Postcall Unwrapped 🎁

PLUS: 💉 vaccine produced, 🦷 toothbrushing boost, & 🎅 Santa mass-produced

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Happy Holidays from Postcall! And… Happy 201st birthday, Louis Pasteur!

Louis Pasteur was a part-time comic… right?

Louis Pasteur is still hailed as the father of microbiology for his groundbreaking contributions to vaccination and pasteurization.

❓Trivia question❓: What specific idea of Pasteur's was met with initial resistance and skepticism?

Now for something special…

Driving these numbers: Markets ended the week in the green (TSX up 1.6% in the last week). Why’s the CAD gaining so much against the USD? The US Fed is signalling rate cuts, while the Bank of Canada is saying they may not follow suit.

🎁 Postcall Wrapped

That’s a wrap! We’re finishing off the first year of Postcall like your favourite burrito — quality bites wrapped up with a bit of spice. Here’s a roundup of our favourite stories from 2023.

House of Commons Sense ♀🏚️

  • In Nov., the House of Commons health committee (which normally only has one woman) swapped in multiple women from different parties to study women’s health in Canada — including gender gaps.

Doctors Without (Provincial) Borders 🧑🏽‍⚕️🇨🇦 

  • Last month, health ministers greenlit a new licensing program, making it easier for Canadian doctors and nurses to work in different provinces… but premiers aren’t happy about it. 

Taking a bite out of rabies 🦇🦨

  • Researchers have found a potential cure for advanced rabies by injecting lab mice with a monoclonal antibody (F11) derived from the Australian bat Iyssavirus, a close relative of the rabies virus. Now the next big move is crafting a human-friendly version of F11 for clinical trials.

Pap Smears Get a Glow Up 🌟

  • Per new CMAJ recommendations, self-swab HPV tests have been rolled out in many provinces across Canada, including Quebec, New Brunswick, and PEI. The screening is recommended for q5y for those aged 25–65 and is just as accurate as the Pap in a gyne office.

The Fall of Phenyl 😵👑

  • In September, the FDA found that phenylephrine (found in many over-the-counter cold and flu meds) was determined ineffective at treating a stuffy nose. Consider using Flonase or antihistamines — or for children, Children’s Tylenol or Children’s Advil instead.

Don’t worry — plenty of other cures for the common cold! 😏

Hold my 🍺 Ozempic 

  • In August, we covered new recommendations from the Canadian Journal of Anesthesia around ozempic. Apparently, the popular diabetes drug was causing delayed gastric emptying, putting the patient at risk for aspiration during induction.

Psilo-vibin’ 😎 🍄

  • Also in August, we explored guided mushroom trips being offered to patients facing end-of-life care. But don’t call yourself a shaman yet — Canada is still experimenting with the therapeutic potential of psilocybin.

Ask your doctor if psilocybin is right for you.

🫀 Taking the Pulse

When we asked you “How was this year for you as a Canadian physician?”, you said…

  • 55% - 😄 “Great” or “Ups and downs, but feeling positive”

  • 45% - 🙁 “It’s been better”

“Sad that as a sub-specialized physician in Quebec in a surgical specialty, I’m not able to operate due to government regulations despite very long wait lists for patients in my field.”

“I still enjoy medicine. Hate the mounds of paperwork, feel AI may help with charting. Plan to try it out to free up some time”

Presented by Prosperous Life MD

“I’ve been getting home on time on clinic days.“

Your colleagues have been saying it. Wondering how?

They’re following the 10 Commandments of Charting that are changing the game for MDs in Canada.

Here’s the first few, but you can click here to read all 10 at Prosperous Life MD.

1: Thou shalt have no identity before "me."

You are so much more than a “doctor”—don’t wrap up your entire identity in your work. You wear many hats, and doctor is just one of them.

2: Thou shalt not make unto thee any graven EHR.

Don’t spend so much time with your electronic health record (EHR) whereby others come to believe you worship at the altar of the EHR. Your work and EHR will not love you back, no matter how much you put into them.

3: Thou shalt not take thy wellbeing in vain.

And I mean, all facets of it—your physical, mental, social, etc., wellbeing.

Why?

  • Seeing as you’re innately worthy, you deserve to take care of yourself.

  • You can only best serve your patients when you’re taken care of.

4: Remember Saturday and Sunday, to keep for rest and fun.

You can’t sustain yourself running a continuous mental marathon, even if you’re behind and have a backlog of charting. Resting and taking time for yourself will make you more efficient when you return to the work you have to do.

Click here to read about these and the remaining Commandments in more depth.

Things your attending might pimp you on 🙋🏽‍♀️👨‍⚕️ 

1. “Should hospitalized patients be brushing their teeth more?”

A new systematic review and meta-analysis set out to determine whether daily toothbrushing was associated with lower rates of hospital-acquired pneumonia (HAP). They concluded that daily toothbrushing may be associated with significantly lower rates of HAP and ICU mortality, shorter duration of mechanical ventilation, and shorter ICU length of stay (LOS). Of note, patients on mechanical ventilation may benefit the most from brushing their teeth. 

2. “GCS ≤ 8, intubate”

A multicenter, randomized trial compared intubation withholding vs. routine practice of tracheal intubation in 225 comatose patients with acute poisoning and GCS < 9. The conservative strategy was associated with a significant clinical benefit for the primary end point (in-hospital death, ICU and hospital LOS) in the intervention group, with a win ratio of 1.85. 

3. “Ever heard of a didelphys uterus?”

It’s an Xmas miracle! A woman from Alabama with a rare double uterus gave birth to fraternal twins earlier this week. In a didelphys uterus, each baby has a womb to itself which results from a maternal congenital defect arising from the Mullerian ducts failing to fuse. Generally, this leads to two separate uterine cavities and two cervices. About 1 in 3 pregnancies may result in spontaneous abortion or preterm birth.

🍔 Quick Bites

Malaria vaccines are in high demand around the world.

1: 🦟 The WHO has prequalified a second malaria vaccine, R21/Matrix-M, shown to be effective in 70-78% of cases. This plus the first WHO recommended malaria vaccine, RTS,S/AS01 — prequalified in 2022 — should make headway for the high-demand, low-supply of malaria vaccines. Developed at the University of Oxford and the Serum Institute of India, R21 can be produced for $2-$4 per dose — comparatively cheap to other childhood vaccines.

2: 🏥 There’s an urgent crisis in Ukraine, aggravated by the ongoing war with Russia: a rise in drug-resistant infections. According to a survey, 14% of patients picked up infections in hospital, 60% of which were resistant to carbapenem. Compare this to a 2016-2017 EU-wide survey, in which 5.5% picked up infections in hospital, with only 6.2% resistant to carbapenem.

3: 😷 Chief public health officer Dr. Theresa Tam warns that COVID-19 has yet to show a discernible seasonal pattern. Because the virus is still evolving rapidly, vaccine rollout programs are harder to plan. The hypothesis is that it will eventually establish seasonality like more common endemic coronaviruses.

4: 🍎 Apple will no longer be able to sell their Watch Series 9 and Ultra 2 in the U.S., if the U.S. International Trade Commission has anything to say about it. The tech in the watches that senses blood oxygen saturation — used in the watches since 2020 — allegedly infringes upon two patents. Now it’s up to U.S. Customs and Borders Protection to make a decision, but don’t worry: they’re still available on our side of the border!

Postcall Picks ✅ 

🇨🇦 Canadian brand Reigning Champ is one of our faves

💳️ Get: a physician banking experience, starting with your mortgage. BMO’s Helen Sy works with med students, residents, and staff to get tailor-made financing exclusive to Canadian doctors. Call or Whatsapp Helen @ 778 885 7618 or email [email protected].

🎁 Buy: new threads at Reigning Champ, and take advantage of up to 50% off on their boxing week sale.

🧑‍⚕️ Scrub: Or maybe Figs are your thing? They’re running 20% off site wide.

🎧️ Listen: to SGEM’s interview with Dr. Mahaleh Mekalai Kumanan, president of the Ontario College of Family Medicine (OCFP) share possible solutions on the current state of family medicine in Canada.

👀 Watch: this 24/7 kitten cam. Because you deserve it.

📈 Trending: This X thread with AI-generated Santas from each province and territory of Canada

🕹️ Game ⛳️

Last week, 73% of you solved it completely, with an average time of 4:33. Can you beat that this week?

First question: What do you call a severe reduction in white blood cells?

‘Tis the season of giving and receiving! 🎁 Gift the link of the crossword puzzle & receive the giftee’s (and our) eternal gratitude.

❓Trivia Answer ❓

Pasteur's germ theory of disease. He proposed that microorganisms are responsible for infectious diseases, but this idea faced resistance — partly because it challenged the prevailing notion of spontaneous generation.

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