Doctors' willingness to refer elderly patients for elective surgery

OBJECTIVES: We aimed to examine the relationship between doctors' willingness to refer elderly patients for elective surgical operations and patients' age, comorbidity, institutionalization, living habits and signs of dementia. METHOD: A random selection of 837 medical doctors in Finland (response rate 56%) received a postal questionnaire consisting of 18 vignettes, i.e. imaginary patient cases. Respondents were asked whether they would refer the patient on the vignette for elective surgical operation, treat the patient conservatively, or choose some other alternative. In the vignettes, the age of patients was randomly varied between 65 and 85, at 5-year intervals, to provide eight different questionnaires, and each respondent obtained one of them. RESULTS: The proportion of doctors willing to refer the patients for surgery was inversely related to the patients' age: in all the vignettes, doctors said they would refer fewer patients in the oldest age groups. Almost all the doctors claimed they would refer healthy, home-dwelling persons aged 65-70 years for operations. In the oldest age groups of patients, the doctors' willingness to refer was highest for cataract operations (69%) and hip prosthesis operations (63%), but only 18% of doctors would refer such patients for coronary by-pass operations. Comorbidity and institutionalization were associated with fewer doctors referring the patients: the proportion of doctors willing to refer these patients was about half that of those willing to refer otherwise healthy and home-dwelling patients. Smoking by patients also decreased the proportions of doctors willing to refer, but moderate signs of dementia in an elderly patient with cataract were associated with only a slight decrease in referring. CONCLUSIONS: Doctors are less willing to refer old patients for elective surgery, but comorbidity, patients' lifestyle and institutionalization have a greater effect on referrals than age.      

Anti-spasmogenic effects of bencianol (ZY15051) on human cerebral arteries in vitro

Experiments were performed to assess the ability of bencianol (ZY15051) to reverse contractions of human basilar arteries in vitro that were induced by a wide range of substances implicated in the aetiology of migraine and cerebral arterial spasm. Bencianol caused a dose-related (1-100 micrograms ml-1) reversal of contractions induced by 5-hydroxytryptamine, noradrenaline, angiotensin II, prostaglandin F2 alpha, and U-46619 (a thromboxane-A2 mimetic). Bencianol was more effective against contractions induced by EC50 compared to maximal concentrations of each agent, and was least effective against the thromboxane-A2 mimetic, U-46619. In addition, contractions induced by thromboxane-A2-like substances generated from guinea-pig lungs were also reversed by bencianol but only at the highest concentration used (100 micrograms ml-1). The relevance of this action of bencianol to migraine and cerebral arterial spasm is discussed.     

MIDDLE EAR RECONSTRUCTION – OUR EXPERIENCE

A comparative study of ossicular reconstrution using four different graft material was carried out on 40 patients as a second stage procedure from July 1989 to June 1991. The graft materials used were : aulologus ossicular bone graft, allogeneic ossicular bone graft, autologus cartilage and bio-compatible materials. All patients were observed for a period ranging from one to two years. Extrusion of ossicular graft was prevented by use of a lace of cartilage between the ossicular graft and neotympanic membrance. Satisfactory results were obtained with cartilage graft in 6%, allogeneic ossicles 70%, autologus ossicular graft 80% and bio-compatible materials 33.3%.KEY WORDS: Ossiculoplasty, Autologus and allogeneic ossicular graft, Total ossicular replacement prosthesis, Partial ossicular replacement prosthesis