Internal Medicine Alert – January 30, 2025

Unhurried Patient Care

Unhurried conversations during patient encounters can improve outcomes for patients and enhance career satisfaction of physicians. Specific communication strategies can foster unhurried conversations without adding undue time to clinical care.

Reduced Control and Workplace Burnout

This cross-sectional study of more than 2,000 physicians from diverse healthcare organizations found that reduced control over specific aspects of practice — such as patient load, clinical hours, and overall workload — was significantly associated with not only higher levels of burnout, but also increased intentions to reduce clinical hours or leave practice altogether.

Arrhythmias in the Holiday Heart Syndrome

A small study of continuous electrocardiogram and breath alcohol concentration in young volunteers during acute excessive alcohol consumption has shown that heart rate and ventricular premature beats increased during the drinking period. During recovery (six to 19 hours), significant arrhythmias such as atrial fibrillation occurred in 5% of the subjects. The observed changes in heart rate variability and breath alcohol concentration suggest that these effects are the result of increased sympathetic nervous system activity associated with excessive blood alcohol concentrations.

Antiplatelet Therapy for Coronary Stent Patients Undergoing Noncardiac Surgery

A larger randomized controlled trial of aspirin monotherapy vs. no antiplatelet therapy in patients more than one year post-drug-eluting coronary stent placement failed to show a difference in ischemic outcomes or major bleeding, but minor bleeding was more common in the aspirin group.

Clostridioides difficile: Reduced Susceptibility to Vancomycin?

Many sites have been reluctant to prescribe fidaxomicin as the first-line agent, despite fairly robust evidence indicating its efficacy relative to vancomycin in preventing recurrences. We still cannot predict who will do well with vancomycin and which patients are likely to relapse or to do more poorly. The gradual emergence of Clostridioides difficile with reduced vancomycin susceptibility may contribute to adverse outcomes when using this agent.

Tirzepatide Injection (Zepbound) for Obstructive Sleep Apnea

The U.S. Food and Drug Administration has approved tirzepatide for the treatment of moderate-to-severe sleep apnea in adults with obesity.