Staying #Up2Date 🚨

1. Holding angiotensin-converting enzyme inhibitors (ACEi) & angiotensin receptor blockers (ARB)

This RCT with 2,222 adults studied holding vs. continuing ACEi or ARB in patients undergoing elective major noncardiac surgery. Continuation strategy was associated with a similar rate of all-cause mortality and major postoperative complications compared with a discontinuation strategy (22% in both groups). Intraoperative vasopressor-requiring hypotension was more common in the continuation group (54% vs. 41%), but the difference in hypotension duration was minimal (3 minutes longer in the continuation group). 

2. Self-discharge associated with overdose risk

This retrospective study found that 3.4% of hospital stays in BC ended in patient-initiated discharge before medically advised (BMA). The unadjusted overdose rate was 10x higher after BMA discharge vs. physician-advised discharge, and after adjusting for confounders. A BMA was associated with increased overdose risk (adjusted HR 1.58; 95% CI 1.31–1.89). 

3. Bladder scan over Foley

A multidisciplinary expert panel developed an algorithm to standardize in-hospital urinary retention. The algorithm recommends bladder scanning over catheterization for symptomatic or asymptomatic patients who haven’t voided after 3 hours. If bladder scanning is unavailable, intermittent straight catheterization (ISC) is preferred initially over indwelling urinary catheter (IUC). Catheterization is advised when bladder scan volumes are ≥300 mL in symptomatic patients or ≥500 mL in asymptomatic patients.

Truth And Reconciliation

How the CMA plans to make amends with Indigenous nations in Canada

What happened: The Canadian Medical Association (CMA) has apologized to Indigenous Peoples for past and present harms brought on to them by medical professionals.

Why it’s interesting: The apology was issued in Victoria, BC during a ceremony held on the traditional territory of the Songhees and Xwsepsum Nations. It featured traditional singers, drummers, dancers, musicians, and storytellers. 

During the ceremony, CMA president Dr. Joss Reimer apologized for the organization’s “deplorable” behaviour towards Indigenous Peoples. She admitted that the CMA contributed to the racism, discrimination, and physical and psychological harm done to First Nations, Inuit, and Mètis people for decades. The association conducted a review of their records and found specific details of the horrific abuse Indigenous Peoples faced at the hands of their physicians. 

Some examples of this included a racially segregated “Indian hospital” system, where Indigenous patients received unsafe care. It was also revealed patients were abused and forced into experimental treatments and sterilization. 

The group also took responsibility for the “Sixties Scoop,” where Indigenous children were abducted from their homes and put into residential schools for decades. A Mètis elder from Saskatchewan said the CMA’s apology is a crucial first step to real reconciliation. 

Bottom line: While the CMA admitting their wrongdoings is an important gesture in reconciling with those they’ve wronged, the work doesn’t stop there. The organization must continue to review their Code of Ethics to ensure it’s free of racism and discrimination, while also training and employing more Indigenous doctors.

Hot Off The Press

1: 🇮🇱🇱🇧 Israeli airstrikes hit Lebanon in a major escalation, killing 569 people, including 50 children, and injuring over 1,800, according to Lebanese officials. As the conflict with Hezbollah intensifies, both sides are ramping up attacks, with Israel targeting over 1,300 sites and Hezbollah firing 240 rockets into northern Israel. Tens of thousands of people in both countries are fleeing amid fears of a full-scale war.

2: 🏥 Ontario's controversial Bill 7 — which allows hospitals to transfer discharged patients to long-term care homes without their consent or face a $400-per-day fine — is being challenged in court for violating the Charter of Rights and Freedoms. Advocates say that the law deprives seniors of autonomy and hasn’t improved hospital bed availability. Meanwhile, the province says it’s necessary to free up beds and ensure patient flow.

3: 💔 New research suggests that childhood trauma raises the risk of developing diseases later in life, with the effects varying by individual experiences and biological sex. This UCLA-led study shows how adverse childhood experiences can disrupt biological systems, with females being more prone to metabolic issues, males to mental health challenges.

4: 📱Jony Ive, Apple’s former design chief, has confirmed he's working with OpenAI's Sam Altman on a groundbreaking AI hardware project. Few details are known, but the project’s rumoured to leverage generative AI for a revolutionary computing device. The reported goal of the project: to build the iPhone of AI.

Notable Numbers 🔢

$15 million: how much Cards Against Humanity is suing SpaceX for. They’ve accused the company of trespassing and damaging land CAH purchased in Texas as part of a 2017 publicity stunt against the border wall. The lawsuit alleges SpaceX used the property without permission, damaging vegetation.

5 in 6: the ratio of Americans who tried to quit smoking in 2022 and failed. Critics argue that both the FDA's strict approval standards and drugmakers' focus on more profitable drugs have stalled progress. Shockingly, no new smoking-cessation drugs have been approved in nearly 20 years.

$863 billion: the market cap of Eli Lilly, which produces Zepbound and Mounjaro. The other big player in weight-loss drugs, Novo Nordisk, has a market cap of $448 billion.

💬 In Our Community

To report or not to report — a dilemma faced by a physician caring for an ophthalmologist in a memory care unit, suspected to have severe dementia while still treating patients. Below is a summary of what others advised them:

• Someone said that the ophthalmologist “wields sharp objects in and around people’s eyes” and should be urgently reported. Many also said “uh… yah” and questioned why this physician is even asking for advice.

• Similarly, some posed questions along the lines of, “would you even be conflicted if they had any other cognitively demanding job? Or do you just not want to be wrong by a physician?”

• Another commenter actually warned that the reporting physician “could actually be punished for not reporting a colleague who was a danger to patients,” and urged them to report this incident immediately. 

• An interesting perspective was brought up about “difficulty of diagnosing neurocognitive disorders in the inpatient setting” (i.e., many other factors that cannot be ruled out, including delirium). This commenter recommended longitudinal follow-up and formal assessment before starting a potentially “life- and career-altering process.”

We found this article reporting that as many as 28% of US physicians with active licenses who are aged 70 and older have mild cognitive impairment or dementia. It also mentioned different strategies to help address this, including mandatory aged-based cognitive screening and self-assessment tools.

Postcall Picks

😭 Laugh: We’re gonna get imaging anyway…

📚 Read: The Butchering Art by Lindsey Fitzharris to learn how surgery started from the bottom and now it’s here. 

🎫 Register: for the physician financial wellness conference to learn more about financial literacy from national experts, including Drs. Soth and Felix from the Money Scope Podcast.

🤑 Save: Get a 3-month Disney+ (with ads) subscription for only $1.99 a month — offer ending September 27th.

Relax

First Question: delusions, hallucinations, disorganized speech, negative symptoms?

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