A Ellsworth — Page 2 | PubMed Health

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Smoking cessation counseling among hospitalized smokers.

The purposes of this study were (1) to describe how much smoking cessation counseling patients receive in a hospital with a nonsmoking policy and (2) to describe the attitudes of these smokers toward the nonsmoking policy. Forty-three (48%) of 89 eligible smokers hospitalized during a one-month period were surveyed by mail. Sixty-eight percent reported receiving, during hospitalization or at the time of discharge, at least one of nine counseling procedures related to smoking cessation. Forty-eight percent reported more than one counseling procedure. Less than 15% received information about symptoms of nicotine withdrawal, means of abstaining during hospitalization, means of permanently quitting, or medications for nicotine withdrawal symptoms during hospitalization. None of the patients had smoking cessation included in plans for future care upon hospital discharge. Only 24% strongly disagreed with the hospital's nonsmoking policy. We conclude that the mere institution of a nonsmoking hospital policy does not ensure that hospitalized smokers are adequately counseled regarding smoking cessation or that this counseling will be considered in discharge planning.

Adult↗

PubMedDate not supplied

Excessive thyroid hormone replacement therapy.

BACKGROUND: Excessive thyroid hormone replacement carries the potential for serious long-term metabolic complications (e.g., accelerated osteoporosis). The increased bioavailability of commercially available products, along with improved laboratory assays for measuring thyrotropin (TSH), has led to an increased chance of actual or detected iatrogenic hyperthyroxinemia. The purpose of this study was to determine the frequency of excessive prescribing and to examine the impact of changes in potency of replacement thyroid hormone formulations and sensitivity of thyroid function tests on its incidence. METHODS: A retrospective chart review was done of patients requiring thyroid hormone replacement therapy treated at a university-based, family medicine residency training program. The following information was extracted from each chart: specific thyroid medication (including dose and date of onset of therapy) and thyroid laboratory tests results (including serum thyroxine [T4] and TSH). This information from two different time periods (1975 to 1981 and 1982 to 1989) was compared using one-way analysis of variance. RESULTS: Serum T4 levels were not significantly different between the two time periods, 1975 to 1981 and 1982 to 1989 (8.06 +/- 2.93 micrograms/dl versus 9.0 +/- 03.69 micrograms/dl; NS), despite significant changes in TS serum levels (23.6 +/- 38.9 mIU/mL versus 7.44 +/- 18.7 mIU/ml; P = 0.009) and levothyroxine dosage (184 +/- 59.6 micrograms/d versus 145 +/- 64.1 micrograms/d; P = 0.002). Significantly more patients had low (supersuppressed) TSH levels between 1982 and 1990 than between 1975 and 1981 (33 percent versus 10 percent; P = 0.02.) CONCLUSIONS: Excessive thyroid hormone replacement with iatrogenic hyperthyroxinemia is a common occurrence. Clinicians need to be aware of this problem and implement measures (e.g., periodic monitoring of TSH) to minimize the occurrence of overdosing and the potential for long-term complications.

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