Healthcare staff attitudes towards the use of electronic cigarettes ('e-cigarettes') compared with a local trust policy.

BACKGROUND: E-cigarette use has risen dramatically in recent years, despite uncertainty over long-term health effects and concerns regarding efficacy as a smoking cessation device. Currently, there is no legislation prohibiting use in public, though many trusts have extended the NHS Smokefree policy to include e-cigarettes. The successful implementation of such policy is, however, unclear. AIM: This study examined staff attitudes towards the use of e-cigarettes in a hospital environment with respect to enforcement of a local trust smoking policy. METHODS: A total of 79 healthcare professionals working at South Tyneside District Hospital, South Shields, completed a written questionnaire regarding use of e-cigarettes, particularly views on use in public and on hospital premises. Factors influencing the likelihood of individuals to challenge the use of e-cigarettes were assessed. RESULTS: In all, 45% of respondents thought that e-cigarettes should be allowed in public places, though a majority (62%) favoured use on hospital grounds compared to within hospital buildings (18%). Over 50% of respondents were unaware of trust policy relating to e-cigarettes and only 25% had ever challenged someone using a device. Roughly, one-third reported that they would still not challenge someone in future, despite being informed of trust policy. Fear of abuse was the most cited reason for not challenging. Expressed concerns of e-cigarette use related to fire risk, 'normalising' smoking behaviour and uncertainty of long-term effects. CONCLUSION: Most staff do not enforce trust policy regarding e-cigarette use. This reflects variation in opinion over use, poor awareness of the policy itself and perceived barriers to implementation, including fear of abuse. Addressing these issues through staff education sessions may help successful future implementation.

Traumatic chylothorax: A case report and review.

Chylothorax is a rare entity characterised by leakage of lymphatic fluid into the pleural cavity from the thoracic duct. We present a case of traumatic chylothorax following a traumatic fracture of the L1 vertebra. An 84-year-old lady presented to the emergency department after being found collapsed at home. She gave a preceding history of one day of diarrhoea. Chest X-ray showed a rightsided effusion. Drainage of the effusion yielded a cloudy, off-white fluid that settled in layers in the drainage container. Pleural fluid examination revealed a lymphocyte-rich transudate with high levels of cholesterol and triglycerides. CT imaging of the chest, abdomen and pelvis revealed an acute left sided pulmonary embolus, and a multisegment burst fracture of the L1 vertebra. The patient was anticoagulated for the pulmonary embolus. Conservative fracture management was advised. Chylous drainage of 1l/24hr was observed. Due to ongoing chylous leak the patient was commenced on a medium-chain fatty acid diet and octreotide. Whilst chylous drainage ceased the patient died from infected pressure sores, malnutrition and acute kidney injury. Spinal trauma can rarely cause disruption of the thoracic duct and chylothorax. Diagnosis of chylothorax hinges on the typically high triglyceride content of chylous fluid and the detection of chylomicrons where the triglyceride concentration is equivocal. Management options for persistently draining chylothorax are varied and range from non-invasive medical measures to radiological and surgical interventions (although the patient in the case we present was an unsuitable candidate for surgery). We discuss pertinent diagnostic testing and put forward possible medical management strategies for chylothorax.

Emphysema and COPD in a young woman.

A 28-year old woman presented with a progressive cough and breathlessness. She had a family history of early onset COPD. Spirometry demonstrated airflow obstruction with no reversibility. An HRCT showed extensive centrolobular emphysema with an upper lobe predominance. Blood tests including an Alpha - 1 Antitrypsin level were normal.

Achieving a smoke-free hospital: reported enforcement of smoke-free regulations by NHS health care staff.

BACKGROUND: In December 2006, all UK NHS trusts introduced smoke-free regulations prohibiting smoking on all NHS sites. These rules are to be enforced by all NHS trust staff. We have investigated the implementation of these regulations by health care workers when they encounter smokers on a NHS hospital site. METHODS: Eighty-five medical and nursing staff working in acute medicine at the Queen Elizabeth Hospital, Gateshead, completed a questionnaire reporting their behavior when exposed to smokers on NHS hospital sites. RESULTS: Over 50% of medical and nursing staff reported that they would not challenge patients, staff or visitors smoking on NHS trust site. There was a trend for employees to be more likely to challenge patients than visitors, and to be more likely to challenge visitors than other staff. Fear of aggression was the most commonly reported reason for not challenging smokers. CONCLUSIONS: Most medical and nursing staff report that they do not enforce NHS smoke-free regulations and do not challenge smokers on NHS sites. This is due to many real and perceived barriers including fear of aggression. Overcoming these barriers is an important area of research to guide successful implementation of future smoking policy. There may be scope for improvement through training in NHS policy and in non-confrontational communication skills.