In This Edition
Literature At A Glance
A guide to this month’s studies
- Burnout among physicians and the general workforce
- Effects of clopidogrel added to aspirin in patients with recent lacunar stroke
- Performance of the HEMORR2AGES, ATRIA, and HAS-BLED bleeding risk prediction scores in patients with atrial fibrillation undergoing anticoagulation
- Probiotics for secondary prevention of hepatic encephalopathy
- Capsule endoscopy for acute obscure GI bleeding
- Perceptions of readmitted patients transitioning from hospital to home
- Thirty-day readmissions after acute myocardial infarction
- One-hour rule-out or rule-in for AMI patients in chest pain
- Aspirin increases bleed risk without reducing risk of stroke in CKD and NVAF patients
Burnout among Physicians and the General Workforce
Clinical question: What is the degree and distribution of burnout within the physician workforce, and how does that compare to the general U.S. workforce?
Background: Professional burnout, work satisfaction, and work-life balance are critical elements to understand in the physician workforce. It is well documented that physicians are at high risk for burnout; however, few extensive studies have looked at rates and the identification of high-risk subpopulations.
Study design: Cross-sectional survey.
Setting: U.S. workforce.
Synopsis: This study included 7,288 physicians (26.7% response rate) and 5,930 controls from the general U.S. population. Validated survey instruments were employed to assess the degree and presence of burnout, depression, and satisfaction with work-life balance.
In aggregate, using a validated, two-item burnout measure, 35.2% of physicians were characterized as having burnout, compared with 27.6% of the general population (P<0.001). Within the physician community, the specialties with the highest risk of burnout included emergency medicine, general internal medicine, family medicine, and neurology.
Important limitations of this study include that the physician and general population surveys were performed at different times (six months apart), that the groups were not ideally matched (age and sex, for example), and the overall response rate of the physician survey was low.
This study sheds light on an important topic for hospitalists. Future studies should continue to probe the problem of burnout and look for creative solutions to mitigate risks that might threaten professional longevity.
Bottom line: Burnout is prevalent among physicians, especially when compared to the general workforce. Physician specialties in front-line patient care are at highest risk.
Citation: Shanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012;20 [Epub ahead of print].
Effects of Clopidogrel Added to Aspirin in Patients with Recent Lacunar Stroke
Clinical question: Does the addition of clopidogrel to aspirin reduce the risk of any type of recurrent stroke, or affect the risk of bleeding or death, in patients who recently suffered a lacunar stroke?
Background: There are no prior randomized, multicenter trials on secondary prevention of lacunar stroke; aspirin is the standard antiplatelet therapy in this setting.
Study design: Double-blind, randomized, multicenter trial.
Setting: Eighty-two clinical centers in North America, Latin America, and Spain.
Synopsis: Researchers enrolled 3,020 patients from 2003 to 2011; criteria included age >30 years old and symptomatic lacunar stroke (proven by MRI) in the preceding 180 days.
Results showed no significant difference between recurrent strokes (any type) in the aspirin-only group (2.7% per year) versus the aspirin-plus-clopidogrel group (2.5% per year). Major hemorrhage risk was much higher in the aspirin-plus-clopidogrel group (2.1% per year) versus aspirin-only group (1.1% per year). All-cause mortality also was much higher in the aspirin-plus-clopidogrel group (N=113) versus the aspirin-only group (N=77).