.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 12/19/2023] [Indexed: 03/03/2024]
Abstract
INTRODUCTION Tobacco addiction is the leading cause of preventable death. During the perioperative period, patients who smoke are at increased risk of systemic as well as surgical site complications. STATE OF THE ART Surgery is an ideal time for change of lifestyle habits. It is vital to seize this opportunity to improve the patient's health in the long- as well as the short-term. Smoking cessation should be encouraged in all surgical patients. Initiating smoking cessation combines pharmacological treatment and a behavioral approach. In this field, significant advances have been recorded over the last decade. This review proposes a practical approach that every practitioner will be able to apply. PERSPECTIVES In this review, we will also examine ongoing research, particularly as regards vaccination and the place of biomarkers. CONCLUSIONS Smoking represents a major source of health-related complications. Smoking cessation must therefore remain a priority in the management of medical and surgical patients.
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Affiliation(s)
- M Mestdag
- Anesthésie-réanimation, université de Liège, Liège, Belgique
| | - S Degey
- Cabinet médical ASTES, Jambes, Belgique
| | - E Deflandre
- Anesthésie-réanimation, clinique Saint-Luc de Bouge, Namur, Belgique; Université de Liège, Liège, Belgique.
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3
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Vu JV, Lussiez A. Smoking Cessation for Preoperative Optimization. Clin Colon Rectal Surg 2023; 36:175-183. [PMID: 37113283 PMCID: PMC10125302 DOI: 10.1055/s-0043-1760870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Cigarette smoking is associated with pulmonary and cardiovascular disease and confers increased postoperative morbidity and mortality. Smoking cessation in the weeks before surgery can mitigate these risks, and surgeons should screen patients for smoking before a scheduled operation so that appropriate smoking cessation education and resources can be given. Interventions that combine nicotine replacement therapy, pharmacotherapy, and counseling are effective to achieve durable smoking cessation. When trying to stop smoking in the preoperative period, surgical patients experience much higher than average cessation rates compared with the general population, indicating that the time around surgery is ripe for motivating and sustaining behavior change. This chapter summarizes the impact of smoking on postoperative outcomes in abdominal and colorectal surgery, the benefits of smoking cessation, and the impact of interventions aimed to reduce smoking before surgery.
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Affiliation(s)
- Joceline V. Vu
- Department of Surgery, Temple University Hospital System, Philadelphia, Pennsylvania
| | - Alisha Lussiez
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
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Abstract
Tobacco use will kill a projected 1 billion people in the 21st century in one of the deadliest pandemics in history. Tobacco use disorder is a disease with a natural history, pathophysiology, and effective treatment options. Anesthesiologists can play a unique role in fighting this pandemic, providing both immediate (reduction in perioperative risk) and long-term (reduction in tobacco-related diseases) benefits to their patients who are its victims. Receiving surgery is one of the most powerful stimuli to quit tobacco. Tobacco treatments that combine counseling and pharmacotherapy (e.g., nicotine replacement therapy) can further increase quit rates and reduce risk of morbidity such as pulmonary and wound-related complications. The perioperative setting provides a great opportunity to implement multimodal perianesthesia tobacco treatment, which combines multiple evidence-based tactics to implement the four core components of consistent ascertainment and documentation of tobacco use, advice to quit, access to pharmacotherapy, and referral to counseling resources.
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5
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Iida H, Kai T, Kuri M, Tanabe K, Nakagawa M, Yamashita C, Yonekura H, Iida M, Fukuda I. A practical guide for perioperative smoking cessation. J Anesth 2022; 36:583-605. [PMID: 35913572 DOI: 10.1007/s00540-022-03080-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 05/24/2022] [Indexed: 12/15/2022]
Abstract
The perioperative management of patients who are smokers presents anesthesiologists with various challenges related to respiratory, circulatory, and other clinical problems. Regarding 30-day postoperative outcomes, smokers have higher risks of mortality and complications than non-smokers, including death, pneumonia, unplanned tracheal intubation, mechanical ventilation, cardiac arrest, myocardial infarction, and stroke. Given the benefits of smoking cessation and the adverse effects of smoking on perioperative patient management, patients should quit smoking long before surgery. However, anesthesiologists cannot address these issues alone. The Japanese Society of Anesthesiologists established guidelines in 2015 (published in a medical journal in 2017) to enlighten surgical staff members and patients regarding perioperative tobacco cessation. The primary objective of perioperative smoking cessation is to reduce the risks of adverse cardiovascular and respiratory events, wound infection, and other perioperative complications. Perioperative preparations constitute a powerful teachable moment, a "golden opportunity" for smoking cessation to achieve improved primary disease outcomes and prevent the occurrence of tobacco-related conditions. This review updates the aforementioned guidelines as a practical guide to cover the nuts and bolts of perioperative smoking cessation. Its goal is to assist surgeons, anesthesiologists, and other medical professionals and to increase patients' awareness of smoking risks before elective surgery.
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Affiliation(s)
- Hiroki Iida
- Japanese Society of Anesthesiologists Perioperative Smoking Cessation Working Group, Kobe, Japan. .,Department of Anesthesiology and Pain Medicine, Gifu University Graduate School of Medicine, Gifu, Japan. .,Anesthesiology and Pain Relief Center, Central Japan International Medical Center, 1-1 Kenkonomachi, Minokamo, Gifu, 505-8510, Japan.
| | - Tetsuya Kai
- Japanese Society of Anesthesiologists Perioperative Smoking Cessation Working Group, Kobe, Japan.,Department of Anesthesiology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Michioki Kuri
- Japanese Society of Anesthesiologists Perioperative Smoking Cessation Working Group, Kobe, Japan.,Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kumiko Tanabe
- Japanese Society of Anesthesiologists Perioperative Smoking Cessation Working Group, Kobe, Japan.,Department of Anesthesiology and Pain Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Masashi Nakagawa
- Japanese Society of Anesthesiologists Perioperative Smoking Cessation Working Group, Kobe, Japan.,Department of Intensive Care Medicine, Tokyo Women's Medical University, Shinjuku, Japan
| | - Chizuru Yamashita
- Japanese Society of Anesthesiologists Perioperative Smoking Cessation Working Group, Kobe, Japan.,Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hiroshi Yonekura
- Japanese Society of Anesthesiologists Perioperative Smoking Cessation Working Group, Kobe, Japan.,Department of Anesthesiology and Pain Medicine, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Mami Iida
- Japanese Society of Anesthesiologists Perioperative Smoking Cessation Working Group, Kobe, Japan.,Department of Internal Medicine, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Ikuo Fukuda
- Japanese Society of Anesthesiologists Perioperative Smoking Cessation Working Group, Kobe, Japan.,Cardiovascular Center, Suita Tokushukai Hospital, Suita, Japan
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6
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Webb AR, Coward L, Meanger D, Leong S, White SL, Borland R. Offering mailed nicotine replacement therapy and Quitline support before elective surgery: a randomised controlled trial. Med J Aust 2022; 216:357-363. [PMID: 35267206 PMCID: PMC9314866 DOI: 10.5694/mja2.51453] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/22/2021] [Accepted: 01/13/2022] [Indexed: 12/31/2022]
Abstract
Objective To assess whether offering free mailed nicotine replacement therapy (NRT) and telephone counselling to smokers on elective surgery waiting lists increases quitting before surgery. Design, setting Randomised, controlled trial at Frankston Hospital, a public tertiary referral hospital in Melbourne. Participants Adult smokers added to elective surgery waiting lists for operations at least ten days in the future, 1 April 2019 ‒ 3 April 2020. Intervention In addition to normal care, intervention participants received a brochure on the risks of low frequency smoking, an offer of Quitline call‐back registration, and an offer of mailed NRT according to reported daily smoking: 1‒9 cigarettes/day, 2 mg lozenges; 10‒15/day, 7‒14 mg patches [three weeks] and 2 mg lozenges; > 15/day, 7‒21 mg patches [five weeks] and 2 mg lozenges. Main outcome measures Primary outcome: quitting at least 24 hours before surgery, verified by exhaled carbon monoxide testing. Secondary outcomes: quitting at least four weeks before surgery, adverse events, and (for those who had quit before surgery) abstinence three months after surgery. Results Of 748 eligible participants (control, 363; intervention, 385), 516 (69%) had undergone elective surgery when the trial was terminated early (for COVID‐19‐related reasons) (intervention group, 274; control group, 242). 122 of the 385 intervention participants (32%) had accepted the offer of cessation support. The proportions of intervention participants who quit at least 24 hours before surgery (18% v 9%; odds ratio [OR], 1.97; 95% CI, 1.22‒3.15) or at least four weeks before surgery (9% v 4%; OR, 2.20; 95% CI, 1.08–4.50) were larger than for the control group. Three months after surgery, 27 of 58 intervention (47%) and 12 of 25 control participants (48%) who quit before surgery reported not smoking in the preceding seven days. No major adverse events were reported. Conclusion Uptake of free mailed NRT and Quitline support by smokers on elective surgery waiting lists was good, and offering additional support was associated with higher proportions of smokers quitting before surgery. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12619000032156 (prospective).
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Affiliation(s)
- Ashley R Webb
- Peninsula Health, Melbourne, VIC.,Monash University, Melbourne, VIC
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7
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Webb A, Tascone B, Wickham L, Webb G, Wijeyaratne A, Boyd DT, Leong S. Hospital entrance smoking is reduced by broadcasting recorded antitobacco messages from Australian primary school children over entrance public address system. Health Promot J Austr 2020; 32 Suppl 2:351-357. [PMID: 33108670 DOI: 10.1002/hpja.435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/17/2020] [Accepted: 10/21/2020] [Indexed: 11/06/2022] Open
Abstract
ISSUE ADDRESSED Smoking near hospital entrances occurs frequently despite smoke-free policies, resulting in multiple issues including second-hand smoke exposure (SHS) to vulnerable populations. Primary school children were engaged through their health curriculum to produce antismoking audio recordings for broadcast over a hospital entrance loudspeaker system to determine if this reduced smoking. METHOD Students produced original recordings against hospital grounds smoking during class workshops, from which a collection (n = 16) was selected. Episodes of entrance smoking and total entrance traffic were recorded using security camera infrastructure over a 5-week period. A computer-controlled entrance loudspeaker played a message which was followed by silence until a new (different) message was played. Intensity of messaging was moderate in week 3 (every 5 minutes), increasing to high in week 4 (3 minutely) and compared to no messages (weeks 1-2 preintervention) and week 5 (postintervention). RESULTS Smokers presented 316 times, smoking 523 cigarettes over 155 hours of observation (patients 70.6%, visitors 29.4%). SHS exposure was high given 172 others used the entrance/hour. Smoking was highest in the preintervention period (weeks 1-2), median five cigarettes/hr [IQR,3-7 (min = 0, max = 12)], falling to four cigarettes/hr during 5-minutely broadcasts [IQR,2-5 (min = 1, max = 14)] (P = .06), but zero cigarettes/hr during 3-minutely broadcasts [IQR,0-1(min = 0, max = 7)] (P < .0001). Postintervention (no broadcasts), smoking increased from zero to 1 cigarette/hr [IQR,0-3 (min = 0, max = 5)]; (P = .052). Nonsmoker movements did not change significantly between each period. CONCLUSION Intensive (3 minutely) broadcasting of short antismoking messages significantly reduced hospital entrance smoking. SO WHAT?: Health services can positively interact with the health curriculum of primary schools against tobacco use while developing low-cost strategies to effectively deter entrance smoking.
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Affiliation(s)
- Ashley Webb
- Department of Anaesthesia, Peninsula Health, Frankston, VIC, Australia.,Anaesthesia Teaching & Research, Monash University, Melbourne, Australia
| | - Belinda Tascone
- Community Health, Peninsula Health, Frankston, VIC, Australia
| | - Lucy Wickham
- Community Health, Peninsula Health, Frankston, VIC, Australia
| | - Gemma Webb
- Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Australia
| | - Avisha Wijeyaratne
- Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Australia
| | - David Thomas Boyd
- Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Australia
| | - Samuel Leong
- Department of Anaesthesia, Peninsula Health, Frankston, VIC, Australia.,Anaesthesia Teaching & Research, Monash University, Melbourne, Australia
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8
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Improving Surgical Outcomes and Patient Health: Perioperative Smoking Cessation Interventions. CURRENT ANESTHESIOLOGY REPORTS 2020. [DOI: 10.1007/s40140-020-00370-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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9
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Wong J, An D, Urman RD, Warner DO, Tønnesen H, Raveendran R, Abdullah HR, Pfeifer K, Maa J, Finegan B, Li E, Webb A, Edwards AF, Preston P, Bentov N, Richman DC, Chung F. Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement on Perioperative Smoking Cessation. Anesth Analg 2019; 131:955-968. [DOI: 10.1213/ane.0000000000004508] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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10
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Webb AR, Coward L, Soh L, Waugh L, Parsons L, Lynch M, Stokan L, Borland R. Smoking cessation in elective surgical patients offered free nicotine patches at listing: a pilot study. Anaesthesia 2019; 75:171-178. [DOI: 10.1111/anae.14863] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2019] [Indexed: 11/27/2022]
Affiliation(s)
- A. R. Webb
- Department of Anaesthesia and Acute Pain Management Peninsula Health Melbourne Vic. Australia
- Monash University Melbourne Vic. Australia
| | - L. Coward
- Department of Anaesthesia and Acute Pain Management Peninsula Health Melbourne Vic. Australia
| | - L. Soh
- Department of Anaesthesia and Acute Pain Management Peninsula Health Melbourne Vic. Australia
| | - L. Waugh
- Department of Surgery Peninsula Health Melbourne Vic. Australia
| | - L. Parsons
- Department of Surgery Peninsula Health Melbourne Vic. Australia
| | - M. Lynch
- Rosebud Hospital, Peninsula Health Rosebud Vic. Australia
| | - L.‐A. Stokan
- Rosebud Hospital, Peninsula Health Rosebud Vic. Australia
| | - R. Borland
- School of Psychological Sciences University of Melbourne Vic. Australia
- Cancer Council of Victoria Melbourne Australia
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11
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Perioperative and Long-Term Smoking Behaviors in Cosmetic Surgery Patients. Plast Reconstr Surg 2017; 140:503-509. [DOI: 10.1097/prs.0000000000003604] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Webb A, Wilson AC. The addition of tick-boxes related to tobacco cessation improves smoking-related documentation in the anaesthesia chart. Anaesth Intensive Care 2017; 45:52-57. [PMID: 28072935 DOI: 10.1177/0310057x1704500108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Australian and New Zealand College of Anaesthetists (ANZCA) 'Guidelines on Smoking as Related to the Perioperative Period (PS12)' recommends that anaesthetists should always ask about smoking, advise quitting and refer patients to their general practitioner (GP) or a telephone quit-line for quit support. In this study we evaluated the effect of adding tick-boxes for 'quit advice given' and 'referral to GP/Quitline' to anaesthesia charts of elective surgical patients to assess whether this intervention changed documentation of compliance with the ANZCA guideline. The anaesthesia charts of all smokers were reviewed for evidence of asking, advising and referring, over two three-month periods (n=999) separated by the intervention of placing a sticker to modify the preoperative charts of all elective patients which added tick-box prompts of advice and referral. No educational campaigns occurred to encourage tick-box use. No changes were made to non-elective charts. Evidence of advice to quit was 1.8% prior to, rising to 18.7% after, the intervention (P <0.001), while evidence of referral rose from 0.9% to 5.8%. There was negligible change in non-elective patients, who did not receive the intervention. The addition of tick-boxes improved the documentation of smoking cessation support, but as documented rates of quit support remained relatively low even after the intervention, tick-boxes alone cannot be relied upon to improve alignment of care with the ANZCA guidelines.
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Affiliation(s)
- A Webb
- Department of Anaesthesia and Pain Management, Peninsula Health, Frankston Hospital, Melbourne, Victoria
| | - A C Wilson
- Anaesthesia HMO, Department of Anaesthesia and Pain Management, Peninsula Health, Frankston Hospital, Melbourne, Victoria
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13
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Bunbury KM, Castanelli DJ. A survey of educator needs to support the implementation of the intrinsic ANZCA Roles in Practice. Anaesth Intensive Care 2015; 43:771-8. [PMID: 26603803 DOI: 10.1177/0310057x1504300616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The 'Roles in Practice' framework was introduced into the revised ANZCA curriculum in 2013. We conducted an online survey of Supervisors of Training in Australia and New Zealand to assess understanding of this framework, and teaching and perceived value of the non-scholar intrinsic roles within the framework. One hundred and forty-three survey responses were received (response rate 60.8%). The majority of respondents (52.1%) reported only a fair understanding of the framework. Formal teaching of all the roles was consistently reported as infrequent, with most teaching occurring through the informal curriculum. The Communicator, Collaborator and Professional Roles were rated as better taught and more important to teach than the roles of Health Advocate and Manager. The Communicator Role was perceived as being the role for which the development of resources would be most valuable. Respondents overwhelmingly nominated small group teaching as the preferred medium for resource development of all intrinsic roles. Our survey indicates that there is a need to increase both the understanding of the Roles in Practice framework and the teaching resources available in the ANZCA Supervisor of Training community.
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Affiliation(s)
- K M Bunbury
- Department of Anaesthesia and Perioperative Medicine, The Alfred Hospital, Melbourne, Victoria
| | - D J Castanelli
- Department of Anaesthesia and Perioperative Medicine, Monash Medical Centre and Monash University, Clayton, Victoria
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14
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Song F, Brown TJ, Blyth A, Maskrey V, McNamara I, Donell S. Identifying and recruiting smokers for preoperative smoking cessation--a systematic review of methods reported in published studies. Syst Rev 2015; 4:157. [PMID: 26560883 PMCID: PMC4642619 DOI: 10.1186/s13643-015-0152-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 10/29/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Smoking cessation before surgery reduces postoperative complications, and the benefit is positively associated with the duration of being abstinent before a surgical procedure. A key issue in providing preoperative smoking cessation support is to identify people who smoke as early as possible before elective surgery. This review aims to summarise methods used to identify and recruit smokers awaiting elective surgery. METHODS We searched MEDLINE, EMBASE, CINAHL, and PsycINFO, and references of relevant reviews (up to May 2014) to identify prospective studies that evaluated preoperative smoking cessation programmes. One reviewer extracted and a second reviewer checked data from the included studies. Data extracted from included studies were presented in tables and narratively described. RESULTS We included 32 relevant studies, including 18 randomised controlled trials (RCTs) and 14 non-randomised studies (NRS). Smokers were recruited at preoperative clinics (n = 18), from surgery waiting lists (n = 6), or by general practitioners (n = 1), and the recruitment methods were not explicitly described in seven studies. Time points of preoperative recruitment of smokers was unclear in four studies, less than 4 weeks before surgery in 17 studies, and at least 4 weeks before surgery in only 11 studies. The recruitment rate tended to be lower in RCTs (median 58.2 %, range 9.1 to 90.9 %) than that in NRS (median 99.1 %, range 12.3 to 100 %) and lower in preoperative clinic-based RCTs (median 54.4 %, range 9.1 to 82.4 %) than that in waiting list-based RCTs (median 70.1 %, range 36.8 to 85.0 %). Smokers were recruited at least 4 weeks before surgery in four of the six waiting list-based studies and in only three of the 18 preoperative clinic-based studies. CONCLUSIONS Published studies often inadequately described the methods for recruiting smokers into preoperative smoking cessation programmes. Although smoking cessation at any time is beneficial, many programmes recruited smokers at times very close to scheduled surgery so that the benefit of preoperative smoking cessation may have not been fully effected. Optimal delivery of preoperative smoking cessation remains challenging, and further research is required to develop effective preoperative cessation programmes for smokers awaiting elective operations.
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Affiliation(s)
- Fujian Song
- Norwich Medical School, Faculty of Medicine and Health Science, University of East Anglia, Norwich, Norfolk, UK.
| | - Tracey J Brown
- Norwich Medical School, Faculty of Medicine and Health Science, University of East Anglia, Norwich, Norfolk, UK.
| | - Annie Blyth
- Norwich Medical School, Faculty of Medicine and Health Science, University of East Anglia, Norwich, Norfolk, UK.
| | - Vivienne Maskrey
- Norwich Medical School, Faculty of Medicine and Health Science, University of East Anglia, Norwich, Norfolk, UK.
| | - Iain McNamara
- Norwich Medical School, Faculty of Medicine and Health Science, University of East Anglia, Norwich, Norfolk, UK. .,Orthopaedic Department, Norfolk and Norwich University Hospital, Norwich, Norfolk, UK.
| | - Simon Donell
- Norwich Medical School, Faculty of Medicine and Health Science, University of East Anglia, Norwich, Norfolk, UK. .,Orthopaedic Department, Norfolk and Norwich University Hospital, Norwich, Norfolk, UK.
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15
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Bottorff JL, Seaton CL, Viney N, Stolp S, Krueckl S, Holm N. The Stop Smoking Before Surgery Program: Impact on Awareness of Smoking-Related Perioperative Complications and Smoking Behavior in Northern Canadian Communities. J Prim Care Community Health 2015; 7:16-23. [PMID: 26385995 PMCID: PMC4672601 DOI: 10.1177/2150131915604827] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: This study aimed to examine the impact of a Stop Smoking Before Surgery (SSBS) program in a health authority where responsibility for surgical services is shared by health professionals in regional centers and outlying communities. Methods: A between-subjects, pre-post mixed method program evaluation was conducted. Elective surgery patients at 2 Northern Canadian hospitals were recruited and surveyed at 2 time points: pre-SSBS implementation (n = 150) and 1 year post-SSBS implementation (n = 90). In addition, semistructured interviews were conducted with a purposeful sample of participants (n = 18). Results: Participants who received information about stopping smoking before surgery post-SSBS implementation were more likely than expected to have reduced their smoking, χ2(1, 89) = 10.62, P = .001, and had a significantly higher Awareness of Smoking-Related Perioperative Complications score than those that were advised to quit smoking prior to SSBS implementation (U = 1288.0, P < .001). Being advised by a health care professional was the second strongest predictor of whether or not participants reduced their smoking before surgery post-SSBS implementation. However, there was no significant change in the number of participants who reported being advised to quit smoking before surgery between groups. Conclusion: Providing surgery-specific resources to increase awareness of and support for surgery-specific smoking cessation had limited success in this rural context. Additional strategies are needed to ensure that every surgical patient who smokes receives information about the benefits of quitting for surgery and is aware of available cessation resources.
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Affiliation(s)
- Joan L Bottorff
- Institute for Healthy Living and Chronic Disease Prevention, University of British Columbia, Kelowna, British Columbia, Canada Australian Catholic University, Melbourne, Victoria, Australia
| | - Cherisse L Seaton
- Institute for Healthy Living and Chronic Disease Prevention, University of British Columbia, Kelowna, British Columbia, Canada
| | - Nancy Viney
- Northern Health Authority, Prince George, British Columbia, Canada
| | - Sean Stolp
- Institute for Healthy Living and Chronic Disease Prevention, University of British Columbia, Kelowna, British Columbia, Canada
| | - Sandra Krueckl
- Canadian Cancer Society, BC and Yukon Division, Vancouver, British Columbia, Canada
| | - Nikolai Holm
- Institute for Healthy Living and Chronic Disease Prevention, University of British Columbia, Kelowna, British Columbia, Canada
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