Search

An elevated cholesterol level is, along with hypertension, cigarette smoking, and obesity, one of the controllable risk factors for coronary artery disease (CAD) (see Table 1, page 54). This fact, [...]

The implantable cardioverter. defibrillator (ICD) increases survival of patients who receive the device. However, candidacy rates have not been calculated for a defined population, and the potential effect of the device on the survival of all patients with head disease has not been estimated. To make these calculations, medical records were re viewed for 1976 to, 1988 in a population demographically similar to the white population of the United States. Definite and possible candidates were identified on the basis of American Head Association/American College of Cardiology guidelines. Candidacy rates ranged from 3.3/100,000 (counting only definite candidates for the entire peded) to 8.7/100,000 (counting definite and possible candidates after 1980). Extrapolated to the 1990 U.S. population, estimates ranged from 8,207 to 21,637 new candidates each year. During an average follow-up of 5 years, half of all deaths among candidates had the potential to he delayed by an ICD. In a similar population that has a death rate from heart disease of approximately 280/100,000, 0.6 to 1.6% of subjects have the potential to have their deaths delayed to some extent by an ICD. (Am J Cardiol 1993;71:77-81)

Background. Although most physicians believe that smoking cessation assistance is important for their patients, the majority of smokers report that they have not received smoking cessation advice from a physician. [...]

It has been known for decades that smoking is harmful to smokers; more recently, cigarette smoke has been shown to be harmful to nonsmokers who breath it in. Allowing smoking in a hospital implies that the hospital approves of smoking, while a smoke-free hospital reinforces an anti-smoking message. Since many of the patients in hospitals are there because of the harmful effects of smoking, smoking should be discouraged. There is broad support for smoke-free health care environments, and such facilities reinforce the desire of employees to quit smoking. There is also a ''halo effect'' around a smoke-free hospital, leading to smoke-free schools and businesses. It also makes economic sense to ban smoking, because of reduced costs for ventilation, cleaning, and replacement of furnishings. This report summarizes the feasibility of, support for, and potential barriers to smoke-free hospitals. Three strategies for implementing smoke-free policies in hospitals are reviewed. Smoke-free hospitals are the law in Minnesota, and all 200 Indian Health Service hospitals and clinics are smoke-free. Several other state hospital associations have urged voluntary bans. Potential barriers are a decline in patient admissions, employee resistance, the special problems of chemical dependency and mental health units, perceived violations of smokers' rights, and the personal habits of the decision-makers at an institution. The range of options for a smoke-free policy starts with no policy at all to an immediate and total ban. A two-year staged approach is recommended, during which time there may be designated smoking areas and smoke-free rooms for patients. No hospital should sell cigarettes or other tobacco products. (Consumer Summary produced by Reliance Medical Information, Inc.)

A study was undertaken to estimate the number of people who would possibly benefit from heart replacement, either by transplantation of a human heart, or implantation of an artificial heart. Previous studies have been based on epidemiologic data and could not review the individual medical records, nor did they include children. The current study reviewed all death certificates filed in a county in Minnesota over a five-year period; deaths caused by heart disease affecting residents of the county were identified. These medical records were reviewed individually by a panel of physicians, who determined whether the person would have met the criteria for heart replacement. The deaths were grouped by age; those younger than 15 were considered pediatric, while those between 15 and 69 were adult. There were 2,645 deaths during the period, of which 265 were cardiac (17 pediatric and 248 adult). All except one of the children who died of heart disease were younger than one year old, and most were newborns. There had been 8,342 live births in the county during this time period. Five children and 35 adults met the criteria for heart replacement. Extrapolation of this information to the total population of the United States indicated that 2,167 children and 16,500 adults could benefit annually from heart replacement. (Consumer Summary produced by Reliance Medical Information, Inc.)

The relationship between cigarette smoking and lung cancer is well-established. To prevent deaths due to smoking, laws, regulations, and social pressures have been implemented throughout the country. Smokers are more likely to quit if their physician advises them to do so. However, less than half the smokers surveyed had ever received such advice from a physician. Additionally, if advice was given, very few physicians provided patients with smoking cessation tools. A smoking cessation program designed for use in a busy family practice setting was evaluated. For each patient who was a smoker, a card was attached to the medical chart as a reminder to the physician to discuss the subject of smoking at each subsequent visit. On the card, current smoking habits and intentions to quit were recorded. The physician could quickly see the history of smoking habits and intentions to quit for the individual patient. Self-help material was given to patients who decided to quit. When quitting goals were set, follow-up calls were made for reinforcement. Counseling sessions provided by the office nurse could be arranged for a small fee. In the clinic studied, the program initially increased quitting rates by three-fold to five-fold. During two years of the program, the overall quit rate was 20 percent. The rate was higher, at 33 percent, for patients who had more frequent doctor's appointments. Although it is difficult to apply results from one clinic to all family practices, the program was well received by both the medical staff and the patients, and it succeeded in helping patients stop smoking. The most effective and feasible approach to smoking cessation is repeated anti-smoking messages conveyed to the smoker over a period of time. (Consumer Summary produced by Reliance Medical Information, Inc.), There is a large discrepancy between apparent potential and actual practice of smoking cessation activities by physicians. This paper describes the 2-year results of an integrated system to support such physician activities with all of their tobacco-using patients. The system consists of organized identification, progress records, brief physician messages, follow-up, and assistance; it focuses on those most interested in quitting. Introduction of the system to one clinic was associated with an initial threefold to fivefold increase in quit rates of all clinic patients using tobacco. After 2 years, the overall quit rate was approximately 20%, rising to 33% for those tobacco users with more clinic contacts or at least 1 year from the first to the latest contact. Such a program has been well accepted by patients, physicians, and office staff and seems to provide the support needed for a feasible and effective long-term smoking cessation intervention in primary care practices., A Systematic Primary Care Office-Based Smoking Cessation Program No longer is there any serious national disagreement with Surgeon General Koop's statement that "smoking is the chief, single, avoidable cause of [...]

One of the obstacles to smoking cessation that I often encounter is my patients' concern about weight gain. Is there any helpful reassurance 1 can give them? * Advice from [...]