RESUMEN
We aimed to test the knowledge, attitude and practice (KAP) of physicians towards erectile dysfunction in the Eastern province of Saudi Arabia. At a scientific meeting about erectile dysfunction, 159 physicians from both government and private sectors answered a 34-item questionnaire in private. The mean total KAP score for the group was below the expected standard of 60%. Male physicians scored significantly higher than females. Urologists scored the highest, followed by andrologists. Surprisingly, physicians with higher qualifications scored lower than those with intermediate qualifications and even less than general practitioners. Those who had practised for > or = 10 years scored better than those with < 10 years practice. The role of cardiologists in the diagnosis and management of erectile dysfunction is discussed.
Asunto(s)
Actitud del Personal de Salud , Disfunción Eréctil , Conocimientos, Actitudes y Práctica en Salud , Médicos , Pautas de la Práctica en Medicina/organización & administración , Cardiología/educación , Cardiología/organización & administración , Competencia Clínica/normas , Estudios Transversales , Curriculum , Educación Médica , Educación de Postgrado en Medicina , Educación de Pregrado en Medicina , Evaluación Educacional , Disfunción Eréctil/diagnóstico , Disfunción Eréctil/epidemiología , Disfunción Eréctil/etiología , Disfunción Eréctil/terapia , Femenino , Necesidades y Demandas de Servicios de Salud , Humanos , Masculino , Medicina/organización & administración , Rol del Médico , Médicos/organización & administración , Médicos/psicología , Salud Pública , Arabia Saudita/epidemiología , Especialización , Encuestas y CuestionariosRESUMEN
We aimed to test the knowledge, attitude and practice [KAP] of physicians towards erectile dysfunction in the Eastern province of Saudi Arabia. At a scientific meeting about erectile dysfunction, 159 physicians from both government and private sectors answered a 34-item questionnaire in private. The mean total KAP score for the group was below the expected st and ard of 60%. Male physicians scored significantly higher than females. Urologists scored the highest, followed by and rologists. Surprisingly, physicians with higher qualifications scored lower than those with intermediate qualifications and even less than general practitioners. Those who had practised for >/= 10 years scored better than those with < 10 years practice. The role of cardiologists in the diagnosis and management of erectile dysfunction is discussed
Asunto(s)
Cardiología , Competencia Clínica , Estudios Transversales , Curriculum , Educación de Postgrado en Medicina , Necesidades y Demandas de Servicios de Salud , Disfunción Eréctil , Rol del Médico , Salud Pública , Encuestas y Cuestionarios , Actitud del Personal de SaludRESUMEN
Electric shock is the only effective therapy against ventricular fibrillation. However, shocks are also known to cause electroporation of cell membranes. We sought to determine the impact of electroporation on ventricular conduction and defibrillation. We optically mapped electrical activity in coronary-perfused rabbit hearts during electric shocks (50 to 500 V). Electroporation was evident from transient depolarization, reduction of action potential amplitude, and upstroke dV/dt. Electroporation was voltage dependent and significantly more pronounced at the endocardium versus the epicardium, with thresholds of 229+/-81 versus 318+/-84 V, respectively (P=0.01, n=10), both being above the defibrillation threshold of 181.3+/-45.8 V. Epicardial electroporation was localized to a small area near the electrode, whereas endocardial electroporation was observed at the bundles and trabeculas throughout the entire endocardium. Higher-resolution imaging revealed that papillary muscles (n=10) were most affected. Electroporation and conduction block thresholds in papillary muscles were 281+/-64 V and 380+/-79 V, respectively. We observed no arrhythmia in association with electroporation. Further, preconditioning with high-energy shocks prevented reinduction of fibrillation by 50-V shocks, which were otherwise proarrhythmic. Endocardial bundles are the most susceptible to electroporation and the resulting conduction impairment. Electroporation is not associated with proarrhythmic effects and is associated with a reduction of vulnerability.
Asunto(s)
Cardioversión Eléctrica , Sistema de Conducción Cardíaco/fisiopatología , Fibrilación Ventricular/fisiopatología , Potenciales de Acción , Animales , Electroporación , Endocardio/fisiopatología , Técnicas In Vitro , Potenciales de la Membrana , Microelectrodos , Músculos Papilares/fisiopatología , Perfusión , Pericardio/fisiopatología , Conejos , Factores de Tiempo , Fibrilación Ventricular/terapiaRESUMEN
OBJECTIVES: We sought to evaluate the relation between warfarin anticoagulation and survival and morbidity from cardiac disease in patients with left ventricular (LV) dysfunction. BACKGROUND: Warfarin anticoagulation plays a major role in the management of patients who have had a large myocardial infarction and in those with atrial fibrillation. However, its use in patients with LV systolic dysfunction has been controversial. METHODS: We reviewed data on warfarin use in 6,797 patients enrolled in the Studies of Left Ventricular Dysfunction (SOLVD) trial and analyzed the relation between warfarin use and all-cause mortality, as well as the combined end point of death or hospital admission for heart failure. We used Cox regression to adjust for differences in baseline characteristics and to test for the interaction between warfarin use and selected patient variables in relation to outcome. RESULTS: On multivariate analysis, use of warfarin was associated with a significant reduction in all-cause mortality (adjusted hazard ratio [HR] 0.76, 95% confidence interval [CI] 0.65 to 0.89, p = 0.0006) and in the risk of death or hospital admission for heart failure (HR 0.82, 95% CI 0.72 to 0.93, p = 0.0002). Risk reduction was observed when each trial or randomization arm was analyzed separately, as well as in both genders. It was not significantly influenced by the presence of atrial fibrillation, age, ejection fraction, New York Heart Association functional class or etiology. CONCLUSIONS: In patients with LV systolic dysfunction, warfarin use is associated with improved survival and reduced morbidity. This association is primarily due to a reduction in cardiac events and does not appear to be limited to any particular subgroup.
Asunto(s)
Anticoagulantes/uso terapéutico , Disfunción Ventricular Izquierda/mortalidad , Warfarina/uso terapéutico , Angina Inestable/complicaciones , Gasto Cardíaco Bajo/complicaciones , Enfermedades Cardiovasculares/mortalidad , Causas de Muerte , Estudios de Cohortes , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Infarto del Miocardio/complicaciones , Modelos de Riesgos Proporcionales , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Riesgo , Disfunción Ventricular Izquierda/complicacionesRESUMEN
OBJECTIVES: This study sought to evaluate the relation between antiplatelet agent (APA) use and survival and morbidity from cardiac disease in patients with left ventricular (LV) systolic dysfunction. BACKGROUND: APAs play an important role in the prevention and treatment of coronary disease. Their effects in patients with LV systolic dysfunction are unknown. METHODS: We reviewed data on APA use in 6,797 patients enrolled in the Studies of Left Ventricular Dysfunction (SOLVD) trial and analyzed the relation between their use and all-cause mortality as well as the combined end point of death or hospital admission for heart failure (HF). We used Cox regression to adjust for differences in baseline characteristics and to test for the interaction between APA use and selected patient variables in relation to outcome. RESULTS: APA use (46.3% of patients) was associated with significantly reduced mortality from all causes (adjusted hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.73 to 0.92, p = 0.0005) and reduced risk of death or hospital admission for HF (adjusted HR 0.81, 95% CI 0.74 to 0.89, p < 0.0001) but was not influenced by trial assignment, gender, LV ejection fraction, New York Heart Association class or etiology. A strong interaction was observed among APA use, randomization group and all-cause mortality. The association between APA use and survival was not observed in the enalapril group, nor was an enalapril benefit on survival detectable in patients receiving APAs at baseline. However, randomization to enalapril therapy significantly reduced the combined end point of death or hospital admission for HF in APA users. CONCLUSIONS: In patients with LV systolic dysfunction, use of APAs is associated with improved survival and reduced morbidity. This association is retained after adjustment for baseline characteristics. APA use is associated with retained but reduced benefit from enalapril.
Asunto(s)
Enfermedad Coronaria/tratamiento farmacológico , Inhibidores de Agregación Plaquetaria/uso terapéutico , Disfunción Ventricular Izquierda/fisiopatología , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Antihipertensivos/uso terapéutico , Gasto Cardíaco Bajo/etiología , Gasto Cardíaco Bajo/fisiopatología , Causas de Muerte , Estudios de Cohortes , Intervalos de Confianza , Enfermedad Coronaria/mortalidad , Muerte Súbita Cardíaca/etiología , Método Doble Ciego , Enalapril/uso terapéutico , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Admisión del Paciente , Placebos , Análisis de Regresión , Factores de Riesgo , Factores Sexuales , Volumen Sistólico/fisiología , Análisis de Supervivencia , Resultado del Tratamiento , Disfunción Ventricular Izquierda/tratamiento farmacológico , Disfunción Ventricular Izquierda/mortalidad , Función Ventricular Izquierda/fisiologíaRESUMEN
Results of the SOLVD prevention trial and of the SAVE trial indicate that long-term treatment with ACE inhibitors in asymptomatic patients with LV systolic dysfunction prevents the progression to overt CHF and reduces hospitalizations for CHF. ACE inhibitors have been shown to reduce mortality in at least some subsets of asymptomatic patients with LV systolic dysfunction, notably those with recent myocardial infarction.
Asunto(s)
Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Gasto Cardíaco Bajo/tratamiento farmacológico , Función Ventricular Izquierda , Inhibidores de la Enzima Convertidora de Angiotensina/farmacología , Gasto Cardíaco Bajo/etiología , Gasto Cardíaco Bajo/fisiopatología , Humanos , Función Ventricular Izquierda/efectos de los fármacosRESUMEN
In a retrospective study, 534 appointments for a cardiology clinic were analysed to determine the frequency of no-show and to identify contributory factors. The overall rate of no-show was 30.1%, which is higher than the 18% and 20% reported from other teaching hospitals. Variables with the strongest univariate association with no-show were nationality (Saudi 35%, non-Saudi 22%; p = 0.0015), gender (males 34%, females 25%; p = 0.03), heart failure (present 44%, absent 27.9%; p = 0.005) and valvular heart disease (present 23.4%, absent 32.6%; p = 0.04). Turning to a stepwise logistic regression to predict no-show behaviour, we found that nationality, gender and heart failure were significant, while valvular heart disease was not. We conclude by recommending that physicians and mass media should share in the responsibility of stressing the importance of keeping out-patient department (OPD) appointments to all patients especially those who are more prone to no-show behaviour, namely male nationals. Telephone and mailed reminders have been used successfully to improve attendance at the OPD, and can be evaluated in our community.
Asunto(s)
Citas y Horarios , Servicio de Cardiología en Hospital/estadística & datos numéricos , Cardiopatías , Servicio Ambulatorio en Hospital/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Aceptación de la Atención de Salud/etnología , Estudios Retrospectivos , Arabia Saudita , Factores SexualesRESUMEN
We interviewed six hundred adults to assess their awareness, attitude and misperceptions about cancer. The mean age (+/- SD) was 31.2 (+/- 8.7) years. Fifty-six percent of the participants were males and 75% were Saudis. Nationality and having a relative who had cancer were found to be insignificant predictors of attained knowledge. Despite a minor difference between males' and females' performance, gender did not influence knowledge. Education was the most significant factor that influenced individuals' knowledge and misperceptions. The most significant difference was noted between those who had university or higher education (level III, 41%) and those who were illiterate or only had primary schooling (level I, 16%). The difference between level I and level II (secondary and high school, 43%) was less obvious. The analysis also showed that individuals who were > 30 years of age generally showed more knowledge and fewer misconceptions about cancer than younger participants. Age, however, together with education deviated only 5% in the variability of the total score. A high level of misperception was observed among all respondents specifically relating to questions regarding side effects of conventional therapy and statements about unproven treatment. This analysis demonstrated that knowledge about cancer was disappointingly poor and the level of misperceptions significantly high. Possessing higher academic credentials alone, is not sufficient to acquire an optimal standard of health knowledge. The data also suggest that there should be comprehensive cancer health education and primary and secondary cancer prevention programs in Saudi Arabia. To achieve this goal, primary care physicians and community cancer centers should work jointly. Brief guidelines are proposed.
RESUMEN
We interviewed 500 adult females without personal history of any type of cancer to assess their awareness and attitude toward various aspects of breast cancer. The mean age (SD) of participants was 31.6 (+/- 8.5) years with a range of 18 to 62 years. After control for level of education, age was not found to be a statistically significant factor that influenced participants' performance. Also not statistically significant was the history of having a relative who had cancer. Conversely, education was the only examined factor that correlated with interviewees' awareness and attitude. Individuals with university or higher education (level III) were more knowledgeable (statistically significant) than uneducated or those with only primary schooling (level I), or those participants who only had intermediate or high school education (level II). On the other hand, the responses of those individuals with education level I generally performed in a fashion similar to those at education level II. The general outcome of this exercise was that unacceptably high proportions of females at all education levels were either wrong or uncertain about some fundamental aspects of breast cancer etiology, risk factors, clinical features, detection methods, and management. Also shown was the relatively high percentages of those, particularly in education level I, who held misconceptions about unconventional management or the complications of conventional methods. We conclude that academic education alone is not enough to assure that recommended health behaviors will be adopted. For establishing cancer health education or cancer prevention and early detection programs, primary care physicians and community cancer centers should work jointly. Brief guidelines are proposed.