Staying #Up2Date 🚨

1. Opioid prescribing in the ED

This Albertan cohort study of opioid prescriptions for high acuity patients in the ED with MSK/GI/GU pain found small increases in hospital admissions (16.4% vs. 15.1%, NNH = 53) and prolonged opioid use (4.5% vs. 3.3%, NNH = 59), with no significant effect on opioid-related ED visits, new opioid agonist therapy, or mortality. Risk was highest in opioid-naive patients, older adults, and males, while those with mental health or substance use disorders had lower incremental risk. 

2. Cannabis use disorder (CUD) associated with schizophrenia

This large population-based cohort study in Ontario examined changes in the population-attributable fraction (PARF) of CUD associated with schizophrenia. The PARF increased from 3.7% pre- to 10.3% post-legalization. Males aged 19 - 24 y.o had the highest PARF post-legalization at 18.9%. While the overall incidence of schizophrenia remained stable, diagnoses of psychosis not otherwise specified (NOS) increased by 83.7% after legalization. 

3. Chronic obstructive pulmonary disease exacerbation (COPDe) & type II diabetes (T2D)

This study used data from three 1:1 propensity score–matched cohort studies that emulated 3 target trials. It compared patients aged 40+ with T2D and active COPD who were started on either SGLT-2is vs DPP-4is, GLP-1RAs vs DPP-4is, or SGLT-2is vs GLP-1RAs. Both SGLT-2is and GLP-1RAs were associated with significantly lower rates of moderate or severe COPDe compared to DPP-4is (2.2 and 1.6 fewer events per 100 PYs, respectively), with minimal differences between SGLT-2is and GLP-1RAs.

You’ve Been Served 🍽️

How to survive a legal storm — without losing your stethoscope.

As a physician, there are certain phrases you never want to hear — and “you’ve been served” is pretty high on that list. About 800 doctors are taken to court yearly for alleged negligence. Mistakes happen, but the right prep helps doctors recover — just like a smooth post-op.

What do I do if legal action comes my way? Dr. Todd Watkins, CEO of the Canadian Medical Protection Association (CMPA), has some advice for physicians if they find themselves in hot water.

• Call the CMPA. As soon as those papers land on a doc’s doorstep, Dr. Watkins says to contact CMPA. The organization will give them legal advice – and, in some cases, financial protection.

• Understand the legal process. A statement of claim begins a legal battle, where physicians discover the allegations against them. Dr. Watkins said understanding legal deadlines can dodge future complications.

• Build a support system. Being sued is stressful, but it doesn’t have to be. Even if it goes to trial (most don’t), it doesn’t mean the physician was negligent. Dr. Watkins urged listeners to have people to lean on while they navigate their cases.

• Don’t alter medical records. Sounds obvious, but Dr. Watkins warns that even minor changes can backfire. He also advises against speaking to anyone other than their lawyer.

Most importantly — don’t panic. Give yourself space to ask your lawyer or the CMPA all the questions you need. Doctors shouldn’t fall down a rabbit hole of looking at old records or trying to talk to the plaintiff, as it can hurt the case and make them look guilty. 

Bottom line: Like surgery, a legal battle has many steps, and following them is in every physician's best interest. For more info, check out the beyond MD podcast. 

Hot Off The Press

1: 🇦🇷 Argentina’s Javier Milei is cutting ties with the WHO, following Trump’s lead and calling the global health body a tool of “social control.” Critics say the move could slash medical funding and deepen healthcare challenges. It’s adding fuel to protests over Milei’s right-wing agenda, which includes banning gender-affirming care for minors and limiting trans women’s access to women’s prisons.

2: 🐷 A pig kidney that works? So far, so good. Tim Andrews, 66, is only the second person to receive a genetically edited pig kidney — and he’s thriving. The Massachusetts General Hospital team behind the transplant calls this a turning point for xenotransplantation, with more trials ahead.

3: 📱 Heads-up for diabetes device users: The FDA’s got a reminder to regularly check alert settings on smartphone-connected devices like CGMs and insulin pumps. Recent reports show missed alerts (often triggered by software or hardware updates) could lead to serious health risks, from hypoglycemia to even diabetic ketoacidosis. The FDA advises turning off auto OS updates, double-checking alert settings after any changes, and regularly confirming that volume and notifications are working properly.

4: ⚖️ Speaking of lawsuits… Horizon Health Network and 2 nurses are denying negligence in the case of Darrell Mesheau, a 78-year-old former diplomat who died after waiting 7 hours in a Fredericton ER. The health authority argues Mesheau received appropriate care, while his family alleges "reckless and outrageous" failures.

5: 🤠 While we thought the big rap beef of last year was over, Kendrick Lamar used his time at the Super Bowl (where the Eagles stopped the Chief’s attempt at a three-peat 40-22) to get everyone dancing on Drake’s grave one more time. Including Drake’s ex Serena Williams.

Notable Numbers 🔢

21.2%: the percentage of flu tests coming back positive last week — a season high, beating last year’s peak of 18.7%. With cases surging (particularly among those 65+), the season’s peak is hitting later than usual. Nearly all cases are influenza A. Despite the spike, hospitalizations remain stable.

113: how many bank customers found themselves with no warning after their accounts were suddenly shut down in 2023. Complaints have surged, with the Ombudsman for Banking Services and Investments seeing a jump from 19 in 2019. Banks say it's to fight financial crime, but critics argue innocent customers are paying the price.

$97.4 billion: Elon Musk's offer to buy OpenAI’s nonprofit arm, which is shaking up Silicon Valley's AI scene. Backed by Musk’s xAI and a group of heavy hitters, the bid aims to return OpenAI to its open-source, safety-first roots, challenging Sam Altman’s controversial shift to for-profit. Altman’s response? “We’ll buy Twitter for $9.74 billion instead.”

Postcall Picks

⚡️ AI: is replacing music producers now? You can make your own with just a simple prompt, using Riffusion.

😂 Laugh: at this adorable meme!

🤑 Save: Whether you’re shopping for a loved one or spoiling yourself this Valentine's Day, Best Buy’s got your back with their V-Day sale! Order online now and pick it up before the 14th.

👨‍👩‍👧‍👦 Spend: time with your crew this Monday in honour of Family Day! The Art Gallery Of Ontario hosts a Family Day weekend event where kids and adults can immerse themselves in arts, culture, and history. 

Relax

First Question: Vital sign with O2, as one would say on rounds

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