Nocturnists, Medicine’s Night Owls
Nocturnists — physicians who work hospital overnight shifts — prefer it for the higher pay and slower pace despite the challenges. The specialists, also known as nighttime hospitalists, work from the evening until the next morning in inpatient hospitals and emergency departments.
They like the quiet, fewer patients and visitors, fewer staff members, and fewer open departments as well as the higher pay: 15% more, on average, than day shifts. But sleep, or the lack thereof, is most definitely a factor because of daytime disturbances, sunlight, barking dogs, construction noises, and family members or roommates who operate on opposite schedules.
Nocturnists are new: Before them, less experienced healthcare professionals worked off hours, resulting in poorer care. A 2008 study found that inpatients who experienced cardiac arrest were at greater risk for death during nights and weekends than during the day shift.
A shortage: Experienced healthcare professionals are still needed to work the night shift, which accounts for the higher pay.
Marital Stress Worsens Heart Attack Outcomes
Marital stress is linked with poorer recovery after myocardial infarction (MI) among younger married or partnered patients, new research shows. A large US cohort of married patients aged 55 years or younger who reported severe marital stress had worse physical and mental health a month after MI than did patients who reported no or mild marital stress, according to a study to be presented at the American Heart Association Scientific Sessions 2022.
They also had worse generic and cardiovascular quality of life, more frequent angina symptoms, and a greater likelihood of having a hospital readmission a year later.
Other factors: The findings held after adjusting for gender, age, race and ethnicity, baseline health status, education and income levels, and employment and insurance status.
Gender disparity: A greater percentage of women than men reported having severe marital stress.
Care for Older Transgender People
The population of older transgender people is increasing, and with it the special challenges of treating them, according to K. Ashley Brandt, DO, an ob/gyn and gender-affirming surgeon in West Reading, Pennsylvania. Yet, there is little research into the management of gender-diverse older patients, and the stigma surrounding gender identity and sexual orientation continues to negatively affect older transgender people, she wrote in a Medscape commentary.
Members of the LGBTQIA+ population in general have higher rates of obesity, sedentary lifestyle, smoking, cardiovascular disease, substance abuse, depression, suicide, and intimate partner violence than does the general same-age cohort.
Poorer prospects: Compared with older lesbian, gay, and bisexual people, older transgender people have significantly poorer overall physical health, disability, depressive symptoms, and perceived stress.
Special needs: Clinicians need to evaluate current gender-affirming hormone therapy regimens and other procedures that can heighten the risk for osteoporosis, cardiovascular disease, and other conditions in aging patients.
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