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Ofori S, Rayner D, Mikhail D, Borges FK, Marcucci MM, Conen D, Mbuagbaw L, Devereaux PJ. Barriers and facilitators to perioperative smoking cessation: A scoping review. PLoS One 2024; 19:e0298233. [PMID: 38861527 PMCID: PMC11166293 DOI: 10.1371/journal.pone.0298233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 01/19/2024] [Indexed: 06/13/2024] Open
Abstract
OBJECTIVE Smoking cessation interventions are underutilized in the surgical setting. We aimed to systematically identify the barriers and facilitators to smoking cessation in the surgical setting. METHODS Following the Joanna Briggs Institute (JBI) framework for scoping reviews, we searched 5 databases (MEDLINE, Embase, Cochrane CENTRAL, CINAHL, and PsycINFO) for quantitative or qualitative studies published in English (since 2000) evaluating barriers and facilitators to perioperative smoking cessation interventions. Data were analyzed using thematic analysis and mapped to the theoretical domains framework (TDF). RESULTS From 31 studies, we identified 23 unique barriers and 13 facilitators mapped to 11 of the 14 TDF domains. The barriers were within the domains of knowledge (e.g., inadequate knowledge of smoking cessation interventions) in 23 (74.2%) studies; environmental context and resources (e.g., lack of time to deliver smoking cessation interventions) in 19 (61.3%) studies; beliefs about capabilities (e.g., belief that patients are nervous about surgery/diagnosis) in 14 (45.2%) studies; and social/professional role and identity (e.g., surgeons do not believe it is their role to provide smoking cessation interventions) in 8 (25.8%) studies. Facilitators were mainly within the domains of environmental context and resources (e.g., provision of quit smoking advice as routine surgical care) in 15 (48.4%) studies, reinforcement (e.g., surgery itself as a motivator to kickstart quit attempts) in 8 (25.8%) studies, and skills (e.g., smoking cessation training and awareness of guidelines) in 5 (16.2%) studies. CONCLUSION The identified barriers and facilitators are actionable targets for future studies aimed at translating evidence informed smoking cessation interventions into practice in perioperative settings. More research is needed to evaluate how targeting these barriers and facilitators will impact smoking outcomes.
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Affiliation(s)
- Sandra Ofori
- Department of Medicine, McMaster University Canada, Hamilton, Canada
| | - Daniel Rayner
- Department of Health Research Methods, Evidence and Impact, McMaster University Canada, Hamilton, Canada
| | - David Mikhail
- Department of Health Sciences, McMaster University Canada, Hamilton, Canada
| | - Flavia K. Borges
- Department of Medicine, McMaster University Canada, Hamilton, Canada
| | - Maura M. Marcucci
- Department of Medicine, McMaster University Canada, Hamilton, Canada
| | - David Conen
- Department of Medicine, McMaster University Canada, Hamilton, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - P. J. Devereaux
- Department of Medicine, McMaster University Canada, Hamilton, Canada
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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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Tan M, He Y, Shi M, Lee KCH, Abdullah HR. Systematic review and meta-analysis of short-term and long-term smoking abstinence rates of intensive perioperative smoking cessation programs vs brief interventions for smoking cessation. Addict Behav 2024; 148:107832. [PMID: 37660498 DOI: 10.1016/j.addbeh.2023.107832] [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: 01/26/2023] [Revised: 07/09/2023] [Accepted: 08/08/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND The perioperative period is an important "teachable moment" where smoking interventions may be particularly effective. We aim to explore the effectiveness of intensive perioperative smoking cessation programs not just on short term, but long term smoking abstinence as well. METHODS This is a systematic review and meta-analysis of randomized controlled trials published between 1 Jan 2007 and 15 May 2022. The studies include perioperative smoking cessation programs that were conducted either in the preoperative surgical clinic or anaesthesia clinic settings. Some programs included follow-up sessions in the postoperative phase. The primary outcomes were short-term and long-term smoking abstinence rates for patients who participated in intensive perioperative smoking cessation programs. Subgroup analyses were also conducted to compare the effects between patients undergoing surgery for smoking-induced and non-smoking induced illnesses. RESULTS In total, thirteen trials with a total of 2597 smokers undergoing elective surgery were included in the analysis. The pooled results show that patients who participated in intensive perioperative smoking cessation programs had a higher chance of abstinence in both short term (OR: 2.41, 95% CI [1.95 to 2.98], p < 0.001) and long term (OR: 1.64, CI [1.23 to 2.2], p < 0.001) periods postoperatively. This effect was seen regardless of whether patients underwent surgery for smoking-induced or non-smoking induced illnesses. CONCLUSIONS Intensive peri-operative smoking interventions are more effective than brief interventions in achieving both short and long term abstinence. Hospitals should consider integrating structured intensive smoking interventions into perioperative care. Further studies examining the optimal timing and duration of such programs will be useful.
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Affiliation(s)
- Monica Tan
- Department of Anesthesiology and Peri-operative Medicine, Singapore General Hospital, Singapore
| | - Yingke He
- Department of Anesthesiology and Peri-operative Medicine, Singapore General Hospital, Singapore
| | - Michelle Shi
- Department of Psychology, Singapore General Hospital, Singapore
| | - Ken Cheah Hooi Lee
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - Hairil Rizal Abdullah
- Department of Anesthesiology and Peri-operative Medicine, Singapore General Hospital, Singapore.
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4
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Alsubaiei ME, Althukair W, Almutairi H. Functional capacity in smoking patients after coronary artery bypass grafting surgery: a quasi-experimental study. J Med Life 2023; 16:1760-1768. [PMID: 38585530 PMCID: PMC10994605 DOI: 10.25122/jml-2023-0282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/20/2023] [Indexed: 04/09/2024] Open
Abstract
Coronary artery bypass grafting surgery (CABG) is an important approach to treating coronary heart disease. However, patients undergoing open heart surgery are at risk of postoperative complications. Cigarette smoking is one of the preoperative risk factors that may increase postoperative complications. Studies show that early mobilization intervention may reduce these complications and improve functional capacity, but the impact of smoking on early outcomes after CABG has been controversial for the past two decades. This quasi-experimental study explored the effects of early mobilization on functional capacity among patients with different smoking histories undergoing CABG. The study involved 51 participants who underwent CABG surgery, divided into three groups: current smokers, former smokers, and non-smokers (n=17 each). A day before surgery, all groups underwent a six-minute walking test (6MWT). Every participant received the same intervention after surgery, including deep breathing exercises, an upper limb range of motion assessment, an incentive spirometer, and walking with and without assistance. Five days postoperatively, all outcomes - including the 6MWT, length of stay (LOS) in the ICU, and postoperative pulmonary complications - were assessed, and the 6MWT was repeated. There was a reduced functional capacity after CABG in ex-smokers (215.8±102 m) and current smokers (272.7±97m) compared to non-smokers (298.5±97.1m) in terms of 6MWT (p<0.05). Current smokers were more likely to have atelectasis after CABG than ex-smokers (76.5% vs. 52.9%), with non-smokers being the least likely to have atelectasis among the three groups (29.4%, p<0.05). Additionally, current smokers required longer ventilator support post-CABG (11.9±7.3 hours) compared to ex-smokers (8.3±4.3 hours) and non-smokers (7±2.5 hours, p<0.01). Smoking status significantly impacts functional capacity reduction after CABG, with current smokers being more susceptible to prolonged ventilator use and atelectasis.
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Affiliation(s)
- Mohammed Essa Alsubaiei
- Department of Physical Therapy, Faculty of Applied Medical Sciences, Imam Abdulrahman bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Wadha Althukair
- Department of Physical Therapy, Saud Al-Babtain Cardiac Center, Dammam, Kingdom of Saudi Arabia
| | - Hind Almutairi
- Department of Quality Improvement and Patient Safety, Dhahran General Hospital for Long Term Care, Dhahran, Kingdom of Saudi Arabia
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Coffman CR, Leng JC, Ye Y, Hunter OO, Walters TL, Wang R, Wong JK, Mudumbai SC, Mariano ER. More Than a Perioperative Surgical Home: An Opportunity for Anesthesiologists to Advance Public Health. Semin Cardiothorac Vasc Anesth 2023; 27:273-282. [PMID: 37679298 DOI: 10.1177/10892532231200620] [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] [Indexed: 09/09/2023]
Abstract
Public health and the medical specialty of anesthesiology have been closely intertwined throughout history, dating back to the 1800s when Dr. John Snow used contact tracing methods to identify the Broad Street Pump as the source of a cholera outbreak in London. During the COVID-19 pandemic, leaders in anesthesiology and anesthesia patient safety came forward to develop swift recommendations in the face of rapidly changing evidence to help protect patients and healthcare workers. While these high-profile examples may seem like uncommon events, there are many common modern-day public health issues that regularly intersect with anesthesiology and surgery. These include, but are not limited to, smoking; chronic opioid use and opioid use disorder; and obstructive sleep apnea. As an evolving medical specialty that encompasses pre- and postoperative care and acute and chronic pain management, anesthesiologists are uniquely positioned to improve patient care and outcomes and promote long-lasting behavioral changes to improve overall health. In this article, we make the case for advancing the role of the anesthesiologist beyond the original perioperative surgical home model into promoting public health initiatives within the perioperative period.
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Affiliation(s)
- Clarity R Coffman
- Anesthesiology, Perioperative and Pain Medicine Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Jody C Leng
- Anesthesiology, Perioperative and Pain Medicine Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Ying Ye
- Anesthesiology, Perioperative and Pain Medicine Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Oluwatobi O Hunter
- Anesthesiology, Perioperative and Pain Medicine Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Tessa L Walters
- Anesthesiology, Perioperative and Pain Medicine Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Rachel Wang
- Anesthesiology, Perioperative and Pain Medicine Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Jimmy K Wong
- Anesthesiology, Perioperative and Pain Medicine Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Seshadri C Mudumbai
- Anesthesiology, Perioperative and Pain Medicine Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Edward R Mariano
- Anesthesiology, Perioperative and Pain Medicine Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Barat E, Vanbergue B, Leguillon R, Chenailler C, Arrii M, Curado J, Varin R, Soubieux A. [Tobacco and surgery: A survey of health professionals' practices and knowledge. A role for the community pharmacist]. ANNALES PHARMACEUTIQUES FRANÇAISES 2023; 81:1082-1089. [PMID: 37481067 DOI: 10.1016/j.pharma.2023.07.005] [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: 03/11/2023] [Revised: 07/09/2023] [Accepted: 07/17/2023] [Indexed: 07/24/2023]
Abstract
OBJECTIVE To evaluate the knowledge and management of preoperative smoking patients by different health professionals. METHOD We conducted a survey among surgeons, anesthesiologists, and pharmacists using questionnaires. The study included 115 pharmacists and 7 physicians. RESULTS Only 28% of pharmacists felt they had the necessary knowledge about smoking cessation before surgery and its consequences. Moreover, pharmacists were informed of the surgery less than one month before in 61% of cases, whereas physicians claimed to inform patients at least 3 months before in 57% of cases. The main reasons mentioned by the pharmacist for not informing the patient about presurgical smoking cessation were a lack of knowledge of the information to be relayed and a late knowledge of the scheduling of a surgery. Additionally, 57% of physicians stated that they never prescribed nicotine replacement products, while 42% of pharmacists felt that they never dispensed them. CONCLUSION The study provides a clear picture of the smoking pathway before surgery and highlights areas for improvement in the management of preoperative smoking patients by different health professionals.
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Affiliation(s)
- Eric Barat
- Department of Pharmacy, CHU de Rouen, 76031 Rouen cedex, France; Normandie University, UNICAEN, Inserm U1086, 14000 Caen, France.
| | | | | | | | - Marianne Arrii
- Department of Pharmacy, CHU de Rouen, 76031 Rouen cedex, France
| | - Jonathan Curado
- Department of Orthopedic, CHU de Rouen, 76031 Rouen cedex, France
| | - Rémi Varin
- Department of Pharmacy, UNIROUEN, Inserm U1234, CHU de Rouen, Normandie University, 76031 Rouen cedex, France
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7
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Patel S, Fantauzzi AJ, Patel R, Buscemi J, Lee HH. Childhood caries and dental surgery under general anesthesia: an overview of a global disease and its impact on anesthesiology. Int Anesthesiol Clin 2023; 61:21-25. [PMID: 36480646 PMCID: PMC9752176 DOI: 10.1097/aia.0000000000000385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Children’s oral health is influenced, negatively and positively, but modifiable social determinants. For high-risk populations, severe disease burden leads to dental treatment under general anesthesia (DGA), which represents a costly and futile use of scarce resources. These clinical events, at the intersection of medicine and dentistry, often involve anesthesiologists to facilitate care. However, clinical interventions do not address the etiology of disease, which are largely rooted in health behaviors. In this review, we will summarize the scope of severe disease on a global scale and its impact on individual and population health and health systems. We will also provide insight into factors that influence DGA utilization from perspectives of families, providers, health systems, policy, and community-level environment. A child’s need for DGA may represent missed prevention opportunities at several levels. However, the surgical period may serve as a prime window to change a family’s oral health behaviors and reduce chance of recurrent disease amongst the highest risk families.
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Affiliation(s)
- Shiragi Patel
- Department of Anesthesiology, Ann & Robert H. Lurie Children's Hospital, McGaw Medical Center of Northwestern University, Chicago, Illinois
| | - Andrés J Fantauzzi
- Department of Anesthesiology, University of Illinois at Chicago, Chicago, Illinois
| | - Raj Patel
- College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Joanna Buscemi
- Department of Psychology, DePaul University, Chicago, Illinois
| | - Helen H Lee
- Department of Anesthesiology, Institute for Health Policy and Research, University of Illinois at Chicago, Chicago, Illinois
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8
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Gavilan E, Fernández E, Minguell J, Trilla E, Zuriguel-Pérez E, Martínez C. Efficacy of Presurgical Interventions to Promote Smoking Cessation: A Systematic Review. Anesth Analg 2023; 136:43-50. [PMID: 36534716 DOI: 10.1213/ane.0000000000006240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The aim of this study was to evaluate the efficacy of presurgical interventions for promoting smoking cessation in terms of achieving smoking abstinence and reducing surgical complication rates. A systematic review of randomized clinical trials (RCTs) published from March 2009 to April 2021 was performed following the PRISMA guidelines. References were found in MEDLINE (via PubMed), Web of Science (WOS), and Cumulative Index to Nursing and Allied Health Literature (CINAHL). RCTs comparing the efficacy of a smoking cessation program directed at an intervention group (IG) versus the usual intervention or another directed at a control group (CG) were included. No language restrictions were applied in the search. All approaches to smoking cessation were admitted (face-to-face, telephone, group, individual, multicomponent, etc.), as were all methods for assessing abstinence, follow-up times, surgical specialties, definitions of smokers, and all types of surgical complications. Four hundred forty-four references were pulled out, and 79 duplicates were discarded. We excluded 346 records that were after application of the inclusion/exclusion criteria. In addition to the remaining 19 articles, 1 article obtained from citation searches was also assessed. We finally included 11 original articles in this systematic review, corresponding to 9 studies, because 2 of the RCTs had 2 different articles referring to different aspects of the same study. The results showed long-term postoperative (6 to 12 months) abstinence rates between 25.0% and 36.4% in RCTs with intensive multicomponent interventions, versus rates about 13.0% in brief interventions. Two multicomponent interventions obtained significant improvements regarding the reduction of short-term postoperative surgical complications. In conclusion, presurgical multicomponent smoking cessation interventions are more effective than brief interventions in terms of achieving abstinence and reducing surgical complications. The follow-up time and the intensity of the interventions were predictors of dropout.
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Affiliation(s)
- Eva Gavilan
- From the Surgical Area, Vall d´Hebron University Hospital, Barcelona, Spain.,International University of Catalonia, Barcelona, Spain.,Multidisciplinary Nursing Research Group, Vall d´Hebron Research Institute, Barcelona, Spain
| | - Esteve Fernández
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain.,Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge, l'Hospitalet de Llobregat, Barcelona, Spain.,School of Medicine and Health Science, Bellvitge Campus, University of Barcelona, l'Hospitalet de Llobregat, Barcelona, Spain.,CIBER in Respiratory Diseases, Madrid, Spain
| | - Joan Minguell
- Orthopedic Surgery and Traumatology Department, Vall d´Hebron University Hospital, Barcelona, Spain.,School of Medicine and Health Science, Vall d´Hebron Campus, Autonomous University of Barcelona, Barcelona, Spain.,Reconstructive Surgery of the Locomotor System, Vall d´Hebron Research Institute, Barcelona, Spain
| | - Enrique Trilla
- School of Medicine and Health Science, Vall d´Hebron Campus, Autonomous University of Barcelona, Barcelona, Spain.,Urology Department, Vall d´Hebron University Hospital, Barcelona, Spain.,CIBBIM-Nanomedicine, Kidney Phisiopathology Research Group, Vall d´Hebron Research Institute, Barcelona, Spain
| | - Esperanza Zuriguel-Pérez
- Multidisciplinary Nursing Research Group, Vall d´Hebron Research Institute, Barcelona, Spain.,Management of Knowledge and Evaluation, Vall d´Hebron University Hospital, Barcelona, Spain
| | - Cristina Martínez
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain.,Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge, l'Hospitalet de Llobregat, Barcelona, Spain.,School of Medicine and Health Science, Bellvitge Campus, University of Barcelona, l'Hospitalet de Llobregat, Barcelona, Spain.,Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California
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9
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Subramanian H, Knight J, Sultan I, Kaczorowski DJ, Subramaniam K. Pre-Habilitation of Cardiac Surgical Patients, Part 2: Frailty, Malnutrition, Respiratory disease, Alcohol/Smoking cessation and Depression. Semin Cardiothorac Vasc Anesth 2022; 26:295-303. [PMID: 36189933 DOI: 10.1177/10892532221130922] [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] [Indexed: 11/16/2022]
Abstract
The concept of "pre-habilitation" comprises screening for and identification of pre-existing disorders followed by medical optimization. This is performed for many types of surgeries, but may have profound impacts on outcomes, particularly in cardiac surgery given the multiple comorbidities typically carried by these patients. Components of pre-habilitation include direct medical intervention by preoperative specialists as well as significant care coordination and shared decision-making. In this second part of a two-part review, the authors describe existing evidence to support the optimization of various preoperative problems and present a few institutional protocols utilized at out center for cardiac presurgical care. This second installment will focus on alcohol and smoking cessation and the management of frailty, malnutrition, respiratory disease, and depression.
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Affiliation(s)
- Harikesh Subramanian
- Department of Anesthesiology and Perioperative Medicine, 6595University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Joshua Knight
- Department of Anesthesiology and Perioperative Medicine, 6595University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ibrahim Sultan
- Department of Cardiothoracic Surgery, 481457University of Pittsburgh Medical center, Pittsburgh, PA, USA
| | - David J Kaczorowski
- Department of Cardiothoracic Surgery, 481457University of Pittsburgh Medical center, Pittsburgh, PA, USA
| | - Kathirvel Subramaniam
- Department of Anesthesiology and Perioperative Medicine, 6595University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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10
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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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11
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Kahwash BM, Gregory KL, Sharp LK, Nyenhuis SM. Results From a National Survey of Asthma Provider Beliefs and Practices Regarding Exercise and Asthma: A Work Group Report of the AAAAI Committee on Sports, Exercise, and Fitness. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1778-1783. [PMID: 35606306 DOI: 10.1016/j.jaip.2022.04.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND National Heart, Lung, and Blood Institute guidelines recommend regular physical activity (PA) for patients with asthma. Health care provider (HCP) counseling represents an effective approach to optimizing patient PA. However, current exercise rates among asthma patients are suboptimal, which suggests that counseling may be improved. OBJECTIVE To understand PA counseling behaviors among HCPs who manage asthma. METHODS A voluntary 36-item survey assessing self-reported awareness of PA recommendations and current clinical practices was sent to 979 randomly selected HCP members of the American Academy of Allergy, Asthma & Immunology (AAAAI). RESULTS The overall response rate was 9.3% (91 of 979). Respondents were physicians (100%) and allergists/immunologists (96%) who reported an average of 18.1 ± 12.3 years in independent practice. Over half (58%) reported personally engaging in 150 min/wk or more of moderate to strenuous PA. Eighty percent of participants were unaware of specific PA guidelines for patients with asthma, yet 66% acknowledged evidence for improved asthma outcomes with moderate exercise. A large majority of respondents believed that patients with asthma (97%) and severe asthma (84%) should pursue exercise. Whereas 90% of respondents support incorporating exercise counseling into asthma care, only 69% regularly counsel asthma patients about PA. Barriers cited included limited time, lack of knowledge regarding how and where to refer patients for exercise, and other medical priorities. Potential facilitators of PA included increasing practitioner education and patient-directed posters in waiting areas. CONCLUSIONS Health care providers recognized PA as an important component of asthma care but were often unaware of specific guidelines. Promoting PA counseling may require using a time-efficient approach to implement counseling at each asthma patient encounter.
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Affiliation(s)
- Basil M Kahwash
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn.
| | - Karen L Gregory
- Oklahoma Allergy and Asthma Clinic, Oklahoma City, Okla; School of Nursing and Health Studies, Georgetown University, Washington, DC
| | - Lisa K Sharp
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois at Chicago, Chicago, Ill
| | - Sharmilee M Nyenhuis
- Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, Ill
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12
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Barrett S, Begg S, O'Halloran P, Rodda K, Barrett G, Kingsley M. “Exercise Is My Medicine”: A Qualitative Study Exploring the Experiences of Non-admitted Patients Receiving Physical Activity Promotion From Hospital Surgeons. Front Public Health 2022; 10:915496. [PMID: 35719636 PMCID: PMC9204139 DOI: 10.3389/fpubh.2022.915496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 05/12/2022] [Indexed: 11/22/2022] Open
Abstract
Background Hospital clinicians are increasingly encouraged to use outpatient consultations as an avenue to deliver opportunistic health promotion. There is a dearth of evidence regarding the acceptance of health promotion initiatives from hospital patients themselves. Methods We explored the experiences of non-admitted patients who, during a routine consultation with a hospital surgeon received a recommendation to increase physical activity (PA) and a recommendation to engage in a PA telephone coaching program. Twenty-two semi-structured interviews were conducted with individuals who had received the recommendation and proceeded to enroll in a telephone coaching intervention to identify factors that influenced behavior change. Data were analyzed thematically. Results Participants' age ranged between 42 and 66 years, with the average age being 54 years. Of the participants, 15 (68%) were women and 7 (32%) were men. Three major themes were identified: (1) the hospital visit represented an opportunity for behavior change that is not to be missed; (2) surgeons were influential in promoting PA change contemplation; and (3) patients welcomed a communication style that promoted autonomy. Conclusions Almost all patients considered receiving the recommendation to engage with the telephone coaching as acceptable and helpful toward PA change. Although working in time-restricted consultations, surgeons delivered the recommendation in a patient-centered, autonomy-supportive way, which influenced behavior change. Hospitals should explore avenues to integrate health promotion into routine care, confident of the acceptability and appropriateness of health promotion practice to hospital patients.
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Affiliation(s)
- Stephen Barrett
- Health Promotion Department, Bendigo Health Care Group, Bendigo, VIC, Australia
- La Trobe Rural Health School, La Trobe University, Bendigo, VIC, Australia
| | - Stephen Begg
- Violet Vines Marshman Centre for Rural Health Research, La Trobe Rural Health School, La Trobe University, Bendigo, VIC, Australia
| | - Paul O'Halloran
- Centre for Sport and Social Impact, La Trobe University, Melbourne, VIC, Australia
| | - Kane Rodda
- Outpatient Rehabilitation Services, Bendigo Health Care Group, Bendigo, VIC, Australia
| | - Gabrielle Barrett
- Health Promotion Department, Bendigo Health Care Group, Bendigo, VIC, Australia
| | - Michael Kingsley
- Holsworth Research Initiative, La Trobe Rural Health School, La Trobe University, Bendigo, VIC, Australia
- Department of Exercise Sciences, University of Auckland, Auckland, New Zealand
- *Correspondence: Michael Kingsley
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Schaaf D. Smoking Cessation Counseling in the PreAnesthesia Testing Clinic: A Quality Improvement Initiative. J Perianesth Nurs 2022; 37:607-612. [DOI: 10.1016/j.jopan.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 11/02/2021] [Accepted: 11/07/2021] [Indexed: 10/18/2022]
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14
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Stahl DL, Matthews LJ. Caring for Parturients with Substance Use Disorders. Anesthesiol Clin 2021; 39:761-777. [PMID: 34776108 DOI: 10.1016/j.anclin.2021.08.006] [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: 10/19/2022]
Abstract
Parturients with substance use disorder require expertise to manage the complexity of intoxication, withdrawal, and chronic use as well as ensure adequate analgesia throughout labor. Opioid use disorder in pregnancy has increased more than 4-fold in the past decade, with a 50-fold geographic variability that now dwarfs other substance use in this population. Understanding not only the medical but also the public health and criminal justice implications of substance use disorder is essential to providing optimal care to this at-risk population.
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Affiliation(s)
- David L Stahl
- Department of Anesthesiology, The Ohio State University, 410 West 10th Avenue, Columbus, OH 43210, USA.
| | - Leslie J Matthews
- Department of Anesthesiology, The Ohio State University, 410 West 10th Avenue, Columbus, OH 43210, USA; Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
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15
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He Y, Tan M, Shi M, Sim XLJ, Lum E, Yoon S, Abdullah HR. Smoking Characteristics and Readiness-to-Quit Status Among Smokers Attending Preoperative Assessment Clinic - A Prospective Cohort Study. Risk Manag Healthc Policy 2021; 14:2483-2490. [PMID: 34163267 PMCID: PMC8214206 DOI: 10.2147/rmhp.s312950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/23/2021] [Indexed: 11/23/2022] Open
Abstract
Background Perioperative smoking is associated with an increased incidence of general postoperative morbidity and mortality. The perioperative period is recognized as an important “teachable moment” that can motivate patients to adopt health changing behaviors. Objective In this study, we aimed to determine the prevalence of smokers among elective surgical patients in an Asian tertiary hospital. We also investigated their smoking characteristics, previous quitting attempts, readiness-to-quit status as well as knowledge of smoking-related postoperative complications. Methods We conducted a single-center prospective cohort study among all patients who attended a preoperative assessment clinic within a 2-month period (August to September 2020) using a preoperative smoking questionnaire. Results A total of 3362 patients participated in the study, of which 348 (10.4%) were current smokers. More than half (65.6%) of the smokers had previously attempted to quit smoking, with most (78%) having made more than one attempt. Forty-nine percent of current smokers were in the pre-contemplation stage of quitting and thirty-one percent were in the contemplation stage. Only twenty-one percent were in the preparation stage of quitting. Thirty-eight percent of patients recognized the importance of smoking cessation perioperatively but only twenty-eight percent were confident of quitting perioperatively. Less than sixty percent of smokers were aware of at least one type of smoking-related postoperative complication. Less than half of the patients (45%) had ever received advice on perioperative smoking cessation from the surgeons. Conclusion A thorough understanding of smokers’ smoking characteristics, barriers to quit and readiness-to-quit status are crucial to establishing a successful multidisciplinary perioperative smoking cessation program. Counselling should address knowledge deficits and be tailored to a patient’s stage-of-change in order to seize this precious perioperative “teachable moment”.
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Affiliation(s)
- Yingke He
- Department of Anaesthesiology, Singapore General Hospital, 169608, Singapore
| | - Monica Tan
- Department of Anaesthesiology, Singapore General Hospital, 169608, Singapore
| | - Michelle Shi
- Department of Psychology, Singapore General Hospital, 169608, Singapore
| | | | - Elaine Lum
- Health Services and Systems Research, Duke-NUS Graduate Medical School, 169857, Singapore
| | - Sungwon Yoon
- Health Services and Systems Research, Duke-NUS Graduate Medical School, 169857, Singapore
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16
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Keyworth C, Epton T, Goldthorpe J, Calam R, Armitage CJ. Delivering Opportunistic Behavior Change Interventions: a Systematic Review of Systematic Reviews. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 21:319-331. [PMID: 32067156 PMCID: PMC7056685 DOI: 10.1007/s11121-020-01087-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Opportunities for healthcare professionals to deliver health behavior change interventions are often missed, but understanding the barriers and enablers to this activity is limited by a focus on defined specialisms/health conditions. This systematic review of systematic reviews collates all the evidence across professional groups to provide guidance to policy makers for implementing healthcare professional delivery of behavior change interventions. Eight electronic databases were searched for systematic reviews reporting patient-facing healthcare professionals’ (e.g., general practitioners, nurses) barriers and enablers to delivering behavior change interventions (diet, physical activity, alcohol reduction, smoking cessation, and weight management). A narrative synthesis was conducted. Thirty-six systematic reviews were included. Four themes emerged as both barriers and enablers: (1) perceptions of the knowledge or skills needed to support behavior change with patients, (2) perceptions of the healthcare professional role, (3) beliefs about resources and support needed, and (4) healthcare professionals’ own health behavior. There were four cross-disciplinary barriers: (1) perceived lack of time, (2) perceived lack of prioritization of health behavior change, (3) negative attitudes towards patients and perceptions of patient risk, and (4) perceptions of patient motivation. The three enablers were as follows: (1) training, (2) context, and (3) attitudes towards delivering interventions. To enhance healthcare professionals’ delivery of behavior change interventions, policy makers should (a) address perceptions about patient need for interventions, (b) support diverse professional groups to identify opportunities to deliver interventions, and (c) encourage professionals to focus on prevention and management of health conditions.
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Affiliation(s)
- Chris Keyworth
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Coupland 1 Building-Room G3, Oxford Road, Manchester, M13 9PL, UK.
| | - Tracy Epton
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Coupland 1 Building-Room G3, Oxford Road, Manchester, M13 9PL, UK
| | - Joanna Goldthorpe
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Coupland 1 Building-Room G3, Oxford Road, Manchester, M13 9PL, UK
| | - Rachel Calam
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Coupland 1 Building-Room G3, Oxford Road, Manchester, M13 9PL, UK
| | - Christopher J Armitage
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Coupland 1 Building-Room G3, Oxford Road, Manchester, M13 9PL, UK.,Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, M13 9PL, Manchester, UK
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17
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Smoking and COVID-19: Adding Fuel to the Flame. Int J Mol Sci 2020; 21:ijms21186581. [PMID: 32916821 PMCID: PMC7555793 DOI: 10.3390/ijms21186581] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/20/2020] [Accepted: 09/07/2020] [Indexed: 01/08/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic, an infection caused by the severe acute respiratory syndrome coronavirus (SARS-CoV-2), has led to more than 771,000 deaths worldwide. Tobacco smoking is a major known risk factor for severe illness and even death from many respiratory infections. The effects of smoking on COVID-19 are currently controversial. Here, we provide an overview of the current knowledge on the effects of smoking on the clinical manifestations, disease progression, inflammatory responses, immunopathogenesis, racial ethnic disparities, and incidence of COVID-19. This review also documents future directions of smoking related research in COVID-19. The current epidemiological finding suggests that active smoking is associated with an increased severity of disease and death in hospitalized COVID-19 patients. Smoking can upregulate the angiotensin-converting enzyme-2 (ACE-2) receptor utilized by SARS-CoV-2 to enter the host cell and activate a ‘cytokine storm’ which can lead to worsen outcomes in COVID-19 patients. This receptor can also act as a potential therapeutic target for COVID-19 and other infectious diseases. The COVID-19 pandemic sheds light on a legacy of inequalities regarding gender, racial, and ethnic health disparities associated with active smoking, thus, smoking cessation may help in improving outcomes. In addition, to flatten the COVID-19 curve, staying indoors, avoiding unnecessary social contact, and bolstering the immune defense system by maintaining a healthy diet/living are highly desirable.
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18
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Inoue Y, Katoh T, Masuda S, Lu X, Koga T, Sadohara T, Sadanaga M, Tanaka E. Perioperative complications of abdominal surgery in smokers. J Anesth 2020; 34:712-718. [PMID: 32577911 PMCID: PMC7511283 DOI: 10.1007/s00540-020-02815-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 06/12/2020] [Indexed: 12/14/2022]
Abstract
Purpose This study examined the association between smoking and perioperative complications of laparoscopic abdominal surgery and whether these complications were reduced with ≥ 4 weeks of preoperative smoking cessation. Methods A total of 555 patients who underwent gastric and colorectal cancer surgeries under general anesthesia were divided into the following groups retrospectively: 290 individuals without smoking history (NS group), 144 previous smokers (stopped smoking more than 8 weeks before surgery, PS group), and 121 current smokers (CS group) divided to two groups according to preoperative smoking cessation for < 4 (CS1, n = 76) and 4–8 weeks (CS2, n = 45). Results When compared with the NS group, postoperative hospitalization duration was significantly longer in the CS1 group (p < 0.01), whereas differences between the CS2 or PS groups and NS group were not significant. The total number of postoperative complications was higher in all groups of smoking than in NS group, independent on preoperative smoking cessation; however, suture failure was significantly more frequent only in CS1 group. Although pack-years did not significantly affect complication rates in smokers, duration of smoking cessation time in PS group was a negative predictor of postoperative complications. Conclusion Providing more than 4 weeks of smoking cessation before gastrointestinal surgery can reduce the duration of hospitalization and rate of suture failure.
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Affiliation(s)
- Yoshikazu Inoue
- Department of Anesthesiology, Japanese Red Cross Kumamoto Hospital, 2-1-1 Nagamineminami, Higashi-ku, Kumamoto, 861-8528, Japan. .,Department of Public Health, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjou, Chuo-ku, Kumamoto, 860-8556, Japan.
| | - Takahiko Katoh
- Department of Public Health, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjou, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Shota Masuda
- Department of Public Health, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjou, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Xi Lu
- Department of Public Health, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjou, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Tadashi Koga
- Department of Anesthesiology, Japanese Red Cross Kumamoto Hospital, 2-1-1 Nagamineminami, Higashi-ku, Kumamoto, 861-8528, Japan
| | - Tomohiro Sadohara
- Department of Anesthesiology, Japanese Red Cross Kumamoto Hospital, 2-1-1 Nagamineminami, Higashi-ku, Kumamoto, 861-8528, Japan
| | - Michiaki Sadanaga
- Department of Anesthesiology, Japanese Red Cross Kumamoto Hospital, 2-1-1 Nagamineminami, Higashi-ku, Kumamoto, 861-8528, Japan
| | - Eiji Tanaka
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, 2-1-1 Nagamineminami, Higashi-ku, Kumamoto, 861-8528, Japan
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19
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Swerdlow BN. Surgical smoke and the anesthesia provider. J Anesth 2020; 34:575-584. [PMID: 32296937 DOI: 10.1007/s00540-020-02775-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 03/07/2020] [Indexed: 01/19/2023]
Abstract
Surgical smoke generated by use of electrosurgical units (ESUs), lasers, and ultrasonic scalpels constitutes a physical, chemical, and biological hazard for anesthesia personnel. Inhalation of particulate matter with inflammatory consequences, pulmonary injury from products of tissue pyrolysis, exposure to mutagens and carcinogens, and the transmission of human papillomavirus (HPV) and possibly other pathogens represent a spectrum of adverse effects associated with the occupational exposure to surgical plume. While adequate operating room ventilation and use of high filtration-efficiency masks offer some protection from these conditions, the most effective method of safeguarding against surgical smoke involves its removal with a dedicated smoke evacuation device (SED). Despite the fact that many professional and governmental agencies have endorsed widespread usage of SEDs, anesthesia providers have been largely silent on this subject, with few reports within the field of anesthesiology and perioperative medicine regarding these hazards. SED use is relatively infrequent in most surgeries, and this condition reflects surgeons' reluctance to employ these devices, likely resulting from lack of education and less than optimal technology. Anesthesia societies and academic centers can serve critical roles in advocating employment of SEDs in much the same way that they have supported perioperative smoking cessation.
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Affiliation(s)
- Barry N Swerdlow
- Nurse Anesthesia Program, Oregon Health and Science University, SON #521, 3455 SW US Veterans Hospital Rd, Portland, OR, 97239, USA.
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20
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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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21
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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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22
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Kito Y, Iida M, Tanabe K, Onuma T, Tsujimoto M, Nagase K, Tokuda H, Iwama T, Kozawa O, Iida H. Smoking cessation affects human platelet activation induced by collagen. Exp Ther Med 2019; 18:3809-3816. [PMID: 31616510 PMCID: PMC6781815 DOI: 10.3892/etm.2019.8025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 07/30/2019] [Indexed: 12/23/2022] Open
Abstract
It is firmly established that smoking is a risk factor of cardiovascular disease, stroke and peripheral vascular disease. Although smoking alters the hemostatic process, the influence of smoking on human platelet activation remains controversial. For patients undergoing surgery, cessation of smoking prior to the procedure is recommended as it increases the risk of postoperative morbidity or mortality. The presented study investigated the effects of smoking cessation on human platelet activation induced via collagen (n=19 patients). Blood samples were taken on four occasions: Before smoking cessation, and at 4, 8 and 12 weeks after smoking cessation. Platelet aggregation using citrated platelet-rich plasma (PRP) was monitored using a PA-200 aggregometer, which determined the size of platelet aggregates using laser scattering methods. A low dose of collagen (1 µg/ml) accelerated platelet aggregation at 4 or 8 weeks after smoking cessation when compared with results before cessation. After 12 weeks, levels of platelet aggregation induced by collagen were almost equal to those recorded prior to smoking cessation. The secretion levels of collagen-induced platelet-derived growth factor (PDGF)-AB at 4 or 8 weeks after smoking cessation were significantly higher than those before smoking was stopped. Furthermore, smoking cessation markedly strengthened the collagen-induced phosphorylation of p38 mitogen-activated protein (MAP) kinase after 4 weeks. The results of the current study indicated that smoking cessation causes temporary short-term human platelet hyper-activation. The further suggest that the incidence of complications due to human platelet hyper-reactivity may be lowered by considering the period of smoking abstinence.
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Affiliation(s)
- Yuko Kito
- Department of Anesthesiology and Pain Medicine, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan.,Department of Pharmacology, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
| | - Mami Iida
- Gifu Prefectural General Medical Center, Gifu 500-8717, Japan
| | - Kumiko Tanabe
- Department of Anesthesiology and Pain Medicine, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
| | - Takashi Onuma
- Department of Anesthesiology and Pain Medicine, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan.,Department of Pharmacology, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
| | - Masanori Tsujimoto
- Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
| | - Kiyoshi Nagase
- Department of Anesthesiology and Pain Medicine, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
| | - Haruhiko Tokuda
- Department of Clinical Laboratory, National Center for Geriatrics and Gerontology, Obu, Aichi 485-8520, Japan
| | - Toru Iwama
- Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
| | - Osamu Kozawa
- Department of Pharmacology, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
| | - Hiroki Iida
- Department of Anesthesiology and Pain Medicine, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
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23
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Coffman CR, Howard SK, Mariano ER, Kou A, Pollard J, Boselli R, Kangas S, Leng J. A short, sustainable intervention to help reduce day of surgery smoking rates among patients undergoing elective surgery. J Clin Anesth 2019; 58:35-36. [PMID: 31059909 DOI: 10.1016/j.jclinane.2019.04.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 04/10/2019] [Accepted: 04/26/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Clarity R Coffman
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Steven K Howard
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States of America; Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States of America
| | - Edward R Mariano
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States of America; Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States of America
| | - Alex Kou
- Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States of America
| | - John Pollard
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States of America; Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States of America
| | - Robin Boselli
- Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States of America
| | - Stephanie Kangas
- Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States of America
| | - Jody Leng
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States of America; Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States of America.
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Keyworth C, Epton T, Goldthorpe J, Calam R, Armitage CJ. 'It's difficult, I think it's complicated': Health care professionals' barriers and enablers to providing opportunistic behaviour change interventions during routine medical consultations. Br J Health Psychol 2019; 24:571-592. [PMID: 30977291 PMCID: PMC6766974 DOI: 10.1111/bjhp.12368] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 02/15/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Internationally, public health strategies encourage health care professionals to deliver opportunistic behaviour change interventions. The present study: (1) examines the barriers and enablers to delivering interventions during routine consultations, and (2) provides recommendations for the design of interventions to increase delivery of opportunistic behaviour change interventions. DESIGN Qualitative interview study. METHODS Twenty-eight semi-structured interviews were conducted with patient-facing health care professionals. The Behaviour Change Wheel informed a framework analysis in which findings were mapped onto the Theoretical Domains Framework (TDF). Intervention functions and behaviour change techniques (BCTs) targeting each TDF domain were identified. RESULTS Health care professionals understood the importance of opportunistic behaviour change interventions (beliefs about consequences), but were sceptical about their capabilities to facilitate behaviour change with patients (beliefs about capabilities). Some clinicians were unwilling to discuss behaviours perceived as unrelated to the patient's visit (social/professional role and identity). Discipline-specific tasks were prioritized, and delivering interventions was perceived as psychologically burdensome. One-to-one contact was favoured over busy hospital settings (environmental context and resources). Seven intervention functions (training, restriction, environmental restructuring, enablement, education, persuasion, and modelling) and eight BCT groupings (antecedents, associations, comparison of outcomes, covert learning, feedback and monitoring, natural consequences, reward and threat, and self-belief) were identified. CONCLUSIONS Across disciplines, health care professionals see the value of opportunistic behaviour change interventions. Barriers related to workload, the clinical environment, competence, and perceptions of the health care professional role must be addressed, using appropriate intervention functions and BCTs, in order to support health care professionals to increase the delivery of interventions in routine practice. Statement of contribution What is already known on this subject? Brief, opportunistic interventions can be a cost effective way of addressing population health problems. Public health policies compel health care professionals to deliver behaviour change interventions opportunistically. Health care professionals do not always deliver interventions opportunistically during routine medical consultations; however the barriers and enablers are currently unclear. What does this study add? This is the first study to examine cross-disciplinary barriers and enablers to delivering opportunistic behaviour change interventions. Across diverse professional groups, working in different medical professions, participants saw the value of delivering opportunistic behaviour change interventions. Targeting key theoretical domains that are shared across professional groups may be useful for increasing the delivery of opportunistic behaviour change interventions.
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Affiliation(s)
- Chris Keyworth
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, UK
| | - Tracy Epton
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, UK
| | - Joanna Goldthorpe
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, UK
| | - Rachel Calam
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, UK
| | - Christopher J Armitage
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, and NIHR Manchester Biomedical Research Centre and Manchester University NHS Foundation Trust (MFT), and NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, UK
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25
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Meijer E, Kampman M, Geisler MS, Chavannes NH. "It's on everyone's plate": a qualitative study into physicians' perceptions of responsibility for smoking cessation. Subst Abuse Treat Prev Policy 2018; 13:48. [PMID: 30541580 PMCID: PMC6290505 DOI: 10.1186/s13011-018-0186-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 11/30/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little research has investigated in-depth how physicians perceive their role in smoking cessation care. This qualitative study sought to understand physicians' perceptions of responsibility for smoking cessation. METHODS Data were collected through individual semi-structured interviews and focus group interviews between June and November 2017 in The Netherlands. We interviewed 5 addiction specialists, 5 anesthesiologist, 4 cardiologists, 8 GPs, 5 internists, 5 neurologists, 2 pediatricians, 6 pulmonologists, 7 surgeons, and 8 youth healthcare physicians (N = 55). Data analysis followed the framework approach. RESULTS The analysis showed that three actors were perceived as responsible for smoking cessation: physicians, patients, and the government. Participants perceived physicians as responsible for facilitating smoking cessation -albeit to different extents-, patients as carrying the ultimate responsibility for quitting smoking, and the government as responsible for creating a society in which smoking uptake is more difficult and quitting smoking easier. Perceptions of smoking itself were found to be important for how participants viewed responsibility for smoking cessation. It remained unclear for many participants which healthcare provider is responsible for smoking cessation care. CONCLUSIONS The organization of smoking cessation care within health systems should be a focus of intervention, to better define physician roles and perceptions of responsibility. In addition, it seems important to target perceptions of smoking itself on the level of physicians and -as suggested by comments by several participants- the government.
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Affiliation(s)
- E. Meijer
- Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - M. Kampman
- Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - M. S. Geisler
- Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - N. H. Chavannes
- Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, PO Box 9600, 2300 RC Leiden, The Netherlands
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26
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Brown JK, Singh K, Dumitru R, Chan E, Kim MP. The Benefits of Enhanced Recovery After Surgery Programs and Their Application in Cardiothoracic Surgery. Methodist Debakey Cardiovasc J 2018; 14:77-88. [PMID: 29977464 DOI: 10.14797/mdcj-14-2-77] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The perioperative care of the surgical patient is undergoing a paradigm shift. Enhanced Recovery After Surgery (ERAS) programs are becoming the standard of care and best practice in many surgical specialties throughout the world. ERAS is a multimodal, multidisciplinary, evidence-based approach to care of the surgical patient that aims to optimize perioperative management and outcomes. Implementation, however, has been slow because it challenges traditional surgical doctrine. The key elements of ERAS Pathways strive to reduce the response to surgical stress, decrease insulin resistance, and maintain anabolic homeostasis to help the patient return to baseline function more quickly. Data suggest that these pathways have produced not only improvements in clinical outcome and quality of care but also significant cost savings. Large trials reveal an increase in 5-year survival and a decrease in immediate complication rates when strict compliance is maintained with all pathway components. Years of success using ERAS in colorectal surgery have helped to establish a body of evidence through a number of randomized controlled trials that encourage application of these pathways in other surgical specialties.
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Affiliation(s)
| | | | | | | | - Min P Kim
- HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
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Gerstein NS, Sanders JC, McCunn M, Brierley JK, Gerstein WH, West SD, Tawil I, Kraai EP, Boyd NH, Bronshteyn YS, Torgeson EL, Schulman PM. The Gun Violence Epidemic: Time for Perioperative Physicians to Act. J Cardiothorac Vasc Anesth 2018; 32:1097-1100. [PMID: 29602543 DOI: 10.1053/j.jvca.2018.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Neal S Gerstein
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM.
| | - John C Sanders
- Shriners Hospitals for Children, Salt Lake City, UT; University of Utah, Salt Lake City, UT
| | - Maureen McCunn
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD
| | - Janet K Brierley
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM
| | - Wendy H Gerstein
- Department of Internal Medicine, Raymond G. Murphy VA Medical Center, Albuquerque, NM
| | - Sonlee D West
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM
| | - Isaac Tawil
- Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, NM
| | - Erik P Kraai
- Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Nathan H Boyd
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM
| | - Yuriy S Bronshteyn
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC
| | - Eli L Torgeson
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM
| | - Peter M Schulman
- Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, OR
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Amornyotin S. Role of an Anesthesiologist in Smoking Patients Undergoing Endoscopic Procedures. JOURNAL OF ADDICTION MEDICINE AND THERAPEUTIC SCIENCE 2017:030-031. [DOI: 10.17352/2455-3484.000023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
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