Summary. Four hundred and twenty-nine patients received myeloablative chemotherapy for solid and haematological malignancies in a bone marrow transplantation unit. Regimens appropriate to the tumour type were administered and haemopoietic reconstitution was achieved with peripheral blood progenitor cells (PBPC; n 275), autologous bone marrow (auto-BMT; n 69) or allogeneic bone marrow (allo-BMT; n 85). World Health Organization (WHO) oral mucositis scores were collected prospectively from the start of chemotherapy (d 1) until d 28 or discharge. Oral mucositis (OM) was experienced by 425 (99%) patients and in 289 (67´4%) this was grade III or IV. Strong opiate analgesia was prescribed for a median of 6 d to 47% of patients. Univariate analysis suggested that the area under the OM curve (AUC; sum of daily mucositis grades, d 1±28) was associated with the myeloablative regimen, haemopoietic progenitor source (PBPC . allo-BMT . auto-BMT), use of myeloid growth factors and age. Multivariate analysis showed that the only independent risk factor for mucositis was the conditioning regimen (P , 0´00005). The mean OM AUC for high-dose melphalan (HDM) regimens (52 grade±days) exceeded busulphan (41), busulphan±cyclo-phosphamide (35), cyclophosphamide±total body irradiation (TBI) (34), cyclophosphamide±carmustine (BCNU) (20) and cyclophosphamide±etoposide±carmustine (CVB) (19). HDM regimens resulted in the highest mean peak OM (3´6), followed by busulphan regimens (2´6), cyclophosphamide/TBI (2´3) and cyclophosphamide±carmustine and CVB (1´4). Busulphan produced significantly delayed OM (median 3 d; P , 0´00005). There was a linear association between the area under the OM curve for each treatment group and the time to reach grade 3 OM (P , 0´00005), but no association with the time to reach grade 4 neutropenia (P 0´24) or thrombocytopenia (P 0´73), implying that haematological and mucosal toxicity are not associated. The cytotoxic regimen is the most significant determinant of OM. Studies investigating agents to ameliorate mucosal toxicity should be stratified according to cytotoxic regimen.

Staff attitudes need to be carefully considered, particularly in psychiatric settings, in attempts to implement smoke-free policies in health care settings.

The UK Department of Health required that by April 2001, all NHS bodies would have implemented a smoking policy. It has been suggested that the best demonstration a hospital can make of its commitment to health is to ban smoking on its premises. This paper reports on an evaluation of the effectiveness of a non-smoking policy in a newly opened NHS psychiatric hospital. Questionnaires were sent to all 156 nursing staff in a psychiatric hospital to assess the effectiveness of the policy in terms of staff smoking behaviour, attitudes to the restriction and compliance with the policy. Of the 156 questionnaires distributed, 92 (58%) were returned; smokers, former smokers and those who have never smoked were quite evenly represented at 34.78%, 34.78% and 30.43%, respectively. Of eight critical success factors for the policy, only one, staff not smoking in Trust public areas, had been achieved. A non-smoking policy was generally accepted as necessary by nursing staff working in a mental health setting. Staff felt that the policy was not effective in motivating smoking nurses to stop and that insufficient support was given to these nurses. The study highlights the importance of introducing staff support systems as an integral part of smoking policies and the role of counterintuitive behaviour in the effectiveness of smoking policy introduction in healthcare settings.