Objectives: To evaluate knowledge and attitude of physicians involved in the management of patients with heart failure regarding implantable cardioverter-defibrillator (ICD). Methods: We conducted personal interviews with physicians involved in treating patients with heart failure. Between October 2015 and February 2016, the study was conducted in hospitals in the Riyadh region where no cardiac electrophysiology service was available. Every participant was met in person and received an oral questionnaire that aimed to assess basic knowledge regarding ICD indications and benefits. Results: Sixty-three physicians were met from 13 hospitals (14 consultants and 49 specialists). Forty-one percent of participants use the recommended cut-off level of left ventricular ejection fraction (LVEF) which is <= 35% as the LVEF criterion for ICD referral in patients with cardiomyopathy. Only 50% of the consultants use <= 35% as the LVEF criterion for ICD referral. Seventy percent of the participants thought that ICD may improve heart failure symptoms. Forty-eight percent of physicians have a defined channel to refer patients to higher centers for ICD implant. There was no statistically significant difference between physicians' knowledge when we categorized them according to three different factors: (1) physician's specialty (cardiology vs. internal medicine); (2) physician's degree (consultant vs. specialist); and (3) physician's location (inside vs. outside Riyadh city). Conclusion: There is a lack of knowledge of current clinical guidelines regarding ICD implantation for patients with heart failure at general hospitals in Saudi Arabia. This finding highlights the need to improve the dissemination of guidelines to practitioners involved in managing patients with heart failure in an effort to improve ICD utilization. (C) 2017 The Authors. Production and hosting by Elsevier B.V. on behalf of King Saud University.

This article describes a study in which a systematic classification of cancer patients was produced on the basis of their needs. A series of 380 cancer patients froth four hospitals in the North West of England responded to a self-completion questionnaire that included a 48-item inventory of psychosocial needs covering seven needs domains (information, health professionals, emotional and spiritual, identity, practical, support, and child care). Latent class analysis was used to identify differing patterns of psychosocial need. Four patterns of need were identified. The groups differed in both quantity and quality of patients' expressed needs. Group A had a high level of expressed needs "across the hoard," whereas Group D had a low level of expressed needs "across the board." Group B had high levels of expressed needs in all except the emotional, spiritual, identity, and practical domains, and Group C had low levels of expressed needs in all but the information and health professionals domains. Because the four groups differed by demographic and socioeconomic characteristics, there is scope for developing. risk scores to predict these patterns of psychosocial needs in patients with cancer. The dangers and limitations of this approach are discussed. (c) 2004 by The Haworth Press, Inc. All rights reserved.

Objective-To analyse the prevalence of neural tube defects in small geographical areas and seek to explain any spatial variations with reference to environmental lead and deprivation.Setting-The Fylde of Lancashire in the north west of England.Design-Cases were ascertained as part of a prospective survey of major congenital malformations in babies born in the Fylde to residents there between 1957 and 1981. A matched case-control analysis used infants with cardiovascular system, alimentary tract, and urinary system malformations as controls. Conditional logistic regression was used to assess the effects of more than 10 mu g/1 lead in drinking water and the Townsend deprivation score.Results-The prevalence of neural tube defects in 1957-73 was higher in Blackpool, Fleetwood, and North Fylde, whereas the three control groups showed no significant spatial variation. In 1957-81 mothers living in electoral wards with either a higher proportion of houses with more than 10 mu g/1 lead in the water or a higher deprivation score had a greater risk of having a baby with a neural tube defect. For spina bifida and cranium bifidum alone, this was also true. For anencephaly, deprivation was less important although the effect of lead was still seen. In some neural tube defects, lead may act independently of other possible factors associated with deprivation. It seemed unlikely that lead levels changed significantly during the survey. The percentage of houses with 10 mu g/1 or more of lead in the water in 1984-5 was similar to that found in Great Britain 10 years previously.Conclusion-There is evidence to suggest that lead is one cause of neural tube defects, especially anencephaly. This could link the known preventive actions of hard water and folic acid. Calcium is a toxicological antagonist of lead. One cause of a deficiency of folic acid is impaired absorption secondary to zinc deficiency, which may be produced or exacerbated by lead.