Objectives: Few studies have been published regarding the relevance of the admission diagnosis to the smoking cessation rate. We studied smoking cessation rates in relation to admission diagnoses in our inpatient smoking cessation programmes. Methods: This retrospective study included all patients recruited into our inpatient smoking cessation programmes at 2 institutions in Singapore between June 2008 and December 2016. Patients were given individualized intensive counselling and were followed up via phone interviews for up to 6-month to assess their smoking status. Multivariable logistic regression was used to analyse potential associations between admission diagnoses and 6-month abstinence. Results: A total of 7194 patients were included in this study. The mean age was 54.1 years, and 93.2% were male. In total, 1778 patients (24.7%) were abstinent at the 6-month follow-up call. Patients who quit smoking tended to be of Chinese ethnicity, have initiated smoking at a later age, be better educated, and have lower Fagerström Test of Nicotine Dependence scores. After adjusting for these factors, patients with a cardiovascular admission diagnosis had a significantly higher probability of quitting tobacco use than patients with a respiratory or other diagnosis. Conclusions In patients acutely admitted to the hospital, a diagnosis of cardiovascular disease was associated with the highest quit rate. Smoking cessation interventions need to be incorporated into all cardiovascular disease treatment pathways to leverage the patient’s motivation and to improve the quit rate. In addition, patients in groups with lower quit rates may benefit from more intensive programmes to increase the rate of successful cessation.

Asthma is the most common chronic respiratory illnessworldwide, and makes up a large part of primary carepractice. Family physicians need to be well-versed inasthma diagnosis, while avoiding overdiagnosis ormisdiagnosis. The tetrad of cough, chest tightness,wheezing and dyspnea are conventionally thought to bethe key presenting symptoms of asthma. However, thesesymptoms can occur in many other conditions, makingaccurate diagnosis of asthma challenging. This article aimsto outline the clinical features and investigations that can help the family physician diagnose asthma and formpossible differential diagnoses in adolescents and adults.Diligent history-taking remains paramount for diagnosis,while no investigation is definitive.

Acute Kidney Injury ; Critical Care ; Female ; Humans ; Male ; Sepsis/therapy*

Hospitals ; Humans

Adult ; Age Factors ; Burnout, Professional ; epidemiology ; psychology ; Cross-Sectional Studies ; Exercise ; Female ; Humans ; Internal Medicine ; education ; Internship and Residency ; Interprofessional Relations ; Male ; Physicians ; psychology ; statistics & numerical data ; Prevalence ; Risk Factors ; Singapore ; epidemiology ; Stress, Psychological ; epidemiology ; psychology ; Surveys and Questionnaires

Adult ; Humans ; Pneumonia/therapy*

Humans ; Pulmonary Disease, Chronic Obstructive/therapy* ; Asthma/therapy*

Humans ; Adult ; Renal Replacement Therapy ; Retrospective Studies ; Acute Kidney Injury/therapy* ; Critical Illness/therapy*

INTRODUCTIONDistractions and interruptions of doctor's work, although common and potentially deleterious in the intensive care unit (ICU), are not well studied.

METHODSWe used a simple observational method to describe the frequency, sources and severity of such distractions, and explore at-risk situations in the ICU. Independent paired observers separately shadowed eight residents and three fellows for 38 sessions (over 100 hrs) in a 20-bed medical ICU.

RESULTSIn total, 444 distractions were noted. Interobserver agreement was excellent at 99.1%. The mean number of distractions/doctor/hr was 4.36 ± 2.27. Median duration of each distraction was 2 mins (interquartile range 2-4 mins; range 1-20 mins). The top three initiators of distractions were other doctors (35.1%), nurses (30.4%) and oneself (18.7%). Of the 444 distractions, 107 (24.1%) were prolonged (lasting ≥ 5 mins), 210 (47.3%) led to a complete pause of current activity and 85 (19.1%) led to complete abandonment of the current activity. On multivariate analysis, physician seniority, time of session and day of week did not predict frequency of distraction. After adjusting for time of session, day of week and type of current activity, urgent distractions (to see another patient, perform immediate procedures or administer medications) and physician juniority were associated with major distractions (complete interruption or termination of current activity), while only urgent distractions were associated with prolonged distractions.

CONCLUSIONDistractions are common in the ICU and junior doctors are particularly susceptible to major distractions.

Adult ; Attention ; Attitude of Health Personnel ; Continuity of Patient Care ; Critical Care ; methods ; organization & administration ; Female ; Humans ; Intensive Care Units ; Internship and Residency ; Linear Models ; Male ; Medical Staff, Hospital ; Nurses ; Observer Variation ; Physicians ; Risk Factors ; Time Factors

Humans ; Artificial Intelligence ; Publications