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A Hospital in a Warzone 🇮🇱🇵🇸
PLUS: Orca whale fins 🐋, fund managers’ cleft chins 🤔, and immunotherapy wins 🙌
Kristen Morrison
November 29, 2023
Hi there! Postcall here — reminding you to enjoy the last day without holiday music!
Semantic satiation — where a word/phrase loses meaning because of repetition — might explain the nostalgia of holiday music. It also explains how monotony leads to boredom 🥱… boredom to anger 😡… anger to suffering <(°.°)>
Let’s move onto this week’s stories!
Health Canada’s Donepezil recall 💊
🫀 Hgb thresholds for transfusion
The role of immunotherapy in advanced endometrial cancer 😷
Al-Shifa Evacuation: A Hospital in a Warzone🇮🇱🇵🇸
Postcall Classics: Bites & picks & our weekly crossword 🧩
Driving these numbers 🤑: What’s driving the market rally that started about a month ago? Falling inflation, along with strong earnings from U.S. companies. Also, there’s the “Santa Claus rally”, an almost yearly phenomenon where markets rise sharply in Q4. But don’t rush to buy just yet - It's earnings week at the big six Canadian banks and analysts expect slow earnings due to rising mortgage strain and high borrowing costs.
Things your attending might pimp you on 🙋🏽♀️👨⚕️
"What are the side effects of Donepezil?"
An Alzheimer's medication called Donepezil has been recalled by Health Canada due to oversized tablets in some bottles, tripling the dosage from 10 to 30mg per tab. At these higher doses, Donepezil can cause or exacerbate side effects like nausea, diarrhea, vomiting, fatigue, loss of appetite, insomnia, and muscle cramps. Donepezil? More like “don’t take ze pill” if it appears larger than usual. 💊
2. “Which Hgb threshold should I use to transfuse my patients?”
This year’s AABB International guidelines, updated in Oct. 2023, recommend a restrictive transfusion strategy for stable hospitalized adult patients — i.e. transfuse if hemoglobin < 70 g/L (strong recommendation, moderate certainty evidence). However, higher thresholds are suggested for specific cases: 75 g/L for cardiac surgery patients and 80 g/L for orthopedic surgery patients or those with preexisting cardiovascular conditions. The recommendations for hospitalized adults with hematologic and oncologic disorders are weaker but similarly uphold restrictive strategies of < 70 g/L.
3. “What is the role of immunotherapy in advanced endometrial cancer?”
In a phase III trial involving patients with newly diagnosed advanced or recurrent endometrial cancer, combining immunotherapy (durvalumab) and chemotherapy (carboplatin/paclitaxel) demonstrated significant progression-free survival (PFS) benefits, further enhanced by adding a PARP inhibitor (olaparib). Improvement in PFS was shown across multiple disease subgroups, suggesting that carboplatin/paclitaxel plus durvalumab, with or without olaparib, may be an effective treatment for advanced or recurrent endometrial cancer.
A Hospital in a Warzone 🇮🇱🇵🇸
On Nov. 17th, Gaza's largest hospital, al-Shifa, evacuated patients and medical staff. The New York Times interviewed several doctors to get a firsthand account of what medicine has become in a warzone. We wanted to highlight their reporting on what life is currently like for our physician counterparts over there.
Why is a hospital at the centre of Israel’s attacks?
The storied medical complex, whose name translates into “House of Healing,” has been described as the beating heart of Gaza. Gaza health ministry officials have held press conferences there, and the government’s media ministry has operated out of the hospital complex. At the same time, Israel claims it’s a “stronghold of Hamas’s military and administrative capabilities.”
Smoke rises as displaced Palestinians take shelter at al-Shifa Hospital [Source: Doaa Rouqa/Reuters]
What does practicing medicine there look like?
“Around 1,600 to 1,700 [patients in the hospital]. But the hospital capacity is 600. So you can only imagine.”
“Each operating room has a small area called recovery, where we put patients right after the surgery just to monitor them until the anesthetic wears out. And that recovery area is where I sleep.”
“Lots of calls. Yes, that’s where I spent my day just looking for water, for food, for fuel for my medical staff here. We don’t have even a bread for the last two days for the medical staff.”
“Just today, we received about 12 children and women, pregnant women. Two of them are pregnant. Where is the hospital dead. They were killed. And we tried — after they killed, we try to do cesarean section after they are killed, the ER, trying to save their babies. But we cannot do that. Unfortunately, the fetus was killed also. We tried to save it. We tried.”
“Two days ago, we got a patient with no one of her family alive. She came alone. 11-year-old. She was disoriented. No one knows the name. And she was in the recovery with no beds. The general manager of the hospital called me and said, I know this is not your case, but please can you take care of this little girl? She has no one here.”
“Even there is a new medical term that we are having. It must be added to medical books. Wounded Child, No Surviving Family. WCNSF. And it happens every hour. I have seen dozens or even hundreds of WCNSF.”
“We work hard. We work more than 18 hours per day.”
To hear the NYT’s perspective and first hand interviews with doctors in Gaza, click here to find The Daily episode.
🍔 Quick Bites
1: 🩺 Alberta has announced that nurse practitioners will be able to set up publicly funded independent practices as early as January, leading to push-back from Alberta doctors. Premier Danielle Smith defends the move as part of the province’s plan to counterbalance the shortage of FPs. (See our article last month on provinces fighting to retain their healthcare staff.)
2: 🐋 Perhaps in an attempt to apologize for the recent trend of sinking yachts, a pod of orcas put on a show off the coast of B.C. last week — breaching, slapping their tails, “clearly having some fun.” Conservation societies surmise that the rise in sightings is due to the growth in sea lion and harbour seal populations.
3: 🇨🇳 Chinese authorities reported an increase in influenza, mycoplasma pneumoniae, RSV, and COVID-19 - so far, it’s attributed to lifting COVID restrictions. The familiar feeling of the early days of the pandemic has caused the WHO to open an investigation. The agency has formally requested China provide detailed information on the reported clusters among children, as well as more data about recent trends in SARS-CoV-2, RSV and other viruses.
4: 💋 According to a recent study at Shanghai Jiao Tong University, less physically attractive fund managers perform better than their attractive counterparts by 2% annually. However, "good-looking” managers are more likely to receive promotions and significantly higher fund flow. Some have deemed this study “interesting and thought-provoking.” Others? “Absurd and offensive.”
5: 🫱🏾🫲🏿 The Anti-Racism Expert Working Group (working on the 2025 CanMEDS update) has shared their viewpoint on changing the model, believing that future doctors should “centre values such as anti-oppression, anti-racism, and social justice, rather than medical expertise.” The document has caused reactions across the spectrum: for example, a National Post opinion contributor has called proposed framework “disturbing.”
Want to share your thoughts on the proposed CanMEDS model? Or have a personal experience to share? Email us at [email protected] and we'll include your anonymized comments in the next issue.
Postcall Picks ✅
🛀 Self-Care: with that Instagram famous spa-grade tea bath from Inoki. Handmade in Toronto, these at-home bathhouse experiences are the perfect self-care gift for when you’re postcall (or in the middle of CaRMS season). Treat yo self! Use our link (or code: POSTCALL10) for 10% off.
🛫 Travel: the top 10 favourite countries of writer/traveller Cassandra De Pecol, who beat two world records visiting every sovereign country in the fastest time. (Spoiler alert: Italy didn’t make the cut.)
🍷 Drink: …only white wine? With holiday parties and family dinners coming up, you should know about a new study out of UC Davis that posits a flavanol called quercetin interferes with metabolism of alcohol, leading to that dreaded “red-wine headache.”
👀 Watch: the worlds largest iceberg (about 6x the size of Toronto!!) has started moving after being stuck to the ocean floor for three decades.
🕹️ Game ⛳️
Did you have your morning coffee? Because it’s time to face the crossword music 🎶…
First question: What is inflammation of the tear sac called? 👁️
Last week’s fastest times: 1:41 and 1:44
As Leonard Nimoy says, “The miracle is this: The more we share the more we have.” So — have more! If you enjoyed our puzzle, please share the link! 👏
Job Opportunities 💼
Role: Cardiothoracic Imaging Radiologist
Location: Manitoba X-ray Clinic Medical Corporation (Winnipeg, MB)
Compensation: $550,000
Role: Anesthesiologist
Location: The University Hospital of Northern British Columbia (Prince George, BC)
Compensation: $500,000
Role: Palliative Care Physician
Location: Yarmouth Regional Hospital (Yarmouth, NS)
Compensation: $250,000 to $300,000
Role: Physician Assistant
Location:The Hospital for Sick Kids (Toronto, ON)
Compensation: $90,000
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