BACKGROUND:Cancer patients who continue smoking are at increased risk for adverse outcomes including reduced treatment efficacy and poorer survival rates. Many patients spontaneously quit smoking after diagnosis; however, relapse is understudied. The goal of this study was to evaluate smoking-related, affective, cognitive, and physical variables as predictors of smoking after surgical treatment among patients with lung cancer and head and neck cancer. METHODS: A longitudinal study was conducted with 154 patients (57% male) who recently quit smoking. Predictor variables were measured at baseline (ie, time of surgery); smoking behavior was assessed at 2, 4, 6, and 12 months after surgery. Analyses of 7-day point prevalence were performed using a Generalized Estimating Equations approach. RESULTS: Relapse rates varied significantly depending on presurgery smoking status. At 12 months after surgery, 60% of patients who smoked during the week prior to surgery had resumed smoking versus only 13% who were abstinent prior to surgery. Smoking rates among both groups were relatively stable across the 4 follow-ups. For patients smoking before surgery (N ¼ 101), predictors of smoking relapse included lower quitting self-efficacy, higher depression proneness, and greater fears about cancer recurrence. For patients abstinent before surgery (N ¼ 53), higher perceived difficulty quitting and lower cancer-related risk perceptions predicted smoking relapse. CONCLUSIONS: Efforts to encourage early cessation at diagnosis, and increased smoking relapse-prevention efforts in the acute period following surgery, may promote long-term abstinence. Several modifiable variables are identified to target in future smoking relapse-prevention interventions for cancer patients. Cancer 2013;119:1420-7. V C 2012 American Cancer Society.KEYWORDS: tobacco use, smoking relapse, head and neck cancer, lung cancer. INTRODUCTIONCigarette smoking is responsible for 30% of all cancer-related mortalities. 1 Lung cancers and head and neck cancers are among the malignancies most strongly linked to tobacco use, 1 and a significant proportion of patients with lung cancer and/or head and neck cancer are current smokers at the time of diagnosis. 2,3 Smoking cessation reduces morbidity and mortality in these patients, 4,5 whereas continued smoking after diagnosis increases patients' risk for other smoking-related illnesses (eg, coronary heart disease), second primary tumors, 6,7 and disease recurrence. 5,6 Continued smoking also has more immediate adverse impact, including reduced cancer treatment efficacy, 8,9 higher rates of treatment complications and side effects, 10-13 greater treatment-related weight loss, 14 and poorer quality of life. [15][16][17] The majority of patients smoking at the time of their diagnosis spontaneously quit smoking (eg, 86% among patients with lung cancer 18 ; 84% among patients with head and neck cancer 19 ), with the greatest proportion of quit attempts occurring at diagnosis. 20 Furthermore, smoking cessation interventions for can...

Objective-To fill a gap in research by examining cancer patient-provider communication regarding tobacco use and patients' perspectives regarding their experiences with smoking cessation and relapse.Methods-In-depth interviews were conducted with 20 lung and head and neck cancer patients and 11 health care providers.Results-Qualitative analyses revealed that cancer patients express high levels of motivation to quit smoking; however patients do not ask providers for assistance with quitting and maintaining abstinence and relapsed patients are reluctant to disclose smoking behavior due to stigma and guilt. Health care providers vary in the advice and type of assistance they supply, and their awareness and sensitivity to relapsed patients' feelings. Whereas providers emphasized long-term risks of continued smoking in their interactions with patients and recommendations for intervention content, patients expressed a preference for a balance between risks and benefits.Conclusion-Findings underscore the need for increased awareness, emphasis, and communication about the immediate risks of continued smoking and the benefits of continued abstinence specifically for cancer patients.Practice Implications-Our findings demonstrate the potential to affect cancer outcomes by improved training in conducting smoking cessation and relapse prevention interventions. Additional training could be given to health care providers to increase adherence to clinical practice guidelines (5 A's), to learn ways to enhance patients' motivation to maintain abstinence, and to deliver smoking messages in a non-threatening manner.

Introduction: The primary objective of this study was to determine whether Altmetric score, number of reads, and citations for paediatric cardiology manuscripts correlate with one another. A secondary objective was to determine the extent to which factors mediated citation number for paediatric cardiology manuscripts. Methods: Data for this study came from manuscripts published in Cardiology in the Young (2010–2021). Data were extracted by using data shared on the journal website. Spearman’s correlation analyses were conducted between manuscript reads, citations, and Altmetric score. Regression analyses were conducted with number of citations as the dependent variable and year of publication, publication type, number of reads, and Altmetric score as independent variables. Results: A total of 2642 manuscripts were included in the final analyses. Reads and citations had poor correlation (r-value 0.32); reads and Altmetric score had negligible correlation (r-value 0.26); and Altmetric score and citations had negligible correlation (r-value 0.07). Year of publication was independently associated with number of citations (β –0.95, p-value <0.01). Manuscript type was independently associated with number of citations (β 1.04, p-value <0.01). Number of reads was independently associated with citations (β 0.01, p-value <0.01). Altmetric score was independently associated with number of citations (β 0.05, p-value <0.01). Conclusion: This study describes the correlation of reads, citations, and Altmetric score in manuscripts published in Cardiology in the Young, demonstrating poor correlation, at best, between these metrics. Each bibliometric index seems to represent a different phenomenon of manuscript consumption. No single bibliometric index in isolation offers ample representation of manuscript consumption.

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Introduction: In children, data on the effects on carnitine supplementation and myocardial function are limited. A few studies have investigated the relationship between serum carnitine levels in the setting of depressed cardiac function and have demonstrated possible benefits. As such, this systematic review and meta-analyses aimed to assess the effects carnitine supplementation on left ventricular function. Materials and Methods: A systematic review of the literature was performed to identify full text manuscripts in English. PubMed, EMBASE, and the Cochrane databases were queried. Studies were included with data from pediatric patients, that used carnitine supplementation and included pre-and post-carnitine data for at least one of the outcomes of interest. Results: A total of six studies including 144 patients were included. Carnitine dosage ranged from 50 to 100 mg/kg/day. The average duration of carnitine therapy was 9.8 months. Left ventricular ejection fraction was higher after carnitine supplementation with a mean difference between groups of 3.56 [95% confidence interval 0.06-7.06, p-value 0.04]. Left ventricular shortening fraction was higher after carnitine supplementation with a mean difference between groups of 3.68 [95% confidence interval 1.22-6.15, p-value 0.01]. Left ventricular end diastolic diameter was higher after carnitine supplementation, but the difference did not reach significance. Conclusion: Carnitine supplementation may augment left ventricular ejection fraction and shortening fraction. Those with lower baseline ejection fraction and shortening fraction appear to benefit the most from carnitine supplementation. Additional studies of the effects of carnitine on cardiac function are warranted.