Objective To assess whether offering free mailed nicotine replacement therapy (NRT) and telephone counselling to smokers on elective surgery waiting lists increases quitting before surgery. Design, setting Randomised, controlled trial at Frankston Hospital, a public tertiary referral hospital in Melbourne. Participants Adult smokers added to elective surgery waiting lists for operations at least ten days in the future, 1 April 2019 ‒ 3 April 2020. Intervention In addition to normal care, intervention participants received a brochure on the risks of low frequency smoking, an offer of Quitline call‐back registration, and an offer of mailed NRT according to reported daily smoking: 1‒9 cigarettes/day, 2 mg lozenges; 10‒15/day, 7‒14 mg patches [three weeks] and 2 mg lozenges; > 15/day, 7‒21 mg patches [five weeks] and 2 mg lozenges. Main outcome measures Primary outcome: quitting at least 24 hours before surgery, verified by exhaled carbon monoxide testing. Secondary outcomes: quitting at least four weeks before surgery, adverse events, and (for those who had quit before surgery) abstinence three months after surgery. Results Of 748 eligible participants (control, 363; intervention, 385), 516 (69%) had undergone elective surgery when the trial was terminated early (for COVID‐19‐related reasons) (intervention group, 274; control group, 242). 122 of the 385 intervention participants (32%) had accepted the offer of cessation support. The proportions of intervention participants who quit at least 24 hours before surgery (18% v 9%; odds ratio [OR], 1.97; 95% CI, 1.22‒3.15) or at least four weeks before surgery (9% v 4%; OR, 2.20; 95% CI, 1.08–4.50) were larger than for the control group. Three months after surgery, 27 of 58 intervention (47%) and 12 of 25 control participants (48%) who quit before surgery reported not smoking in the preceding seven days. No major adverse events were reported. Conclusion Uptake of free mailed NRT and Quitline support by smokers on elective surgery waiting lists was good, and offering additional support was associated with higher proportions of smokers quitting before surgery. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12619000032156 (prospective).

Aim: To evaluate the risk of acute kidney injury (AKI) in patients who receive vancomycin (VNC) and piperacillin-tazobactam (PTZ) combination therapy. Method: A single centre, retrospective audit of adult patients treated with VNC alone and in combination with PTZ between 2014-2015. Data was extracted from digital medical records and therapeutic drug monitoring sheets completed by clinical pharmacists. Rates of AKI and duration of combination therapy were analysed by chi-square, with logistic regression analysis completed to control for nephrotoxins, intensive care unit admission, use of inotropes and pre-existing chronic kidney disease. Results: Out of 525 vancomycin courses, that met the inclusion criteria, 211 had PTZ co-prescribed during the study period. Combination therapy was significantly both associated with an increased rate of AKI compared to VNC use alone (17.5% vs 10.5%, P = 0.02). The mean duration of combination therapy was 4 days (1-17 days). Increased duration of exposure to combination therapy was also associated with a higher incidence of AKI (3.8 days vs. 5.2 days, P = 0.014). VNC-TPZ combination was identified to be an independent risk factor for AKI (OR 1.73, 95% CI 1.01-2.96, P = 0.046) after adjusting for other known risk factors for AKI, including vasopressor use and intensive care unit admission. Conclusion: Combined use of VNC-PTZ, as well as the duration of combination therapy are both associated with an increased risk of AKI compared with VNC alone. The results are similar to previous literature reports of AKI from the combination of antibiotics. Healthcare providers need to be vigilant and limit the exposure to this combination as clinically appropriate.

IntroductionSmoking is a leading cause of premature deaths globally. The health benefits of smoking cessation are many. However, majority of quit attempts are unsuccessful. One way to potentially improve success rates is to evaluate new combinations of existing smoking cessation therapies that may work synergistically to decrease the intensity of withdrawal symptoms and cravings.AimsTo evaluate the feasibility, efficacy and safety of the combination of varenicline and nicotine replacement therapy (NRT) lozenges versus varenicline alone in assisting hospitalised smokers to quit.Methods and analysisThis is a multicentre, randomised, placebo-controlled trial. Adults with a history of smoking ≥10 cigarettes per day on average in the 4 weeks prior to their hospitalisation will be recruited. Participants will be randomly assigned to either the intervention group and will receive varenicline and NRT lozenges, or the control group and will receive varenicline and placebo lozenges. All participants will be actively referred to behavioural support from telephone Quitline. Participants are followed up at 1 and 3 weeks and 3, 6 and 12 months from the start of treatment. The primary outcome is carbon monoxide validated prolonged abstinence from 2 weeks to 6 months after treatment initiation. Secondary outcomes include self-reported and biochemically validated prolonged and point prevalence abstinence at 3, 6 and 12 months, self-reported adverse events, withdrawal symptoms and cravings, adherence to treatment, Quitline sessions attended and others. According to the Russell Standard, all randomised participants will be accounted for in the primary intention-to-treat analysis.Ethics and disseminationThe trial will be conducted in compliance with the protocol, the principles of Good Clinical Practice, the National Health and Medical Research Council National Statement on Ethical Conduct in Human Research (updated 2015) and the Australian Code for the Responsible Conduct of Research (2018). Approval will be sought from the Human Ethics Committees of all the participating hospitals and the university. Written informed consent will be obtained from each participant at the time of recruitment.Trial registration numberAustralia New Zealand Clinical Trials Registry (ACTRN12618001792213).

Background Understanding smoking behaviors in hospital patients who smoke may improve inpatient cessation treatments. This study aimed to describe smoking‐related behaviors, past‐quit attempts, and self‐reported difficulties experienced in quitting among those who enrolled in a smoking cessation trial of varenicline. Methods Baseline data were obtained from adult hospitalized smokers (average ≥ 10 cigarettes/day in 4‐weeks prior to hospitalization) who enrolled in a randomized, placebo‐controlled trial of varenicline ± nicotine lozenges at five Australian public hospitals. A logistic regression model tested the association between participant characteristics and quitting in the previous 12 months. Results Participants' (n = 320; 57% male, 52.5 ± 12.1 years old) motivation and confidence in quitting were high. A total of 120 participants (37.5%) had attempted quitting in the previous 12‐months. Prior hospitalization (P = .008) and employment status (P = .015) were significantly associated with past quit attempts. No statistically significant differences were noted in the reason for hospitalization or the level of nicotine dependence between participants who attempted quitting in the previous 12 months and their counterparts. Smoking cessation pharmacotherapy was used by 55% of those attempting to quit; nicotine replacement therapy (65.2%) and varenicline (16.7%) most common. Stress or anxiety, urges to smoke and a lack of motivation were the difficulties experienced in past quit attempts. Conclusions Those who had a prior hospitalization and were unemployed had significantly greater odds of reporting past quit attempts. Further research is needed to investigate the degree of adherence among inpatient smokers with the smoke‐free hospital policies and the frequency of NRT provision and uptake on admission.