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Smoking - Do vascular surgeons practise what they preach?
Abstract
Smoking is a major health problem in Great Britain and cigarette consumption is rising. Although there are studies concerning the smoking habits of hospital physicians, nurses and oral and maxillofacial surgeons, little is known about the smoking habits of vascular surgeons and the advice given by them to their patients. A questionnaire survey was conducted involving 422 members of the Vascular Surgical Society of Great Britain and Ireland. The response rate was 74%. The median age of responders was 51 years (range, 32-69 years) of whom 98% were men. Of responders, 98% routinely advise patients to stop smoking, 10% advise nicotine gum/patch, 39% provide antismoking information sheets, 11% are involved in an antismoking clinic/group and 74% check to see whether patients continue to smoke. The majority of responders would be prepared to offer revascularisation in patients who continue to smoke. Only 8 surgeons (3%) would not advise revascularisation in this group of patients. Only 10% of respondents were current smokers, 37% were ex-smokers and 53% had never smoked. Vascular surgeons, therefore, seem to practise what they preach.
... Every one of the included 246 studies described smoking prevalence among physicians. The main aim of examining smoking prevalence among physicians was reported in most studies (n = 117) [24,26,27,29,32,33,[35][36][37][38][39][40][41]44,45,48,49,[53][54][55][56]58,59,68,69,72,73,76,78,82,84,85,87,[90][91][92][93][94][95][97][98][99][102][103][104]107,108,110,115,[119][120][121]126,[131][132][133][135][136][137][138]141,142,[144][145][146][147][148][149]151,154,[156][157][158]160,161,[163][164][165]167,[169][170][171][172]174,176,[178][179][180]182,183,185,187,[189][190][191][192][193][194]196,197,199,[201][202][203][204]207,211,213,218,224,225,227,231,239,[241][242][243]. Fifteen studies also aimed to assess the use of other substances in physicians. ...
... Fifteen studies also aimed to assess the use of other substances in physicians [29,37,[93][94][95]117,118,124,141,161,165,171,193,239,248]. Other outcomes presented were demographic characteristics and health status of physicians in 58 studies [22,23,30,31,42,43,46,57,60,[63][64][65][66]74,75,80,88,89,96,100,106,114,116,123,125,[128][129][130]134,139,143,153,155,162,176,177,181,184,195,198,208,223,238,239,249,[251][252][253][254][255][256][257][258][259][260][261]263,264], the evaluation of smoking cessation counselling among physicians in 50 studies [25,26,28,33,35,40,55,61,62,67,70,79,86,92,97,99,101,104,105,111,136,142,144,145,152,157,168,183,[189][190][191]197,201,[203][204][205]209,210,212,214,218,219,[234][235][236]241,242,244,247,250], the attitude of physicians towards prevention and promotion of a healthy lifestyle in seven studies [122,140,206,208,220,222,228], the knowledge on tobacco effects in 20 studies [24,33,39,44,50,53,61,62,78,91,98,119,154,178,199,204,216,217,240,247], and the examination of the link between smoking habits of physicians and their practice of providing minimal smoking cessation advice in 26 studies [7,8,21,47,58,81,83,109,112,127,150,159,175,[186][187][188]208,211,213,224,225,232,237,244,246,262]. Finally, the primary outcome was not clearly defined in 16 studies [34,51,52,71,77,113,166,173,200,215,221,226,229,230,233,245]. ...
... Physicians were recruited from health centers in 94 studies, either monocentric in 50 studies [21,26,29,30,37,[41][42][43]46,49,56,79,80,97,115,120,121,[132][133][134]156,162,163,167,170,179,181,182,184,190,193,194,196,202,204,212,217,225,228,229,232,235,244,250,256,257,259,260,263,264] or multicentric in 44 studies [24,39,53,54,72,83,[89][90][91][92]98,111,112,117,119,123,126,128,130,131,141,152,168,169,178,197,201,203,205,207,214,216,219,220,224,227,231,[236][237][238]242,243,253,261]. They were also recruited from specific lists in 68 studies, either from specific societies in 14 studies [22,40,47,77,78,110,158,180,183,189,221,222,230,240], associations in 23 studies [7,59,67,87,94,95,[106][107][108]118,129,135,142,206,209,223,234,239,245,249,251,254,262], medical or specific registers in 22 studies, [23,38,85,88,113,127,139,144,145,154,159,165,173,177,186,192,199,208,210,246,248,258] and lists from ministries of health in 9 studies [33,35,45,99,116,140,146,166,218]. Finally, recruitment procedure was not defined in 84 studies [8,25,27,28,31,32,34,36,44,48,[50][51][52]55,57,58,[60][61][62][63][64][65][66][68][69][70][71][73][74][75][76]81,82,84,86,93,96,[100][101][102][103][104][105]109,114,122,124,125,[136][137][138]143,[147][148][149][150][151]153,155,157,160,161,164,171,172,[174][175][176]185,187,188,191,195,198,200,211,213,215,226,233,241,247,252,255]. ...
Background:
Smoking is a major public health problem. Although physicians have a key role in the fight against smoking, some of them are still smoking. Thus, we aimed to conduct a systematic review and meta-analysis on the prevalence of smoking among physicians.
Methods:
PubMed, Cochrane, and Embase databases were searched. The prevalence of smoking among physicians was estimated and stratified, where possible, by specialties, continents, and periods of time. Then, meta-regressions were performed regarding putative influencing factors such as age and sex.
Results:
Among 246 studies and 497,081 physicians, the smoking prevalence among physicians was 21% (95CI 20 to 23%). Prevalence of smoking was 25% in medical students, 24% in family practitioners, 18% in surgical specialties, 17% in psychiatrists, 16% in medical specialties, 11% in anesthesiologists, 9% in radiologists, and 8% in pediatricians. Physicians in Europe and Asia had a higher smoking prevalence than in Oceania. The smoking prevalence among physicians has decreased over time. Male physicians had a higher smoking prevalence. Age did not influence smoking prevalence.
Conclusion:
Prevalence of smoking among physicians is high, around 21%. Family practitioners and medical students have the highest percentage of smokers. All physicians should benefit from targeted preventive strategies.
... [7][8][9] However, smoking cessation practices for patients facing surgery vary significantly. 10,11 First, many surgeons report a perceived lack of time to deliver interventions, and a lack of knowledge regarding adjunct therapies (such as behavioral counseling and adjunct smoking cessation medications). [12][13][14][15][16][17][18][19] Second, when smoking cessation counseling is delivered, research shows that it often focuses on identifying and cataloging the risky behavior rather than motivating patients to change it. ...
Background:
Despite the recognized benefits of smoking cessation, many clinicians question if a brief smoking cessation intervention can help dedicated smokers with peripheral arterial disease understand nicotine dependence and harms related to smoking. We investigated the impact and durability of a multi-modal smoking cessation intervention on patient attitudes regarding nicotine dependence and the health effects of smoking.
Methods:
We conducted a pilot cluster randomized trial of a brief smoking cessation intervention at eight vascular surgery practices between September 1, 2014 and August 31, 2015. Compared with control sites, patients at intervention sites received protocolized brief cessation counseling, medications and referrals to a quitline. After their clinic visit and again at 3 months, participants completed a brief survey about patient attitudes regarding nicotine dependence and the health effects of smoking. Responses to questions were analyzed using Chi(2) and student's t-tests.
Results:
All trial participants (n=156) complete the initial survey, and 75 (45%) participants completed the follow-up survey. Intervention and control patients both reported a greater than 30-pack-year history (80% vs 90%, p=0.07) and previous failed quit attempts (77% vs 78%, p=0.8). Compared to usual care, patients in the intervention group were more likely to describe hearing advice to quit from their surgeon (98% vs. 77%, p<0.001), and expressed "a lot" or "some" interest in quitting (95.4% vs 85.7%, p=0.05). Patients in the intervention group were also more likely to acknowledge their addictive behaviors, consistently scoring higher on question bank items regarding nicotine addiction (52.9 vs 48.0, p=0.006) and the negative health effects of smoking (scaled score 56.6 vs 50.6, p=0.001). When re-surveyed three months after intervention, patients in the intervention group had larger declines in nicotine dependence and health effects domains, suggesting durable impact of the intervention on patient attitudes regarding nicotine addiction and smoking harms.
Conclusions:
Brief smoking cessation counseling by a vascular surgeon increases patient interest in smoking cessation and awareness of smoking harms, and this effect was durable three months after intervention. This evidence suggests that even brief counseling within a surgical clinic has the potential to impact patient desire to quit.
... There is a wide variation in the reported survey response rates, particularly among physicians, typically ranging from 29 to 74% (17)(18)(19)(20)(21)(22). The response to our survey was therefore with the expected range, but was somewhat disappointing given the fact that this indirectly reflects the interest of the responder. ...
Objetivo: Comparar la calidad de vida (CDV) de los egresados de una Escuela de Medicina peruana que migraron al extranjero y de los que permanecieron en el país. Material y método: Se utilizó un cuestionario basado en una combinación de dos herramientas para medir la CDV de proveedores de salud previamente validadas, para evaluar auto-satisfacción (grupo A), las relaciones interpersonales y sociales (grupo B) y los niveles de satisfacción personal (grupo C). Es cuestionario se envió por correo electrónico a los graduados de la Universidad Peruana Cayetano Heredia. Resultados: La tasa de respuesta fue 35%. Los niveles de ingreso económico fueron significativamente menores en los médicos que permanecieron en el Perú en comparación con los que migraron. En muy pocas preguntas se encontró diferencia significativa. En el grupo A, los médicos que migraron percibieron una CDV significativamente mayor solo en la expectativa de futuro. En el grupo B, esto se alcanzó diferencias sólo en el grado de apoyo y el nivel de conflicto entre colegas , y en el grupo C, en el nivel de información recibida acerca de los resultados de su trabajo ("feedback"), el esfuerzo físico del trabajo diario (estrés físico), las oportunidades de expresar lo que se piensa y necesita, el esfuerzo del hospital para mejorar la CDV de sus trabajadores, el entrenamiento necesario para realizar el trabajo diario, y la variedad en el trabajo. Los médicos que migraron percibieron una mayor aceptación en la profesión, en la sociedad en general y dentro de la comunidad donde viven. De manera significativa más médicos que migraron no tenían intenciones de cambiar sus niveles actuales de vida. Conclusiones: La CDV percibida de los médicos estudiados fue similar en la mayoría de preguntas examinadas entre ambos grupos, a pesar de la marcada diferencia encontrada en los niveles de ingreso económico. La migración medica teniendo el Perú como procedencia parece ser un factor favorable en el logro de una adaptación exitosa a una nueva cultura. (Rev Med Hered 2010;21:187-196).
Objective
Smoking rates have declined, however it remains the primary modifiable risk factor for vascular disease. While vascular surgeons often advise patients to quit, few provide assistance. We sought to understand patients’ interest in quitting and determine factors that influence this willingness to quit.
Methods
Anonymous surveys were given to vascular surgery clinic patients in a single institution over a 5-month period. Demographic information, smoking status, cessation attempts, and barriers to quitting were obtained. Nicotine dependence was determined using the Fagerstrom Test, and willingness to quit was assessed using a contemplation ladder. Patient’s willingness to quit was evaluated in relation to symptomatic status, previous/planned operation, and nicotine dependence levels.
Results
A total of 490 patients (92%) completed the survey with 109 (22%) current smokers, 195 (40%) former smokers, and 186 (38%) never smokers. Never smokers were more likely to be female and employed while smokers were more likely to be disabled. Although 51% of smokers displayed moderate/high nicotine dependence, 54% demonstrated willingness to consider quitting within 6 months. The primary barrier to cessation identified was previous failed attempt(s) to quit in 44%. Most (90%) had previously attempted quitting, 63% attempted three or more times and the most common technique used was “quitting cold turkey”. Fifty-nine percent of patients reported physicians’ had offered assistance in cessation, but only 2% had been in a cessation program. There was no correlation between willingness to consider quitting and symptomatic status, previous/planned operation or nicotine dependence. Smokers of less than 10 cigarettes/day had a lower nicotine dependence level (p = .0001) and higher willingness to consider quitting (p = .0015), as did those who had fewer failed prior attempts to quit and who didn’t believe it was too late to quit.
Conclusion
The majority of our vascular patients self-report as non-smokers. Over half of those who smoke demonstrate willingness to consider quitting within 6 months, which is not dependent on nicotine dependence, previous/planned operation, or symptomatic status. Those who smoke less than 10 cigarettes per day, have fewer past failed attempts to quit, and believe that it’s not too late to quit are more likely to consider quitting. Vascular surgeons should be more aware of previous quit attempts and patterns of smoking and be proactive in assisting patients in cessation attempts.
Background:
National smoking rates have declined; however, it remains the primary modifiable risk factor for nearly all vascular disease. While vascular surgeons have the availability to treat patients via medical or surgical/endovascular means, involvement in risk factor modification may be lacking. This study seeks to understand vascular surgeons' involvement in tobacco cessation and risk factor modification and to determine if practice variables had any effect on provision of these services to vascular surgery patients.
Methods:
Anonymous electronic surveys examining tobacco cessation and risk factor modification were sent to the Vascular & Endovascular Surgery Society members (n = 633). Influence of time from training, practice type (dichotomized into academic and nonacademic vascular surgeons), hospital size, region, and workload was assessed, and data were analyzed by univariate contingency tables.
Results:
A total of 149 (24%) surveys were completed. While the majority of respondents ask patient's smoking status (97%), assess willingness to quit (84%), and advise patients to quit (95%), only 34% prescribe medications to assist in cessation, 7% see patients in tobacco cessation follow-up, and 3% verify cessation with cotinine levels or carbon monoxide monitoring. Surgeons who prescribed medications for cessation are more likely to assess patient's willingness to quit, prescribe/advise nicotine replacement, or prescribe initial statin or other lipid-lowering medications. There was no difference in perceived education received during training in risk factor modification, but only 26% of respondents thought they were well trained. Comparing academic to private practice vascular surgeons, there was no difference in cessation techniques used; however, academic surgeons were less likely to perform endovascular procedures for claudication in patients who continued to smoke (29% vs. 46%, P = 0.03) and more likely to prescribe an initial antihyperlipid medication (65% vs. 39%, P = 0.0018).
Conclusions:
Tobacco dependence remains a critical issue for vascular surgery patients; however, there is wide variation in cessation techniques used. The majority of vascular surgeons are not well versed in cessation techniques and risk factor modification, and thus, efforts should be made to provide this education in vascular surgery training programs.
At a hospital with maximum medical care (800 beds, cardiologic, oncologic, pneumologic and thorax-surgical sections), tobacco-related diseases can always be documented. Many patients are anxious to stop smoking and apply for help. Help is often offered, but gets sabotaged by the nicotine addiction of the staff itself. Though they have a dining-room of their own and patients have got a "smokers' balcony", both groups often meet at the hospital entrances and in the courtyard. Does the staff feel discriminated because of this? Was their authority questioned? What about their responsibility and their role as health experts for their patients? A questionnaire found out about the employees' differing smoking habits and these were related to their professional activities. Furthermore, an interest was taken in their attitude toward smoking/non-smoking areas and the degree to which they were molested by smokers. The majority of smoking staff is found in the nursing field. One third of them was in favor of a general smoking ban, 56% in favor of a limited one (among them 63% of the smokers), 31,4% of the smokers think it is a discriminating idea if they are only allowed to smoke in specially designated areas. Two thirds were in favor of separate smoking rooms for patients and staff, nearly as many (65,1%) are opposed to staff smoking in places where patients have access to. 80% of them reject a general smoking permission in all the recreation rooms.
Health care providers who feel prepared are more apt to assume tobacco interventionist roles; therefore, educational preparation is critical. A nonprobability sample of health professions students at an urban academic health center were asked to respond to a twenty-two-item survey eliciting demographic, behavioral, and tobacco-related attitudinal information. Frequency distributions were assessed with Pearson chi-square statistics. The overall response rate was 76.7 percent, and final sample size was 319. Current use of spit tobacco (ST) was 2.5 percent and current smoking 5.6 percent. In comparing current smokers to nonsmokers and current ST users to nonusers, we found that no differences in proportion agreeing with any of the five questions about attitudes and opinions were statistically significant at p-value 0.05. At least 70 percent of students from each of six health professions programs agreed it was their professional responsibility to help smokers quit, and at least 65 percent agreed to the same responsibility for helping ST users quit. The proportion agreeing that their programs had course content describing their role in helping patients quit tobacco use varied widely by program from 100 percent agreement among dental hygiene and pharmacy students to 14.6 percent of physical therapy students (p-value <0.001). When asked whether their program adequately prepared them to help smokers quit, agreement ranged from 100 percent among dental hygiene students to only 5.5 percent among physical therapy students (p-value <0.001). Almost 90 percent of dental hygiene students agreed that they were adequately trained to help ST users quit, but no other program had a percentage of agreement above 34 percent (p-value <0.001). Consistent and comprehensive multidisciplinary tobacco-related curricula could offer desirable standardization.
Medical and surgical SpRs were interviewed to determine what efforts they make to stop patients smoking.
Telephone interview of 53 SpRs in the Oxford region.
The majority regularly asked whether patients smoked, few did anything about it. Surgical SpRs were less likely than medical SpRs to advise patients to stop, discuss smoking-related health problems, discuss the benefits of quitting or advise nicotine replacement therapy. Few SpRs had been trained to counsel smokers and less than half felt that their input helped patients to stop.
Medical education is lacking in teaching students and junior doctors how to help patients stop smoking.
The provision of smoking care, including the management of nicotine withdrawal and assistance with a quitting attempt, is identified as an important part of the overall care of hospitalised patients. Levels of smoking care delivery in hospitals have been less than optimal. Increasing this care across multiple facilities and units within NSW Health represents a significant challenge. This article examines levels of smoking care delivery in NSW hospitals, and research evidence and best practice recommendations to inform potential strategies to increase such care. It also reviews statewide initiatives implemented by NSW Health to enhance the delivery of smoking care and suggests further strategies that could facilitate this.
Hospitals are key settings for the provision of smoking cessation care. Limited data are available that describe the prevalence and type of such care delivered routinely in this setting. We reviewed studies conducted in hospitals and published between 1994 and 2005 that reported levels of smoking care delivery. This review describes the proportion of patients receiving, and the proportion of health professionals providing, various smoking cessation care practices. We used both descriptive and meta-analytic methods. According to the meta-analysis, smoking status was assessed in 60% of patients, 42% were advised or counseled to quit, 14% were provided with or advised to use nicotine replacement therapy (NRT), and 12% received referrals or follow-up. Significantly fewer patients received follow-up or referrals than were assessed for smoking status or received advice or counseling to quit. Some 81% of health professionals reported they assessed smoking status, 70% advised or counseled patients to quit, 13% provided NRT or advised its use, and 39% provided referrals or follow-up. Significantly fewer health professionals advised or prescribed NRT than assessed smoking status or advised or counseled patients to quit. Statistical heterogeneity was indicated for all smoking care practices. Levels of smoking cessation care are less than optimal in hospitals, and the levels of some important care practices are particularly low. Future research should identify effective methods for increasing smoking care provision in this setting. In addition, standardized measures of smoking care should be developed. Hospital organizations should enhance and continue to monitor their delivery of smoking care.
To document how often patients with varying cardiovascular risk levels reported receiving lifestyle advice from general practice.
Cross sectional descriptive survey by postal questionnaire.
5 general practices in Bedfordshire.
4941 people aged 35-64 years who had consulted a general practitioner at least once during the 12 months before completing the questionnaire and who subsequently attended for a health check as part of the OXCHECK trial.
Report of having received advice from a general practitioner or practice nurse about smoking, alcohol consumption, exercise, or diet during the 12 months before completing the questionnaire. Cardiovascular risk assessed by a nurse during structured health check.
The overall reported rate of advice was 27% for smoking, 4.5% for exercise, 12% for diet, and 3% for alcohol consumption. Those with unhealthy behaviour profile or at increased cardiovascular risk received more advice--for example, 47% of smokers with a history of cardiovascular disease received advice on smoking. Among those at increased risk, men were more likely than women to receive advice about exercise (11% v 4%, p = 0.04) and alcohol consumption (10% v 4%, p = 0.007), while women received more advice about weight (17% v 23%, p < 0.001). The rate of receiving advice was unaffected by age, marital status, or social class.
The low rate of lifestyle advice reported by patients implies that more preventive advice could be provided in primary care.
To determine the effects of smoking, plasma lipids, lipoproteins, apolipoproteins, and fibrinogen on the patency of saphenous vein femoropopliteal bypass grafts at one year.
Prospective study of patients with saphenous vein femoropopliteal bypass grafts entered into a multicentre trial.
Surgical wards, outpatient clinics, and home visits coordinated by two tertiary referral centres in London and Birmingham.
157 Patients (mean age 66.6 (SD 8.2) years), 113 with patent grafts and 44 with occluded grafts one year after bypass.
Cumulative percentage patency at one year.
Markers for smoking (blood carboxyhaemoglobin concentration (p less than 0.05) and plasma thiocyanate concentration (p less than 0.01) and plasma concentrations of fibrinogen (p less than 0.001) and apolipoproteins AI (p less than 0.04) and (a) (p less than 0.05) were significantly higher in patients with occluded grafts. Serum cholesterol concentrations were significantly higher in patients with grafts that remained patent one year after bypass (p less than 0.005). Analysis of the smoking markers indicated that a quarter of patients (40) were untruthful in their claims to have stopped smoking. Based on smoking markers, patency of grafts in smokers was significantly lower at one year by life table analysis than in non-smokers (63% v 84%, p less than 0.02). Patency was significantly higher by life table analysis in patients with a plasma fibrinogen concentration below the median than in those with a concentration above (90% v 57%, p less than 0.0002). Surprisingly, increased plasma low density lipoprotein cholesterol concentration was significantly associated with improved patency at one year (85%) at values above the median compared with patency (only 68%) at values in the lower half of the range (p less than 0.02).
Plasma fibrinogen concentration was the most important variable predicting graft occlusion, followed by smoking markers. A more forceful approach is needed to stop patients smoking; therapeutic measures to improve patency of vein grafts should focus on decreasing plasma fibrinogen concentration rather than serum cholesterol concentration.
Objective.
—To evaluate the efficacy of a new nicotine inhaler system for smoking cessation.Design.
—A 1-year, randomized, double-blind, placebo-controlled study.Setting.
—Medical outpatient clinic with physicians experienced in smoking cessation assistance.Subjects.
—A total of 286 volunteers who smoked at least 10 cigarettes daily recruited through a local newspaper.Intervention.
—Subjects were randomly allocated to nicotine inhalers (n=145) or placebo (n=141) to be used for 3 months followed by tapering for 3 months in the context of minimal levels of advice and support.Main Outcome Measure.
—Continuous smoking abstinence at weeks 6, 12, 24, and 52, verified by measurements of carbon monoxide in expired air.Results.
—Continuous smoking abstinence was significantly higher for the active nicotine inhaler group compared with the placebo inhaler group. The respective success rates were 28% and 12% after 6 weeks, 21% and 9% after 12 weeks, 17% and 8% after 6 months, and 15% and 5% after 1 year (P=.02 to.001). The mean nicotine substitution based on cotinine determinations after 2 weeks was 43% (SD, 45%) of smoking levels. The treatment was well tolerated, and no serious adverse events were reported.Conclusions.
—In this setting the nicotine inhaler appeared safe to use and increased success rates of smoking cessation attempts.(JAMA. 1993;269:1268-1271)
Two groups of patients were followed up for four to eight years after first referral or admission to hospital for intermittent claudication (IC) in a study of the natural history of the disease and of factors determining its outcome. In one series of 60 patients, those who stopped or reduced smoking after referral had a much improved prognosis. Thus even after the diagnosis of IC it is extremely important that patients should be encouraged to stop smoking, since this correctable factor appears to be of greater importance in determining outcome than other medical risk factors for the disease that are less amenable to treatment. In the second study, 160 patients were followed up for eight years after first hospital admission. They had a total of 480 hospital admissions and had spent 11 190 days in hospital; their life expectancy after the age of 60 was about half that of the general population. Age, coronary artery disease, cerebrovascular disease, and diabetes were associated with an adverse outcome.
The association of cigarette smoking and atherosclerorosis was investigated in 1320 autopsied men, 25--64 years of age. Aortic and coronary lesions were evaluated visually in coded specimens and objectively by analysis of radiographs. Using schedules that had been tested on pairs of living persons, interviewers obtained estimates of cigarette smoking habits of the deceased men from surviving relatives. Data were analysed for black and white men in the total sample of cases and also in groups according to the presence (selected disease group) or absence (basal group) of diseases thought to be associated with smoking (emphysema, lung cancer, etc.) or with coronary heart disease (myocardial infarction, hypertension, diabetes, stroke, etc.). Atherosclerotic involvement of aorta and coronary arteries was greatest in heavy smokers and least in nonsmokers for both races in the total sample of cases, the basal group and the selected disease group.
The effects of smoking and plasma risk factors on the patency of prosthetic femoro-popliteal bypass grafts were investigated in 93 patients entered into a multicentre trial of prosthetic graft materials (70 patients had patent grafts and 23 patients had occluded grafts 2 years after surgery). The smoking markers thiocyanate and fibrinogen were significantly higher in patients with occluded grafts, whereas LDL-cholesterol was significantly higher in patients with patent grafts 2 years after bypass. Based on smoking markers, graft patency in smokers was 57% at 2 years by life table, compared to 78% in non-smokers. P less than 0.05. Fibrinogen was an important variable, predicting graft occlusion with graft patency in patients with below median fibrinogen levels, being 84% at 2 years by life table compared to 51% in those with above median fibrinogen levels, P less than 0.025. Although increased levels of LDL-cholesterol have been associated with accelerated atherosclerosis, patients with above median levels of LDL-cholesterol had improved graft patency (83%) at 2 years compared to patency in patients with below median LDL-cholesterol (60%), P less than 0.05. The plasma risk factors associated with the failure of prosthetic grafts are similar to those associated with the failure of saphenous vein grafts, indicating that higher fibrinogen levels and smoking may contribute to an hypercoagulable state. Greater efforts are needed to stop patients smoking after vascular reconstruction.
A survey of the smoking habits and attitudes towards smoking of all staff working in a teaching hospital with a specialist thoracic department has been carried out. Six hundred and sixty three (70%) of the 949 members of staff returned a voluntary self completed questionnaire. Completion rates were highest among medical, administrative, and clerical staff, and lowest among domestic and catering staff. Of the 663 responders, 136 (23%) admitted to being current smokers and 135 (19%) to being ex-smokers. The great majority of responders (81-94%, depending on area of work) believed that more areas of the hospital should be entirely smoking free. Most responders, however, believed that some accommodation should be made available to staff (70%), patients (52%), or visitors (59%) who wished to smoke. About a quarter of smokers expressed interest in joining a group to help them give up smoking.