Staying #Up2Date 🚨

1. Don’t sleep on this 💤

The SURMOUNT-OSA studies have shown that Tirzepatide, a GIP/GLP-1 receptor agonist, may be a treatment for obstructive sleep apnea (OSA). In both studies, patients had moderate-to-severe OSA with mean of 51.5 events/hour on the apnea-hypopnea index (AHI) and BMI ≧30 kg/m². In trial 1, which included patients not using CPAP, the mean change in AHI at week 52 was −25.3 events per hour (95% confidence interval [CI], −29.3 to −21.2) with tirzepatide and −5.3 events per hour (95% CI, −9.4 to −1.1) with placebo. This ended up being an estimated treatment difference of −20.0 events per hour (95% CI, −25.8 to −14.2) (P<0.001). In trial 2, which included patients using CPAP, the estimated treatment difference was −23.8 events per hour (95% CI, −29.6 to −17.9) (P<0.001). 

2. A new tool 🫀

There’s a new cardiovascular risk calculator in town, aptly called “PREVENT.” How does it differ from the traditional ASCVD risk calculator we have all grown to love/hate? 

• It includes additional metabolic and renal factors such as BMI, eGFR, HbA1c, and uACR.

• Patients’ zip codes can be used to account for risks conferred by social circumstances. 

• Estimates are provided for CV disease, for ASCVD (i.e., coronary disease plus stroke), and for heart failure with 10- and 30-year risks generated for those 30-79 and 30-59 y.o., respectively.

3. A bolus of coffee pls ☕ 

Caffeine can raise your heart rate, but does it raise your blood pressure too? In this Italian cohort study researchers collected office, home, and 24-hour ambulatory blood pressure (BP) readings in 1400 participants - stratified into nonconsumers, moderate- (1–2 cups daily), or heavy-consumers (≥3 cups daily). At baseline and 10-year follow-up, ambulatory and home readings for BP were no different among groups after adjusting for confounders.

Harm Reduction At Your Fingertips 👇

Swapping chips for condoms may save lives.

What happened: Brantford, Ontario is getting a new special vending machine that offers harm reduction supplies.

Why it’s interesting: The company behind the vending machines for harm reduction (VMHR), Our Healthbox, seeks to eliminate barriers for people seeking harm reduction supplies in their community. REACH Nexus, a research group connected to Our Healthbox, has already placed 6 machines around Canada — in places like Peterborough, Ottawa, and Winnipeg — but this is the first one in southwestern Ontario.

The machine will be available when SOAR Community Services is closed to the public. Products like naloxone, condoms, pipes, and HIV kits will be offered. Our Healthbox is anonymous and free to use, though it does require users to create an account. One scientist says the vending machines take pressure off healthcare workers (but we haven’t seen supporting data)

Brantford’s rate of opioid-related deaths and ED visits for opioid instances have been higher than the provincial average since 2017. Advocates say that having access to naloxone and other harm reduction supplies, especially after hours, is vital.

The program in Ottawa — the first Canadian city to get VMHRs — has been considered a success. Another VMHR in Tulsa, Oklahoma has to be restocked every day.

But: There have been some concerns regarding Our Healthbox. Some are worried that the machine (and the access it provides to products like naloxone or fentanyl test strips) might endorse the use of harmful substances. Some others say they don’t like where the machines are being placed. Officials at the company responded that for those affected by addiction, or people who need access to contraceptives, compassionate care is needed.

Bottom line: We’re still waiting for the final verdict from REACH Nexus, but if Brantford’s program has outcomes like Ottawa or Tulsa, it’s expected to be a success. The company said they plan to release 100 more machines across Canada.

Hot Off The Press

1: 🦠 Scientists are zeroing in on why some people never get COVID-19, the virus that still kills about 20 people a week in Canada. For example, a recent study in Nature identified a specific gene in people who haven’t been infected. Studies that examine early immune responses could help in the development of nasal spray forms of vaccines.

2: 🧠 A new Boston University study has shown that an AI program could predict whether people would develop Alzheimer’s within 6 years of showing signs of mild cognitive impairment. The tool had a 78.5% accuracy rate. Detecting the disease early is crucial to getting patients the care they need.

3: 🏡 Your land might be worth more soon: the BC government will require cities to allow more homes on lots currently meant for single-family houses or duplexes. This new law, Bill 44, applies to towns with over 5,000 people and lets them build up to 4 units on a lot, or 6 units if the lot is near public transit. The goal is to create 130,000 new homes over the next 10 years.

4: 🩸Doctors in Canada are working to address the high rate of diabetes-related amputations, particularly among Black Canadians, who face a higher risk due to delayed diagnosis and lower screening rates. Programs are being developed to train personal support workers to identify early signs of foot complications in patients' homes, which can prevent up to 85% of amputations.

5: 🐎 Democrats are reportedly talking about replacing Joe Biden as the party’s nominee after a stumbling performance at the first presidential debate last week.

6: 🧑‍⚖️ The US Supreme Court ruled on Monday that Trump has broad immunity from prosecution for actions that were within his constitutional powers as president. This is a landmark decision recognizing for the first time any form of presidential immunity from prosecution, and will likely hamper several active cases against Trump.

Correction: In our last issue, we made the typo "surgeons administered a single-spinal anesthesia shot" during a procedure. That's our bad — we know all you anesthesiologists deserve the credit! Our apologies for any confusion.

Notable Numbers

2014: the last time there was a direct commercial flight from Canada to Greenland — until now. Arctic tourism is on the rise, and a new flight route connecting Nunavut and Greenland started this week.

99%: the efficiency of a CRISPR-based genetic technique that intends to eliminate primary African malaria vector, Anopheles gambiae mosquitoes, and also reduce malaria transmission.

$300 billion: the value of the global pet industry. Psychologist Hal Herzog has pointed out that research suggesting that owning a pet improves health is fuzzy at best, and propaganda of the pet care industry at worst.

💬 In Our Community

Do you think your specialty choice impacts your longevity? Or maybe it’s your lifestyle that informs your specialty choice?

There’s an interesting study shared on Facebook called “Medical specialties and life expectancy: An analysis of doctors’ obituaries 1997–2019,” published in Lifestyle Medicine.

Here’s what we took away from the study and the online discussion:

1. On average, doctors tend to live longer than the general population in the UK.

2. Different medical specialties seem to be associated with different lifespans:

   1. General practitioners (family doctors), surgeons, and pathologists tended to live the longest, with average ages at death around 80 years.

   2. Emergency medicine doctors had the youngest average age at death at about 59 years.

      1. Other studies show people that work shifts and night hours have a lower life expectancy.

      2. BUT this finding should be interpreted cautiously because emergency medicine is a relatively new specialty, so there may not be enough older emergency doctors yet to give an accurate picture.

   3. Emergency medicine doctors had a higher proportion of accidental deaths compared to other specialties.

      1. Our favourite response to this: "Great news for ER docs. We don't need to save for retirement!"

   4. Radiologists used to incur significantly higher radiation doses. New trainees would not be impacted as much by radiation.

   5. Anesthesiologists also die earlier, but we’re not sure why.

While this study provides interesting insights, it has limitations. For example, not all doctors have obituaries published in the British Medical Journal, so the data might not represent all doctors perfectly.

Postcall Picks

😂 Laugh: in honour of new residents’ first week on the job!

🎧 Listen: to the White Coat Investor Podcast this week, where an ER doc discusses how he reached millionaire status only 5 years into practice.

🤑 Save: Gymshark is having their biggest sale of the year — save up to 60% on your workout essentials today.

🧠 Learn: Discover the opportunities and challenges of rural medicine in Canada, including difference in salaries, community involvement, professional growth, burnout rates, and isolation.

🎂 Celebrate: with us and other MDs on our 1-year birthday (if you’re in Vancouver tomorrow)! We’re serving up food, open bar, and a fun time with other engaged readers. RSVP here.

Relax

First Question: What is the CTV medical drama based at (fictional) York Memorial Hospital in Toronto?

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