2016-2018年上海市戒烟门诊患者干预效果分析

【目的】了解上海市戒烟门诊就诊患者的一般情况、吸烟情况、戒烟情况以及1个月随访情况,为进一步有效开展戒烟门诊提供科学依据。【方法】调查2016年1月1日-2018年12月31日前往项目选定戒烟门诊就诊的841名吸烟者,并于1个月后完成725名患者的随访工作,利用SPSS软件分析收集到的相关数据。【结果】2018年就诊患者中91.3%为男性;50.6%年龄在35~55岁;57.1%学历程度在小学及以下;60.2%是企业,商业,服务业工作人员。44.1%的患者每天吸烟支数在10~20支;34.6%的患者烟龄在10~20年;38.6%的患者起床后5 min内吸第1支烟。72.1%的患者在前往戒烟门诊前尝试过戒烟;14.8%的患者使用过电子烟帮助戒烟;33.9%知晓戒烟门诊的途径是本医院医生的告知;61.4%决定戒烟的原因是关注自己和家人的健康。2018年戒烟门诊1个月的时点戒烟率为48.8%;44.0%的患者认为对戒烟帮助最大的关键是自己的决心;46.2%戒烟未成功患者认为,最大的阻碍是烟瘾发作。【结论】上海市戒烟门诊的开设能够帮助患者戒烟,但依然存在一些问题。针对前往戒烟门诊的患者特点,应及时找出戒烟门诊宣传上的薄弱点,例如女性、低文化水平以及务农职业的患者较少;依据患者吸烟的情况,切实提升戒烟门诊服务质量;找出戒烟门诊在提供再次戒烟服务过程中的切入点,更好地完善上海市戒烟门诊的建设工作。     

Sources and types of referral to a haematology department

An audit was undertaken of the case notes of all new outpatients referred to the haematology department at the Leeds General Infirmary over a one-year period. The source, reason for referral, final diagnosis and outcome were determined in each case, along with essential biographical details. The results show that general practitioners initiated over half of all referrals, often prompted by written comments from a hematologist on a full blood count advising them that further tests were required. Almost a third came from other departments at the study hospital and the remainder originated from hospitals outside the district. Most general practitioner referrals were made with a request for a diagnosis. Hospital initiated referrals were more likely to have a final diagnosis of a malignant haematological disease, whereas those from general practice tended to have benign or self-limiting conditions. Ninety-one per cent of patients referred had an abnormality. There were low numbers of both clinic defaulters and those patients required to be re-referred to other specialties. These results suggest that the high quality of referrals is largely due to the general practitioner's decision to refer patients based on the full blood count result. This often occurs after discussion with haematology medical staff. The possible impact of the government's White Paper proposals on this outpatient service is discussed.     

Polycythaemia following renal transplantation.

Polycythaemia has developed in 10 of 59 regularly reviewed patients with renal transplants surviving more than three months. The pathology of the raised haemoglobin level was heterogeneous. Three patients had a picture characterized by a normal red cell mass and reduced plasma volume. Seven patients had a raised red cell mass; in 3 of these this was associated with a period of abnormal liver function and fitted with the state of raised red cell mass in association with hepatic transaminitis. The remaining 4 patients form a unique, previously undefined group with no features to explain the underlying aetiology of the polycythaemia. The patients had a trouble-free post-transplant course with early establishment of graft function. It is proposed, from the data obtained from in vitro culture studies, that the early return of good renal function allows the erythroid compartment to expand in response to circulating erythropoietin. The establishment of an erythron of increased size allows for a persistently raised haemoglobin in the presence of normal erythropoietin levels.     

Cervical lymphadenopathy resulting in a diagnosis of lymphoma

BACKGROUND AND AIMS: Currently there is no protocol in the west of Scotland for the investigation of a patient with a lymph node in the neck which might contain lymphoma. The aim of this audit was to examine the current management of these patients. METHODS: Data were collected on 112 patients diagnosed as having lymphoma from a neck node biopsy within a 12 month period from 1st November 2004 to 31st October 2005. Biopsy data were collected in combination with the first point of consultation, investigations used to arrive at diagnosis and any associated complications. RESULTS: Eighty seven percent of patients underwent excision biopsy with complications noted in 7%. Fine needle aspiration cytology (FNAC) was carried out in 60% of which 34% were ultrasound guided. Core biopsy was carried out in 17% of which 63% were ultrasound guided, Forty-five percent of patients were first referred to ear, nose and throat (ENT) surgery, 17% to general surgery, 14% to haematology, 13% to general medicine and 11% to other specialties. CONCLUSION: This audit shows that there was a wide range of first points of consultation and diagnostic procedures used. It is recommended that there should be access for all patients with cervical lymphadenopathy to a weekly neck lump clinic with standardised protocols for lymphoma diagnosis. This should ensure that patients are diagnosed accurately and treated in a timely manner.     

A controlled trial to integrate smoking cessation advice into primary care practice: Doctors Helping Smokers, Round III.

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. We therefore tested whether on-site recruitment, training, and organizational assistance in incorporating a smoking intervention system of documented efficacy into nonvolunteer primary care practices would result in higher rates of smoking cessation advice to patients. METHODS. This was a nonrandomized trial comparing all 10 primary care clinics in an intervention area to all 8 primary care clinics from a geographically separate control area. The evaluation was based on the smoking intervention activities of each of the clinics as reported on preintervention and postintervention mail surveys of cohorts of regular smokers seen in the clinics. RESULTS. Preintervention, 22.9% +/- 11.2% of the intervention clinic cohort and 21.9% +/- 9.6% (P = .84) of the control clinic cohort reported that they had been asked about tobacco during a clinic visit in the prior 6 months. Postintervention, the intervention clinic cohort was significantly more likely to report that someone had asked them if they smoked (39.8% +/- 12.3% vs 26.0% +/- 12.2%; P less than .05), that their physician asked them to quit if they were currently smoking (40.5% +/- 12.1% vs 26.4% +/- 14.6%; P less than .05), and that someone had commended them if they had recently quit smoking (28.2% +/- 19.8 vs 11.3% +/- 11.8%; P less than .05). CONCLUSIONS. The intervention significantly increased the rates at which a population of primary care clinics identified their patients who smoked, advised them to quit smoking, and commended those who had recently quit smoking.     

Smoking habits and attitudes of medical,students towards smoking and antismoking campaigns in fourteen european countries

From an ongoing global international survey we present the results for 14 European countries. The survey was carried out through a WHO-based questionnaire given to the students at the beginning of their first year and during the course of their final year. Daily smokers comprised 13.7% in first year and 21.5% in final year, with an overall variation between 3 and 33% according to country. There were already 16% of ex-smokers among first year students. More than 50% of smokers had made attempts to quit. 60% of daily smokers, and almost all others, thought that they would no longer be smoking in five years time.Knowledge of aetiology was moderate in first year. It later improved but there remained many lacunae in final year, e.g. less than 30% were aware that smoking was a cause of coronary artery disease. There was little knowledge of public health measures for smoking control.Attitudes were greatly influenced by smoking; ex-smokers were similar to non-smokers, with occasional smokers intermediate between these and daily smokers. Only 25% accepted a preventive and educative role in advising patients. As regards smoking, students were concerned with their personal health and with advising patients whom they knew to have smoking-related disease, but in general had little conception of smoking as a public health problem.The differences between countries indicate that both habits and attitudes are social and cultural problems. In most of the centres there seemed to be much room for improvement of medical education in this field.Corresponding author. with the collaboration of Institut d'Administration des Entreprises, Bordeaux, France and Laboratoire d'Informatique Médicale et de Bio-Statistique, Univ. Bordeaux II, Pr. R. Salamon, Dr. Y. Praque et A. Corson with the tecnical assistance of Mme S. Redon, Assistante Ingénieur de l'INSERM, Bordeaux, France.     

天津市戒烟门诊158名就诊吸烟者戒烟状况调查

目的 了解天津市戒烟门诊就诊吸烟者的人群特点、吸烟情况、戒烟情况,为更有效的开展戒烟门诊服务提供科学依据。方法 调查前来三家戒烟门诊就诊的158名吸烟者,并于一个月后进行随访。结果 就诊吸烟者中50%(79/158)是通过医生推荐或转诊至戒烟门诊,47.5%(75/158)决定戒烟的原因是自身患病,59.5%(94/158)的人尝试过戒烟;就诊吸烟者的平均烟龄为19.5年,平均每日吸烟量为16.3支;一个月随访的应答率为86.7%(137/158),一个月随访的时点戒烟率为43.1%(59/137),未戒烟者的一个月时点减烟率为56.4%(44/78);27.0%(37/137)的人认为医生或药物对其戒烟帮助最大。结论 天津市戒烟门诊能提高吸烟者的戒烟率,但目前就诊人数较少,还应继续加大戒烟门诊的宣传力度。     

Pulmonary function testing in a general medical practice

This study examined the feasibility and yield of spirometric screening in a general medicine clinic. Each of 354 randomly selected patients answered a questionnaire on respiratory symptoms and performed pulmonary function tests. Pulmonary testing required approximately two minutes and cost 95¢ per patient. Former smokers who stopped smoking because of symptoms displayed a higher prevalence of abnormalities than expected, and life-long smokers a lower prevalence (P<0.001). Fifty-three percent of current smokers had an abnormal pulmonary function test, and forty-two percent of these had no severe pulmonary symptoms. Pulmonary function tests performed in an outpatient clinic are rapid and expensive. Such tests demonstrate a large number of abnormalities which can be used to encourage smoking cessation.     

"I'll give up smoking when you get me better": patients' resistance to attempts to problematise smoking in general practice (GP) consultations

This paper focuses on general practice consultations where the issue of patients' smoking is raised and problematised by general practitioners (GPs) by linking it to their presenting or ongoing medical conditions. The data are taken from a larger study in one country of the UK, of the factors influencing discussion of smoking between GPs and patients who smoke. Consultations have been examined informed by the conversation analysis literature, with a focus on patients' resistance to doctors' problematisation of smoking. It is argued that, despite evidence from other areas of health care that advice is most effective when it is personalised, and despite GPs' expressed views that a preferred way of topicalising smoking is to make links to a patient's current medical problems, this is not generally the case in these consultations. Linking smoking to current problems commonly results in explicit resistance from patients of a kind that is rarely seen in other medical consultations. It is postulated that this results from the moral implications of linking a person's health status with their own behaviour, thereby undermining their claim to legitimate illness and to medical help.     

Inadequate recording of alcohol-drinking,tobacco-smoking and discharge diagnosis in medical in-patients: failure to recognize risks including drug interactions

Summary. The records of 62 men and 43 women, 14–88 years old, admitted to general medical wards in a public teaching hospital during 1991 were examined for discharge medications and for the recording of alcohol-drinking, tobacco-smoking and discharge diagnosis. Drinking and smoking status was unrecorded in 22.9% and 21.9% of patients respectively. Twenty-four patients had 31 potential drug interactions which were related to the number of drugs prescribed and to drinking alcohol; 10.5% of the patients had interactions involving alcohol and 2.9% tobacco. Six patients received relatively or absolutely contraindicated drugs, including one asthmatic given two β-blockers. The drugs prescribed indicated that some patients had conditions such as gastro-oeso-phageal disorders, diabetes and obstructive airways disease which had not been recorded. Inadequate recording of diagnoses, alcohol and smoking status creates risks to patients and may cause opportunities for preventive care to be missed. This study provides the basis for the development of undergraduate and postgraduate education programmes to address these issues and so decrease risks to patients which arise from inadequate recording practices. Incomplete diagnoses also adversely affect hospital funding where this depends on case-mix diagnostic groups. Quality assurance programmes and other strategies are being implemented to improve medical recording and prescribing habits.     

Evaluation of a televised stop-smoking clinic.

A stop-smoking clinic was designed to fit into the format of a local television news program in New York City. A step-by-step quitting plan consisting of twenty 30- to 90-second segments was broadcast each weekday evening for 4 weeks in August 1975. Almost 4,800 smokers "registered" for the clinic by postcard, and a sample of 310 was followed up at the end of the clinic and 1 month later. The majority of the respondents were women. The average age was 47 for men and 49 for women. They had been smoking for more than 30 years, and when they registered for the clinic, they were averaging more than 30 cigarettes a day. Almost half had never been off cigarettes for as long as 24 hours. In general, the respondents were similar to the hardcore smokers that usually attend smoking clinics. Almost 10 percent reported that they had stopped smoking by the end of the broadcasts. The rate of quitting among men was twice that among women. A major factor differentiating those who quit from those who did not was the number of programs they had seen. The lower rate of quitting among women was due mostly to the women smokers over age 50 in the sample. The study indicated that use of the mass media may be an effective way to reach the large number of smokers who would not attend organized clinics but who may be able to stop smoking on their own with minimal support and guidance.     

Proxy respondents in reproductive research: a comparison of self- and partner-reported data

The quality of proxy reporting was assessed among 136 prenatal patients and their spouse/partners recruited from the obstetric services of a New Jersey hospital between 1985 and 1987. The concordance, sensitivity, and specificity of proxy reports about partners' occupation, smoking, and drinking were examined in relation to self-reports. Overall, private patients provided better proxy data than did clinic patients, and women provided better data than did men. No consistent effects on the quality of proxy reports were found in relation to age, level of education, marital status, or length of cohabitation. Partners' recent job titles appeared to be quite accurately reported, whereas partners' smoking and drinking patterns were less well-reported. For alcohol use in particular, there was evidence of considerable misclassification resulting from proxy reports even when kappa statistics and intraclass correlation coefficients suggested good agreement. Use of proxy respondents is unnecessary in reproductive studies and should be avoided when it may produce misleading results. Our data indicate that private prenatal patients and their partners can give reasonable proxy reports about job titles and smoking, but not about alcohol use. The high proportion of clinic patients who did not refer a partner (or whose partners could not be contacted) limits the generalizability of our results for this group and gives cause for concern about collecting proxy information from clinic populations.     

Nosocomial transmission of Saccharomyces cerevisiae in bone marrow transplant patients

Saccharomyces cerevisiae is an unusual cause of clinical infection. We describe three bone marrow transplant patients on a haematology unit who developed possible invasive disease with the organism. Two patients died and both these patients appeared to have a related strain of S. cerevisiae. Screening for S. cerevisiae from throat and stool samples revealed four further patients who were carriers. Genotyping of the invasive and carriage strains demonstrated an indistinguishable strain from patients who had been on the unit at the same time, suggesting cross-infection.     

Five year follow-up of a smoking withdrawal clinic population.

Eight hundred volunteers who attended smoking clinics at Roswell Park Memorial Institute from 1964-1965 were followed up five years later to ascertain their current smoking status. From three waves of a mailed questionnaire, plus a telephone campaign, we obtained 559 usable responses. The relationship between smoking status at the five-year follow-up and clinic protocols and selected social and psychological characteristics as determined during the clinics were examined. Of those individuals contacted five years after the clinic, 17.8 per cent were not smoking. Variations in clinic protocol in terms of drugs and education methods had no relation to long-term smoking withdrawal. Several social and psychological variables, however, were related to smoking behavior five years after the clinics. Non-smokers were more likely than smokers to be males, to be older, to have smoked less before the clinic, to have started smoking at a later age, to have a milieu that was supportive of their stopping, and to have fewer indices of neurosis and fewer psychosomatic symptoms.     

Bias in maternal reports of smoking during pregnancy associated with fetal distress

BACKGROUND: Studies examining the adverse effects of smoking during pregnancy commonly use maternal reports. We hypothesized that if an adverse event occurred during pregnancy, women may underreport smoking. This study looked for bias in maternal report of smoking if fetal distress occurs. METHODS: Data were collected prospectively from patients attending The MotheRisk Program who smoked during pregnancy, and were categorized by delivery outcome, maternal and neonatal characteristics, and the raw number of cigarettes smoked per day during pregnancy reported at clinic and at follow-up. The difference between these two values was compared. RESULTS: 95 women had uneventful deliveries and 25 had fetal distress. Women who reported fetal distress decreased their report of smoking after delivery compared to their original report during pregnancy, whereas women with an uneventful labour did not (p = 0.04). CONCLUSIONS: Our results suggest that if an adverse pregnancy outcome occurs, mothers may tend to underreport their cigarette consumption.     

Trends in bacteraemia on the haematology and oncology units of a UK tertiary referral hospital

As part of ongoing surveillance of infection in the haematology and oncology units at Belfast City Hospital, microbiologically documented bloodstream infections over three 12-month periods 1994/5, 1998/9 and 1999/00 were reviewed. Gram-positive organisms were the most common cause of blood stream infection in the haematology unit causing 66%, 56% and 64% of episodes of monomicrobial bacteraemia in 1994/5, 1998/9 and 1999/00, respectively. In haematology patients, enterococci have emerged as an important cause of bacteraemia, with increasing levels of glycopeptide resistance, and the 'non-fermenting Gram-negative rods other than Pseudomonas aeruginosa' are an increasingly common cause of monomicrobial and polymicrobial bacteraemia. In oncology patients, Gram-negative organisms (predominantly enterobacteriaceae) were more common than Gram-positive organisms, causing 50% and 54% of monomicrobial bacteraemia in 1998/9 and 1999/00, respectively. Changes in patient population, underlying diseases and chemotherapeutic agents may explain these findings. The spectrum of infection seen in haematology and oncology patients changes as management evolves. Ongoing co-operation between haematologists, oncologists and microbiologists is important to detect trends in epidemiology, which can be used to design empirical antibiotic regimens and guide infection control policies.     

Age-related macular degeneration and smoking cessation advice by eye care providers: a pilot study

Smoking is a modifiable risk factor for age-related macular degeneration (AMD), the leading cause of irreversible vision loss in the United States. We conducted a pilot study among eye care providers and AMD patients to assess smoking cessation preferences and cessation services offered at a large academic medical center. Most patients who smoke reported never being advised to quit smoking, although most eye care providers reported that they had advised smokers to quit. Two-thirds of providers expressed a desire for additional training and resources to support patient quit attempts, indicating the need for the integration of smoking cessation opportunities in the clinic setting.     

Peer Reviewed: Age-Related Macular Degeneration and Smoking Cessation Advice by Eye Care Providers: A Pilot Study

Smoking is a modifiable risk factor for age-related macular degeneration (AMD), the leading cause of irreversible vision loss in the United States. We conducted a pilot study among eye care providers and AMD patients to assess smoking cessation preferences and cessation services offered at a large academic medical center. Most patients who smoke reported never being advised to quit smoking, although most eye care providers reported that they had advised smokers to quit. Two-thirds of providers expressed a desire for additional training and resources to support patient quit attempts, indicating the need for the integration of smoking cessation opportunities in the clinic setting.