ABSTRACT
INTRODUCTION: Smoking cessation support (SCS) in the hospital is essential; patients often struggle to maintain quit attempts, which necessitates assistance from healthcare professionals (HCPs). However, unknown barriers can obstruct the implementation of SCS in hospitals. This study aims to uncover barriers to the implementation of SCS in psychiatric, somatic, inpatient, and outpatient hospital settings. METHODS: In the period from June to September 2021, HCPs in a large secondary care hospital in the Region of Southern Denmark completed an online, cross-sectional study, providing sociodemographic details and listing potential barriers to SCS. They also shared additional barriers in the form of free-text responses. Descriptive statistics and thematic analysis of free-text responses were performed. RESULTS: Of 1645 HCPs surveyed, 409 elaborated their response in the free-text field assessing unlisted barriers. Top listed barriers, reported by more than one-third of participants, included: 'lack of time' (45.1%), 'lack of patient motivation' (34.3%), and 'insufficient knowledge on how to support' (32.2%). Free-text responses revealed three barrier-related, which we grouped under the themes of: 'Concerned about the patient', 'Not part of my job', and 'Inappropriate setting'. CONCLUSIONS: This quantitative and qualitative study identifies barriers to SCS on multiple levels in the hospital setting, i.e. on the patient, provider, and organizational levels. These results can inform healthcare organizations and professionals in the implementation of SCS in routine hospital care.
ABSTRACT
Chronic hypoparathyroidism (HypoPT) is a common complication after total thyroidectomy and it impacts affected patients' quality of life (QoL). This study aimed to assess the QoL in patients with chronic HypoPT independently from their concurrent hypothyroidism and other comorbidities. For this purpose a follow-up study was performed, including 14 patients who developed chronic HypoPT after total thyroidectomy and 28 age- and sex-matched patients who had intact parathyroid function after total thyroidectomy. We used the RAND Short Form 36 Health Survey (SF-36) to compare the QoL between patients with or without chronic HypoPT. Chronic HypoPT patients had lower QoL scores in all domains of the RAND-SF-36 questionnaire and significant impairment in six of eight domains after adjustment for relevant confounders. They were more often operated because of a toxic diagnosis (p = .01), often being Graves disease. Additionally adjusting for surgical indications resulted in three of eight domains being significant affected. Chronic HypoPT is associated with significantly impairment of QoL, independently of the concurrent disease of hypothyroidism, comorbidities, and prospective values of TSH and serum (se)-ionized-Ca++. There is a need for more focus and better treatment of patients experiencing chronic HypoPT after surgery. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
ABSTRACT
INTRODUCTION: Hypoparathyroidism (HypoPT) is the most common complication after total thyroidectomy (TT). Recent literature report incidences of HypoPT that are higher than previously anticipated. This study aimed to assess the incidence of transient and chronic HypoPT in patients undergoing TT and to specify risk factors and recovery time. METHODS: This was a retrospective review of patients undergoing TT in the period from 2013 to 2018 due to benign thyroid disease in a Danish university hospital. In total, 187 patients were eligible for inclusion. Data were collected from internal medical files, the Thykir database sheets and patient records. HypoPT was defined as SE-ionised-Ca2+ levels (Less than 1.16 mmol/l) and inappropriately low parathyroid hormone levels. RESULTS: The incidence of transient and chronic HypoPT was 81 (43.3%) and 25 (13.4%), respectively. Younger ages and toxic indication for surgery were independent risk factors for transient and chronic HypoPT. Incidences in Graves' disease population were 70.5% and 27.3%, respectively. Resolution within the first months was seen in 48.2% of the patients with acute transient HypoPT. CONCLUSIONS: The incidence of chronic HypoPT after TT is higher than previously reported. This is primarily due to a lack of consistency in the definition and follow-up time between studies. Younger patients and those with a toxic indication for surgery are at higher risk of HypoPT after TT than other patients. FUNDING: none. TRIAL REGISTRATION: The study was approved by the Danish Data Protection Agency (REG-015-2019) and The Ethical Committee of Central Denmark (No. 66792).
