Sherry Merkur

Outcome of lacrimal surgery in older patients

BACKGROUND Performance of lacrimal surgery under neuroleptic (local) anesthesia has greatly facilitated the procedure and decreased the associated morbidity. We reviewed the outcome of lacrimal surgery in older patients to determine whether such surgery can be performed safely in the outpatient setting in this group. METHODS Review of the office and hospital charts and the surgical and anesthetic records of 120 patients (84 women and 36 men) aged 70 to 90 years who underwent lacrimal drainage procedures (dacryocystorhinostomy [DCR], canaliculodacryocystorhinostomy, DCR with insertion of a Jones tube, or a revision endonasal procedure with probing and tube insertion) at a university-affiliated hospital in Toronto in 1996. The interval between surgery and data collection ranged from 10 to 22 months. RESULTS Of the 120 patients 65 were aged 70 to 75 years, 38 were 76 to 80 years, 11 were 81 to 85 years, and 6 were 86 to 90 years. Ninety-six patients had a unilateral procedure, and 24 (22 of whom were aged 70 to 80) had a bilateral procedure. Concomitant conditions, such as hypertension and cardiac disorders, were found in 104 patients (87%). Of the 120 patients 98 (82%) (including all those aged 81 to 90) had local anesthesia, and 22 (18%) had general anesthesia. In one case anesthesia had to be changed from local to general during the procedure because of noncompliance. A total of 112 patients (93%) whose surgery was planned as a day procedure were able to leave the hospital the same day. Three additional patients were admitted to hospital for an overnight stay because of increased bleeding at the time of surgery (one patient) or a history of cardiac problems (two patients). Five patients who had planned overnight stays because of cardiac problems did well during surgery and were discharged the same day, without consequence. None of the patients had to be readmitted at a later date for bleeding or health problems. In 109 patients (91%) the presenting symptom(s) was completely relieved. Overall, 116 patients (97%) had a totally open system with no reflux on syringing. INTERPRETATION The surgical goals and techniques of lacrimal surgery in older patients were not compromised by performing the surgery in the outpatient setting and under neuroleptic anesthesia in most cases.

EU law and health professionals

In November 2005, a young French woman received the world’s fi rst ever face transplant. The operation was carried out in Amiens, France, by a team that was mainly French but contained one Belgian. This case exemplifi ed very visibly the benefi ts that free movement of health professionals can bring to the delivery of the increasingly complex health care being provided in Europe. The benefi ts of professional mobility extend far beyond the very specialized care involved in that exceptional case. Within Europe, there are both surpluses and shortages of health professionals. The opening of borders offers a means to ensure that appropriate health professionals and potential patients are brought together, whether through movement of patients or, as is discussed in this chapter, movement of professionals. In addition, there are particular issues that arise in border areas, where patients may live closer to a hospital across the border than to one in their home state. 1 Especially where these areas are sparsely populated, it is simply good management of resources to ensure that health professionals can also move across borders, working in the most appropriate facilities, wherever they are situated. Yet there are also dangers. The large economic differences between Member States, which have grown substantially with the two most recent enlargements to the European Union, pose a challenge for the poorer countries. A plentiful supply of health professionals, coupled with formidable physical barriers to migration, meant that, during the communist era, wages were very low in comparison with other occupations. The facilities in which health care was delivered refl ected this situation. Cheap labour reduced the incentive to invest in labour-saving technology, which, in any case, was expensive and, 14 EU law and health professionals

Promoting Tobacco Awareness and Smoking Cessation for Working Women

This chapter will focus on workplace interventions for tobacco awareness and smoking cessation, with a particular focus on women. The first section of this chapter defines this public health problem; details the epidemiologic characteristics, socioeconomic impact, and future perspectives; and presents the institutional and legislative framework, including nonsmokers’ rights, compliance with the law, health warnings, and smoking bans. The second section identifies the related risk factors, explaining why women tend to smoke, the population at risk, causal factors, and promoters, as well as preventable risk factors. Section three also looks at whether smoking is related to worksite factors, and how smoking may affect a woman’s professional life. The role of working women as mothers, where they act as role models and convey healthy lifestyles to the family, is explored in the fourth section. The fifth section presents examples of prevention, such as best practice in promoting tobacco awareness and smoking cessation, avoidance of exposure, healthy lifestyles, and general guidelines. Available resources, including online and published material, is available in the sixth section. The chapter concludes with three case studies provided in Appendix 1.