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In this study, Shanafelt et al measure burnout in a sample of more than 7000 US physicians and a probability-based sample of more than 3400 working adults from the general population. The authors found that 45.8% of US physicians studied had at least 1 symptom of burnout, with substantial differences in burnout by specialty. Compared with working US adults, physicians were more likely to have symptoms of burnout and be dissatisfied with work-life balance.
Following the publication of 2 large trials that found atenolol-based regimens less effective than other antihypertensive drugs for the prevention of cardiovascular events in patients with hypertension, the first-line status of β-blockers has increasingly been called into question. Using electronic medical record and health plan data from a large registry, Parker et al compared incidence rates of myocardial infarction, heart failure, and stroke in patients initiating treatment with 1 of 2 β-blockers, atenolol or metoprolol. Compared with atenolol users, there were no differences in rates of incident cardiovascular events in metoprolol users. Large registries similar to the one used in this analysis may be useful for addressing comparative effectiveness questions that are unlikely to be resolved by randomized trials.
Kale et al performed a cross-sectional analysis using data from the 1999 and 2007 National Ambulatory Medical Care Survey to examine the frequency with which patients visit generalists and specialists for primary care services between 1997 and 2007. For primary care visits for common symptoms and diseases between 1999 and 2007, there was no change in the proportion of visits to primary care physicians (58.1% and 57.2%, respectively; P = .79). These findings suggest that primary care physicians may not have been sufficiently available to patients or that patients might prefer the care of specialists.
Effective protocols have been developed to treat nicotine dependence, obesity, and alcoholism, yet research suggests that they are rarely used. This may be because physicians are dissatisfied with treating these conditions. Using data from a national survey of primary care physicians, Rasinski et al found that physicians were most satisfied with treating nicotine dependence (62% experienced “some” or “a lot” of satisfaction), followed by obesity (57% experienced “some” or “a lot” of satisfaction) and alcoholism (50% said they experienced “some” or “a lot” of satisfaction. Multivariable analyses showed that physicians who believed that medicine was a calling were more likely to report satisfaction treating each condition. Those dissatisfied with medicine as a career were significantly less likely to report satisfaction treating nicotine dependence and alcoholism, and those who believed that the patient was responsible for the condition were significantly less likely to report satisfaction treating alcoholism.
The Sub-Saharan Africa Survey of Heart Failure (THESUS–HF) was a prospective, multicenter, observational survey of patients with acute heart failure (HF) admitted to 12 university hospitals in 9 countries. Patients with acute HF were evaluated for HF etiology, treatment, and outcomes over 6 months. Acute HF affects patients in sub-Saharan Africa at an extremely early age and is mostly due to hypertension and primary cardiomyopathies. The disease leads to a high burden of readmission and death, similar to that observed in other countries, affecting younger patients in the prime of their life. These data challenge us to recognize and respond to HF in Africa by responding to the common precursors, such as hypertension, and the urgent need for culturally sensitive interventions.
Patients included in THESUS–HF per country.
In This Issue of Archives of Internal Medicine. Arch Intern Med. 2012;172(18):1362. doi:10.1001/archinternmed.2011.987