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Now back to our regular programming. Take a deep breath — and soak in that Postcall chillness…

✅ And let’s get to this week's headlines.

• Justice for Bronny ⚖️

• What patients might say this week 🙊 

• Making “breast” friends with AI 👯‍♀️

• Can we fix it? 🚜🔧No, we can’t?! ❌ 

• Quick bites 🍉

• 💼 Job opportunities

Justice for Bronny ⚖️

Will high-profile cases of cardiac arrest among young athletes shift guidelines in the US and Canada towards implementation of screening ECGs?

Why it’s important: Earlier this summer, Bronny James, LeBron’s eldest, suffered a cardiac arrest secondary to an unspecified congenital heart disease during USC basketball practice. Buffalo Bills safety, Damar Hamlin, had a similar scare earlier this spring, collapsing on the field due to commotio cordis (a blow to the chest resulting in arrhythmia, not a Harry Potter spell). Both athletes are expected to return to play, but a wave of lobbyists in the US are demanding that ECGs be mandatory for student athletes to minimize sudden cardiac death (SCD).

Why it matters: The European Society of Cardiology and the International Olympic Committee recommend using ECGs as part of a pre-participation examination of young competitive athletes to reduce the risk of SCD, estimated to occur in 1 in 40,000-80,000 of athletes per year. In Canada, there is currently no systematic screening process to identify athletes at risk. Instead, the Canadian Cardiovascular Society (CCS) endorses a tiered approach and recommends against first-line/blanket mass performance of ECG. Instead, questionnaires and physical exams are recommended as a starting point. Admittedly, they’re not very good — a meta-analysis of 15 studies reported a pooled sensitivity of 20% for history and 9% for physical examination in identifying disease.

Post-call’s take:

• An analysis of the questionnaires used by U-SPORTS institutions in Canada revealed that only 10% strictly follow guideline-endorsed questions and less than half (43%) contain at least 75% of the recommended items, revealing a lack of standardization with the current screening.

• Potential harms of screening ECGs may include inappropriate restriction, psychological and career impact, and the potential for unnecessary testing.

• ECGs don’t grow on trees — the price for an ECG can be anywhere from $150-300 a pop.

Bottom line: We’ll have to wait for updated CCS guidelines for the final verdict, but for now, the good ‘ol H&P is preferred over ECGs for screening for SCD in young athletes.

Source: https://www.frontiersin.org/articles/10.3389/frph.2021.732318/full

What patients might say this week 🙊 

1. Will my kids get E.Coli from daycare?

Eleven Calgary daycares have been closed after 128 lab-confirmed cases of shiga toxin-producing E.Coli. Of these, there are nine confirmed cases of HUS with some patients requiring dialysis.

2. Can I get a kidney transplant from a pig?

A new study showed that for the first time ever, scientists have been able to grow a solid humanized organ — the kidney — inside another species using stem cells. After the developing humanized kidneys were transferred into surrogate pig mothers, they had normal structure and tubule formation at 28 days.

3. Where can I find a Black healthcare provider?

A new directory of Black health-care professionals across Canada launched last Thursday, connecting patients with allied health professionals such as doctors, nurses, PT/OT, and pharmacy. The platform’s co-founder emphasized that the tool can be used by anyone to expand access to primary care.

Making “breast” friends with AI 👯‍♀️

As usual, when when the robots rise, our job worries crystallize.

What happened: Two recent studies show that specific applications of AI performed similarly to highly trained radiologists in detecting breast cancer.

• A Lancet study, led by breast radiologist Kristina Lång from University of Lund in Sweden, was the first of its kind to use AI to detect breast cancer from mammograms in a randomized control trial.

• Another smaller study published in Radiology found that radiologists and AI came to similar conclusions after reviewing the same mammograms.

Why it matters: Breast cancer is the most common cancer among adults, with more than 2.3 million cases diagnosed each year. In Canada, national guidelines state that women over the age of 50 should get screening mammograms regularly (may be changing to 40 soon).

Prove it with numbers! In the Swedish trial:

• The study randomly assigned screening mammograms from more than 80,000 women to two groups.

  • In the intervention group, one radiologist was supported by an AI model (Transpara version 1.7.0) which triaged out the lower risk scans.

  • The control group used a standard double reading by two radiologists.

• The AI-supported screening group detected about 20% more cancers.

• Recall (rate at which the screened patient needed follow-up) was 2.2% in the intervention group and 2.0% in the control group.

• The false positive rate was 1.5% in both groups.

• The PPV of recall was 28.3% in the intervention group and 24.8% in the control group.

• Due to the triaging, the radiologists in the AI-supported screening group improved their efficiency by reading about 44% fewer mammograms than those in the standard group.

Yes, but… Despite promising findings, researchers say technology still has limitations.

• Dr. Mojola Omole, a breast oncologist and surgeon in Ontario's Scarborough Health Network, is concerned with the technology's ability to detect breast cancer in women with more dense tissue. “Typically Black and Asian women can have more dense breast tissue, which hides the cancer.” And in the Swedish trial, the race and ethnicity of the women wasn't recorded.

• Lång's study also found that AI can over-diagnose cancers that might not end up being harmful to the patient. “AI doesn't compare the current mammogram it's reading to past ones, nor does it know that the patient might have already had a biopsy for a certain abnormality.”

Postcall’s Take: You can finish your radiology residency with confidence (for now). These recent studies are compelling examples of how AI could be used in healthcare to relieve a strained workforce, but researchers still need years of refining these tools and understanding the potential impact before applying them in practice.

Details at CBC

Can we fix it? 🚜🔧No, we can’t?! ❌ 

What happened: You’d think 24 Sussex Drive (a.k.a. the traditional residence of Canada’s prime ministers) would be where our PM resided. But after Justin Trudeau’s 2015 inauguration, he didn’t move into the illustrious 155-year-old mansion where he spent much of his childhood (courtesy of Pierre Trudeau) but the nearby Rideau Cottage. The cottage is actually a small(ish) house on the grounds of Rideau Hall, the official residence of the Governor General. Do they know Justin's squatting in their laneway house?😱

If 24 Sussex Drive is awaiting Justin’s return, it’ll be waiting a long time — and not only because Justin and his crew are stranded in New Delhi. According to an unnamed official’s fresh tea spillage, 24 Sussex Drive might be permanently abandoned for: 1) building a new house, or 2) making Rideau Cottage the forever home for PMs.

But why, Justin??: According to a 2021 report by the National Capital Commission, after decades of neglect, 24 Sussex Drive is a mess even Bob the Builder can’t fix, with crumbling stonework, mould, asbestos, and highly flammable electrical wiring. You know it’s bad when even rodents can’t survive there.

Bottom line?

They say money can’t buy happiness, but $36.6 million CAD (excluding security maintenance) would upgrade 24 Sussex Drive from “critical condition” to “good condition” because no, babe, you’re not ugly, you’re just poor.

Trudeau said, “No prime minister wants to spend a penny of taxpayer dollars on upkeeping that house.” Yet, heritage experts hope the house’s historical and symbolic importance will be recognized for preservation. To restore or not to restore 🤔? ‘Tis the question. 

🍔 Quick Bites

1: If your medical knowledge is sharp as your Pokémon expertise, have we got the game for you!

2: Scientists grew a whole model of human embryo… without sperm or egg. It even released hormones that gave a positive pregnancy test result in the lab. Here’s how.

3: Disability insurance rates are going up (for example, RBC’s discount is decreasing by 15% on Oct. 1), so if you’re in the market, we recommend you start looking ASAP. Want more info on disability insurance before deciding? Stay tuned, because we’ve got a deep dive in an upcoming issue of Postcall.

4: Tim Hortons is now selling vintage-inspired streetwear in their new online store. It’s not their first time around the streetwear block—back in 2021, they sold “Timbiebs,” a super successful line of Justin Bieber-branded merch (belieb it or not).

5: 💍 Got plans to propose? You might be in luck—diamond prices are falling by more than 40%. Here’s why. 

6: The long-awaited iPhone 15 (and 15 Pro) just came out yesterday and we’re pumped. After years of waiting, we can finally ditch our Apple Lightning connectors and use the same dang cords (USB-C) we use for everything else. Here’s our favourite review.

Job Opportunities 💼 

Role: General Cardiologist

• Location: University Hospital of Northern British Columbia (Prince George, BC)

• Compensation: $500,000+

• Learn more

Role: Anesthesiologist

• Location: St. Martha's Regional Hospital (Antigonish, NS)

• Compensation: $300,000 - $350,000

• Learn more

Role: Chief, Department of Paediatric Laboratory Medicine (DPLM)

• Location: Sick Kids Hospital (Toronto, ON)

• Compensation: $400,000 - $450,000

• Learn more

Role: Rheumatology

• Location: UNH/Sinai Health (Toronto, ON)

• Compensation: $260,000+

• Learn more

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