Familial atrial fibrillation mutation M1875T-SCN5A increases early sodium current and dampens the effect of flecainide.

AIMS: Atrial fibrillation (AF) is the most common cardiac arrhythmia. Pathogenic variants in genes encoding ion channels are associated with familial AF. The point mutation M1875T in the SCN5A gene, which encodes the α-subunit of the cardiac sodium channel Nav1.5, has been associated with increased atrial excitability and familial AF in patients. METHODS AND RESULTS: We designed a new murine model carrying the Scn5a-M1875T mutation enabling us to study the effects of the Nav1.5 mutation in detail in vivo and in vitro using patch clamp and microelectrode recording of atrial cardiomyocytes, optical mapping, electrocardiogram, echocardiography, gravimetry, histology, and biochemistry. Atrial cardiomyocytes from newly generated adult Scn5a-M1875T+/- mice showed a selective increase in the early (peak) cardiac sodium current, larger action potential amplitude, and a faster peak upstroke velocity. Conduction slowing caused by the sodium channel blocker flecainide was less pronounced in Scn5a-M1875T+/- compared to wildtype atria. Overt hypertrophy or heart failure in Scn5a-M1875T+/- mice could be excluded. CONCLUSION: The Scn5a-M1875T point mutation causes gain-of-function of the cardiac sodium channel. Our results suggest increased atrial peak sodium current as a potential trigger for increased atrial excitability.

Service quality perceptions and patient satisfaction: a study of hospitals in a developing country.

Patients'perceptions about health services seem to have been largely ignored by health care providers in developing countries. That such perceptions, especially about service quality, might shape confidence and subsequent behaviors with regard to choice and usage of the available health care facilities is reflected in the fact that many patients avoid the system or avail it only as a measure of last resort. Those who can afford it seek help in other countries, while preventive care or early detection simply falls by the wayside. Patients'voice must begin to play a greater role in the design of health care service delivery processes in the developing countries. This study is, therefore, patient-centered and identifies the service quality factors that are important to patients; it also examines their links to patient satisfaction in the context of Bangladesh. A field survey was conducted. Evaluations were obtained from patients on several dimensions of perceived service quality including responsiveness, assurance, communication, discipline, and baksheesh. Using factor analysis and multiple regression, significant associations were found between the five dimensions and patient satisfaction. Implications and future research issues are discussed.

Service quality in public and private hospitals in urban Bangladesh: a comparative study.

This study compared the quality of services provided by private and public hospitals in urban Bangladesh. Using twenty-four scale items, patient perceptions were sought on five aspects of service quality including responsiveness, assurance, communication, discipline and baksheesh. Because private hospitals are not subsidized, it was felt that the incentive structure would induce them to provide better services than public hospitals on the measures of service quality. This contention was largely supported. The results also indicated that both groups have room for improvement.

Determinants of customer satisfaction with hospitals: a managerial model.

States that rapid changes in the environment have exerted significant pressures on hospitals to incorporate patient satisfaction in their strategic stance and quest for market share and long-term viability. This study proposes and tests a five-factor model that explains considerable variation in customer satisfaction with hospitals. These factors include communication with patients, competence of the staff, their demeanour, quality of the facilities, and perceived costs; they also represent strategic concepts that managers can address in their bid to remain competitive. A probability sample was selected and a multiple regression model used to test the hypotheses. The results indicate that all five variables were significant in the model and explained 62 per cent of the variation in the dependent variable. Managerial implications of the proposed model are discussed.

How consumers view hospital advertising.

This paper examines consumer attitudes toward hospital advertising. The results do not support recent findings in other professional fields that consumers are favorably disposed toward this marketing activity. From a demographic perspective, there were differences in attitudes based on gender, age, and education. Income levels had no significant relationship with attitudes. However, consistent results were found on the relative proportion of consumers who were able to recall hospital advertisements. Mostly, they recalled hospital ads seen on TV and newspapers.

Public and private hospitals in Bangladesh: service quality and predictors of hospital choice.

This study compares the quality of services provided by public and private hospitals in Bangladesh. The premise of the paper was that the quality of hospital services would be contingent on the incentive structure under which these institutions operate. Since private hospitals are not subsidized and depend on income from clients (i.e. market incentives), they would be more motivated than public hospitals to provide quality services to patients to meet their needs more effectively and efficiently. This premise was supported. Patient perceptions of service quality and key demographic characteristics were also used to predict choice of public or private hospitals. The model, based on discriminant analysis, demonstrated satisfactory predictive power.

Choice and evaluation of hospitals in Bangladesh: insights from patients and policy implications.

PIP: This paper attempts to gain insights into the health care system of Bangladesh from the perspectives of hospital patients. The study is based on survey data obtained from 207 recipients of health care services from 57 hospitals in Dhaka City. Patients' choice of hospital is influenced by referrals of doctors (28.7%), reputation of the hospital (23.7%), referral by family and friends (17.4%), closeness to home (14.9%), cost (7.4%) and other miscellaneous factors (7.9%). The major reason for selecting a particular hospital is for treatment (86%). Only few choose preventive or health maintenance services. Demographic trends indicate that better educated and more affluent people are more likely to seek private hospital care, while those who are less educated and less affluent are more inclined to seek public hospital care. The average length of hospital stay, both for private and public hospitals, was 9.9 days. Longer hospital stays are positively associated with nonavailability of needed medicines, poor upkeep of facilities, need to provide "tips" for services, lack of prompt services, a suffocating environment, and unexplained hospital costs. Average satisfaction rate was 4.85, with private hospitals earning higher average ratings than public facilities. The highest income groups gave the highest quality ratings (5.26) compared to other income groups. Implications of findings for health policy are outlined.^ieng

Explaining blood donation: the trust factor.

Appealing to people's altruism may not be the best way to reach those who never donate blood. Rather, the authors found that several variables influence the decision, including whether or not people trust blood banks. Decreasing the perception that there are health risks associated with donating blood can also go a long way toward increasing the declining pool of blood donors.

Physician attitudes toward pharmaceutical sales representatives.

Physicians in northwestern Pennsylvania were surveyed to identify the factors that influenced their attitudes toward pharmaceutical sales representatives (PSRs). The results suggest that physicians' attitudes were influenced by the information and educational support they received from PSRs, selling techniques used by the PSRs to promote their products, and the volume of patients they saw.