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358. Placing patients in the queue for coronary surgery: do age and work status alter Canadian specialists' decisions?

Author

Naylor, C D, Levinton, C M, Baigrie, R S, and Goldman, B S

Subjects
AGE distribution, CARDIOLOGY, COMPARATIVE studies, CORONARY artery bypass, DECISION making, EMPLOYMENT, HEALTH care rationing, RESEARCH methodology, MEDICAL cooperation, RESEARCH, RESOURCE allocation, RISK assessment, EVALUATION research, PATIENT selection
Abstract

Objective: To determine the effects of age and work status on whether and where cardiovascular specialists would place hypothetical patients in the queue for coronary surgery.Materials and Methods: Mailed survey presenting a set of clinical scenarios either to be rated on a scale with 7 time frames for urgency of need or to be designated as questionable/inappropriate for intervention. The basic scenario was a patient with mild-moderate stable angina, good left ventricular function, and limited coronary disease; operative risks and stress test results were varied. Three identifiers were used: "45-year-old civil servant gainfully employed"; "45-year-old laborer disabled by angina, faces job loss"; and "75-year-old retiree, angina limits golf."Participants: Cardiologists and cardiac surgeons practicing in five Ontario medical centers (n = 120).Results: There was a 59% response rate (120 usable responses). Large shifts in willingness to intervene occurred in favor of the disabled laborer (p less than 0.0001) and against the retiree (p-value ranges from 0.04 to less than 0.0001, depending on operative risk and stress test results), but not for the employed civil servant. Striking effects (p less than 0.0001) were also evident in ratings of waiting time, with the order of priority being the disabled laborer first, the civil servant second, and the retiree last. The overall mean shift due to work status or age was equal to, or larger than, the mean shift due to clinical factors, such as stress test results, changes in severity of stable angina, and extent of coronary disease.Conclusion: Cardiovascular specialists may place considerable weight on age and work status in determining urgency and appropriateness of coronary revascularization. Risk-benefit concerns may partly explain shifting thresholds for intervention, but not differential waiting times. The influence of these factors should be sought in utilization audits and addressed from an ethical perspective. [ABSTRACT FROM AUTHOR]

Published
1992
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364. Medical genetics in Israel.

Author

Goodman, R M, Bonne-Tamir, B, Adam, A, Voss, R, Bach, G, Shiloh, Y, Katznelson, M B, Barkai, G, Goldman, B, and Padeh, B

Published
1989

367. Permanent Cardiac Pacing After Open-heart Surgery: Acquired Heart Disease.

Author

Goldman, B. S., Hill, T. J., Weisel, R. D., Scully, H. E., Mickleborough, L. L., Pym, J., and Baird, R. J.

Subjects
CARDIAC pacing, ARRHYTHMIA treatment, ELECTRIC stimulation, CARDIAC surgery, HEART diseases
Abstract

Retrospective review of 5,942 patients who underwent open-heart surgery for acquired heart disease revealed that 123 patients (2.1%) required permanent cardiac pacing postoperatively; 4.6% of these underwent predominantly valvular surgery and 0.6% had coronary bypass. The most important factors appeared to be: 1) preoperative evidence of a conduction disorder; 2) advanced patient age; 3) dense calcium in the aortic annulus; 4) valvular surgery and, especially, tricuspid valve surgery; and 5) poor myocardial protection. Postoperative permanent pacing had a considerable impact on patient morbidity from maintenance operations; most complications were lead-related problems. [ABSTRACT FROM AUTHOR]

Published
1984
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368. World Survey on Cardiac Pacing.

Author

Goldman, B. S. and Parsonnet, V.

Subjects
SURVEYS, CARDIAC pacing, CONFERENCES & conventions, CARDIAC pacemakers, MEDICAL technology, EPIDEMIOLOGY, MEDICAL economics
Abstract

Focuses on the issues covered by 1979 World Survey of the World Symposia on Cardiac Pacing. Epidemiology and indications; Technology and hardware of current pacemaker usage; Pacemaker follow-up; Socio-economics of pacemaker therapy.

Published
1979
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396. Outstanding contribution. Detection of chromosomal aberration in fetuses arising from recurrent spontaneous abortion by comparative genomic hybridization.

Author

Daniely, M, Aviram-Goldring, A, Barkai, G, and Goldman, B

Abstract

Chromosomal abnormalities (mostly aneuploidy) account for 50% of fetal losses in the first 8-15 weeks of gestation. Cytogenetic analysis of aborted fetal material depends on conventional tissue culturing and karyotyping. This technique is laborious and is subject to problems including external contamination, culture failure and selective growth of maternal cells. Comparative genomic hybridization (CGH) was used to determine the chromosomal constitution of 27 fetuses arising from recurrent spontaneous abortion. In 12 samples, the CGH results were compared to the results obtained by conventional cytogenetic techniques. Correlation was found in 75% of samples. Overall, CGH detected chromosomal abnormalities in 48% of the samples, including trisomies, monosomies, and partial chromosome gains and losses. The preliminary data in this study show that CGH can be added, at least as a complementary method, to the traditional cytogenetic techniques used in the investigation of recurrent spontaneous abortions. [ABSTRACT FROM PUBLISHER]

Published
1998
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