Perioperative medicine training resources: U2M17: Considerations for optimizing patient safety and outcomes

Ensuring informed consent is properly obtained is a legal, ethical and professional requirement on the part of all treating health professionals and supports person-centred care.

This guideline applies to all healthcare professionals who support people wishing to quit smoking. It is intended to be relevant to the wider primary care setting, and is not limited to general practice. This is reflected in the multidisciplinary composition of the guideline development Expert Advisory Group.

Abstract
Smoking is one of the major public health problems and a major cause of preventable diseases. Today there are many ways to combat with tobacco use which is the chief risk factor for avoidable diseases. Pharmacotherapy and other supportive therapies based on motivation and cognitive-behavioral approaches are used in treatment. Among those, concentrating on behavioral changes are gaining more popularity as number of people who stop smoking using behavioral therapies are increasing, so is the interest on psychological models. Transtheoretic model is known as behavioral changes model which is widely used in smoking cessation and developed for the first time by Prochaska and DiClemente. It uses appropriate intervention according to the stage of the individual. According to Transtheoretic model, five stages are to be passed for behavior change. Motivational techniques are important for succesfull passing of a stage and should be structured for preparation to the next stage. Each stage should be evaluated for the transition to the next stage. Transtheoretic model is a significant tool for smoking cessation with its ability to use different models of behavior changes. This flexibilitaly of Transtheoretic model makes the model treatment of choice in different addictions. In this review we focus on the features of Transtheoretic model.

This is the third paper in a series, Kicking Bad Habits, on how people can be encouraged to adopt healthier behaviour. Information-based health campaigns are a major part of the government's health promotion strategy. A £75 million marketing programme has been recently announced to encourage healthy behaviour in children. This paper looks at the theory and selected evidence of interventions in practice, and what this can tell us about the role of information in behaviour change programmes.

Abstract
Background: One of the biggest challenges that primary care practitioners face is helping people change longstanding behaviours that pose significant health risks.

Objective: To explore current understanding regarding how and why people change, and the potential role of motivational interviewing in facilitating behaviour change in the general practice setting.

Discussion: Research into health related behaviour change highlights the importance of motivation, ambivalence and resistance. Motivational interviewing is a counselling method that involves enhancing a patient's motivation to change by means of four guiding principles, represented by the acronym RULE: Resist the righting reflex; Understand the patient's own motivations; Listen with empathy; and Empower the patient. Recent meta-analyses show that motivational interviewing is effective for decreasing alcohol and drug use in adults and adolescents and evidence is accumulating in others areas of health including smoking cessation, reducing sexual risk behaviours, improving adherence to treatment and medication and diabetes management.

Abstract
Tobacco smoke is the leading cause of preventable premature death worldwide. While the majority of smokers would like to stop, the habitual and addictive nature of smoking makes cessation difficult. Clinical guidelines suggest that smoking cessation interventions should include both behavioural support and pharmacotherapy (e.g. nicotine replacement therapy). This commentary paper focuses on the important role of behavioural interventions in encouraging and supporting smoking cessation attempts. Recent developments in the field are discussed, including 'cut-down to quit', the behaviour change techniques taxonomy (BCTT) and very brief advice (VBA) on smoking. The paper concludes with a discussion of the important role that health professionals can and should play in the delivery of smoking cessation interventions.

Abstract
Background: Successful conflict resolution is vital for effective teamwork and is critical for safe patient care in the operating room. Being able to appreciate the differences in training backgrounds, individual knowledge and opinions, and task interdependency necessitates skilled conflict management styles when addressing various clinical and professional scenarios. The goal of this study was to assess conflict styles in anesthesiology residents via self- and counterpart assessment during participation in simulated conflict scenarios.

Methods: Twenty-two first-year anesthesiology residents (first postgraduate year) participated in this study, which aimed to assess and summarize conflict management styles by 3 separate metrics. One metric was self-assessment with the Thomas-Kilmann Conflict Mode Instrument (TKI), summarized as percentile scores (0%-99%) for 5 conflict styles: collaborating, competing, accommodating, avoiding, and compromising. Participants also completed self- and counterpart ratings after interactions in a simulated conflict scenario using the Dutch Test for Conflict Handling (DUTCH), with scores ranging from 5 to 25 points for each of 5 conflict styles: yielding, compromising, forcing, problem solving, and avoiding. Higher TKI and DUTCH scores would indicate a higher preference for a given conflict style. Sign tests were used to compare self- and counterpart ratings on the DUTCH scores, and Spearman correlations were used to assess associations between TKI and DUTCH scores.

Results: On the TKI, the anesthesiology residents had the highest median percentile scores (with first quartile [Q1] and third quartile [Q3]) in compromising (67th, Q1-Q3 = 27-87) and accommodating (69th, Q1-Q3 = 30-94) styles, and the lowest scores for competing (32nd, Q1-Q3 = 10-57). After each conflict scenario, residents and their counterparts on the DUTCH reported higher median scores for compromising (self: 16, Q1-Q3 = 14-16; counterpart: 16, Q1-Q3 = 15-16) and problem solving (self: 17, Q1-Q3 = 16-18; counterpart: 16, Q1-Q3 = 16-17), and lower scores for forcing (self: 13, Q1-Q3 = 10-15; counterpart: 13, Q1-Q3 = 13-15) and avoiding (self: 14, Q1-Q3 = 10-16; counterpart: 14.5, Q1-Q3 = 11-16). There were no significant differences (P > .05) between self- and counterpart ratings on the DUTCH. Overall, the correlations between TKI and DUTCH scores were not statistically significant (P > .05).

Conclusions: Findings from our study demonstrate that our cohort of first postgraduate year anesthesiology residents predominantly take a more cooperative and problem-solving approach to handling conflict. By understanding one's dominant conflict management style through this type of analysis and appreciating the value of other styles, one may become better equipped to manage different conflicts as needed depending on the situations.