Utility of electrophysiologic testing for sudden death risk stratification in cardiac sarcoidosis patients with mildly impaired left ventricular function.

BACKGROUND: Ventricular arrhythmias (VA) account for at least 25% of deaths caused by cardiac sarcoidosis (CS) and may arise in patients with mildly impaired LVEF (>35%). OBJECTIVE: In the current study, we examine whether EP study may be used for sudden death risk stratification in CS patients who have mildly impaired LVEF and a diagnosis of highly probable or probable CS according to the World Association of Sarcoidosis and Other Granulomatous Diseases Sarcoidosis Organ Assessment Instrument (WASOGI). METHODS: All patients: (1) exhibited a diagnosis of highly probable or probable CS according to the WASOGI, (2) exhibited cardiac MRI findings consistent with CS, (3) exhibited LVEF >45% and (4) underwent EP study. Device interrogations, transmissions and medical records were reviewed for all patients. RESULTS: We identified 46 CS patients with mildly impaired LVEF. VA were induced in 11 patients and 10/11 patients underwent ICD placement. Thirty-five patients had no VA and 24/35 patients underwent placement of an ILR. During the follow-up period, the VA event rate was 6.5%. The negative and positive predictive values of the EP study for the development of VA were 100% and 27.2%, respectively. CONCLUSIONS: In CS patients with mildly impaired LVEF and a diagnosis of highly probable or probable CS, a negative EP study was highly predictive of the absence of VA. The successful execution of future prospective studies is contingent upon enrollment of phenotypically homogenous cardiac sarcoidosis patients.

Developing the inner scientist: book club participation and the nature of science.

The leap from science student to scientist involves recognizing that science is a tentative, evolving body of knowledge that is socially constructed and culturally influenced; this is known as The Nature of Science (NOS). The aim of this study was to document NOS growth in first-year premedical students who participated in a science book club as a curricular option. The club read three acclaimed nonfiction works that connect biology to medicine via the history of scientific ideas. Students' NOS status was assessed as informed, transitional, or naïve at the beginning and end of the academic year using the Views of Nature of Science Questionnaire-Form C (VNOS-C). Focus group interviews and document analysis of assignments and exams provided qualitative evidence. VNOS-C scores improved over the academic year regardless of book club participation. Students who participated in book club had marginally better NOS status at the end of the year but also at the beginning, suggesting that book club may have attracted rather than produced students with higher NOS status. It is notable that an improvement in NOS understanding could be detected at all, as there have been few reports of NOS growth in the literature in which NOS was not an explicit topic of instruction.

Patient opinion of the doctor-patient relationship in a public hospital in Qatar.

OBJECTIVE: To analyze the factors associated with the level of satisfaction of outpatients in their relationship with their doctor at the largest public hospital in Qatar. METHODS: This study was a cross-sectional survey of attitudes. Researchers surveyed 626 outpatients at Hamad General Hospital in Doha, Qatar from September 2009 to January 2010 using a novel questionnaire assessing satisfaction with patients' interaction(s) with their doctor (spent time with patient, took case seriously, maintained confidentiality, and the overall quality of visit). RESULTS: Mean responses on 4 Likert scale items (one to 5) were as follows: "spent enough time with patient" = 4.39; "doctor took case seriously" = 4.57; "satisfaction with doctor-patient confidentiality" = 4.71; "overall quality of visit" = 4.46. Age, gender, citizenship, level of education, and number of visits did not significantly impact the level of satisfaction. For 73.1% of patients, the physician's qualification was the most important factor in choosing a doctor. Of those surveyed, 40.7% of men and 28.1% of women preferred to see a doctor of their own gender. A positive correlation between perceived communication and satisfaction with the doctor-patient encounter was established. CONCLUSION: This study found that patients in the Out-Patient Department at Hamad Hospital were highly satisfied with their relationships with their doctors, and physician qualification was the most significant factor in choosing a doctor. A significant number of males and females preferred a physician of their own gender. Communication difficulty correlated with lower satisfaction.