Staying #Up2Date 🚨

1. O2 therapy in COPD 💨

In this single-centre study from China, researchers randomized 228 patients with acute COPD exacerbations and moderate hypercapnic respiratory failure (pH, 7.25–7.35; pCO2, ≥50 mm Hg) to either high flow nasal cannula (HFNC) or non-invasive ventilation (NIV). Treatment failure (intubation, or switch to the other therapy) occurred significantly more often among patients who received HFNC (26% vs. 14% for NIV; number needed to harm, 9), supporting current guidelines to treat this patient population with NIV. 

2. Cataract sx trends 📈

In this Ontario population-based study, researchers analyzed differences in socioeconomic status among patients who accessed surgery at not-for-profit public hospitals vs. private for-profit surgical centres before and during the period of expanded public funding for private for-profit centres (Jan 2017 - March 2022). At private centres, the rate of cataract surgeries rose 22.0% during the funding change period for patients in the highest socioeconomic status quintile; for patients in the lowest socioeconomic status quintile, the rate fell 8.5%. At public hospitals, the rate of surgery decreased similarly among patients of all quintiles of socioeconomic status. 

3. AFib in long-term care (LTC) 🫀

In this study, residents of LTC with AFib (CHADS ≥1 for men; ≥2 for women; mean 4.6) were found to receive antiplatelets more commonly over oral anticoagulants: 27% received an oral anticoagulant only, 12% received an oral anticoagulant +  antiplatelet, and 32% received an antiplatelet only. Almost one third of patients received no antithrombotic drug. Among patients who received antiplatelets, 91% were taking aspirin, with 55% having no clear indication for its use (e.g., no peripheral arterial disease, no ischemic heart disease).

Cancer Uproar

Male-specific cancers have been rising over the past 30 years.

What happened: A new study found that by 2050, cancer cases and deaths among men are projected to rise.

Why it’s interesting: The study found that cases will increase by 84%, while deaths will increase by 93%. The research analyzed about 30 cancer types including lung, prostate, and colorectal cancer. 

According to another study published in the Journal of Clinical Oncology, one reason scientists are predicting the surge in male cancer patients is because men tend to smoke and drink more than women. There are other reasons, too, including the lack of programs for male-specific cancers, and that men participate less in shared screening programs.

Countries with lower-income populations and life expectancies and men over the age of 65 are more likely to see larger increases in men’s cancer deaths. The study measured countries in Europe and the Mediterranean’s development in health, knowledge, and standard of living. 

But: Researchers say there are ways governments can lower the risk of infection:

• Expanding universal health coverage worldwide.

• Equipping health systems with appropriate products for cancers diagnoses, like medical labs, pathology, and treatment services.

• Making resources more affordable for anyone who might need them. 

Bottom line: While it might be scary to think about the sudden rise in cancer diagnoses, researchers hope that understanding the cause of the surge can help lessen the future burden.

Hot Off The Press

1: 🏥 A 10-month-old baby in Gaza has been paralyzed by polio, the first case of polio in 25 years in the region. The World Health Organization and UN agencies are pushing for vaccination, but the campaign is being severely hindered by widespread displacement and damaged infrastructure. In Gaza, 90% of the population has been displaced since the conflict began.

2: 💉The Democratic Republic of Congo urgently needs mpox vaccines. Despite requesting them 2 years ago, the shots remain unavailable due to a delayed approval process by the WHO. Because they haven’t officially approved or issued an emergency use license for the vaccines, organizations like UNICEF and Gavi can’t distribute them to low-income countries.

3: 🏫 We told you about the growing trend of concierge medicine a few weeks back — well, it turns out that it’s spreading to university campuses, too (in the US, for now). An anesthesiologist started UniversityMD, a service that ensures your kids get faster access to a doctor… for $600/month.

4: 💍 Apple has filed a patent for a smart ring that could track biometric signals, interact with other devices, and control the user's environment. With competitors like Samsung and Oura already in the market, Apple's advantage may lie in its ecosystem integration and emphasis on privacy.

5: 💔 Female doctors face a 76% higher risk of suicide compared to the general population, according to a study spanning 20 countries. Suicide rates among doctors have overall declined, but the elevated risk for female physicians suggests an urgent need for targeted prevention efforts. Experts emphasize the importance of gender-specific interventions and better mental health support for all healthcare workers.

6: 🇨🇦 The federal government has announced some big changes to immigration, such as a reduction in the temporary foreign worker program and potential reductions in new permanent residents. This is part of their effort to decrease pressure on our healthcare and housing systems.

7: 📱 BC just announced that phones are now banned from bell to bell in schools (joining Manitoba, Saskatchewan, Alberta, Quebec, Ontario and Nova Scotia). We’re supportive of creating space for distraction free learning and less cyber-bullying, but if we know anything about teenagers, it’s that enforcement may be a challenge.

Notable Numbers 🔢

100%: is the tax that Canada will implement on all China-made electric cars starting on Oct. 1. Yes, this will include Teslas.

40-75: the recommended age range for colorectal cancer (CRC) screening in the US. CRC screening becomes riskier and less beneficial for those over 75 years, especially for individuals with limited life expectancy. However, many older adults continue to undergo colonoscopies, often without significant benefits.

15%: the increased risk of Type 2 diabetes for eating 1.8 ounces of processed meat each day, according to a recent study. Researchers analyzed data from nearly 2 million adults across 20 countries, reviewing survey data on participants’ diets and then their health an average of 10 years later.

1.8 million: the number of people who die from lung cancer every year. Currently, global clinical trials are underway for a mRNA vaccine for the world’s deadliest cancer.

💬 In Our Community

We spotted an interesting discussion about goals of care surrounding death and dying with patients’ loved ones. Mainly, an internist shares frustrations about families' resistance to end-of-life care for elderly patients nearing death. Here’s a summary of the most popular replies:

• A palliative care director thought that families pursuing full code goals are likely self-serving. This had 1k+ upvotes, and many mentioned the “son/daughter from…” phenomenon, where families overcompensate to try and prove their care for the patient after not being involved in their lives for many years. 

• Another physician mentioned that many “don't talk about death as much as they should.” They recommended physicians should have goals of care conversations early with patients, emphasizing the importance that patients share their wishes with families. 

• A clinical ethicist provided some insight and mentioned several points that may contribute. First, different providers offer conflicting information about prognosis and treatment options, leading to confusion for family members. Second, health literacy as a barrier to communication (especially for non-English speaking or vulnerable populations). Finally, they recommended avoiding giving statements of minimal hope when the reality of the situation is very futile, as families will hold onto that.

• A nurse made note of the common belief that patients and their families hold, that “medicine enables [health care professionals] to cheat death indefinitely.” Many agreed with this sentiment and cited system-based failure where futile life-prolonging efforts, such as feeding tubes and IV fluids, are offered without nuanced thought and conversation regarding their efficacy. 

Read the rest of the conversation and contribute your own thoughts here.

Postcall Picks

😭 Laugh: at the circle of medicine… Long story short, “the PCP will take care of it.”

📚 Read: Working Stiff by Dr. Judy Melinek, a riveting memoir that takes you on a behind-the-scenes journey of the makings of a forensic pathologist. 

📺 Watch: the nurse who can smell Parkinson’s Disease and what it means for the future of this progressive disorder.

🤑 Save: up to $120 with a free 12-month free DashPass for DoorDash with any Amazon Prime subscription — new or existing!

💳️ Buy: -ing a new phone soon? Wait another week or so, as the new iPhone 16 will be announced on Sept 9th.

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