Staying #Up2Date 🚨

1. Acupuncture for sciatica

In this RCT from China, participants were randomly assigned to 4 weeks of 10 sessions of acupuncture (n = 110) vs. sham acupuncture (n = 110). Coprimary outcomes were changes in visual analog scale (VAS) for leg pain and Oswestry Disability Index (ODI), both of which had significant reduction in the acupuncture group 4 weeks, with benefits persisting through week 52.

2. Heart failure reduced ejection fraction (HFrEF) therapy

This study in the CMAJ studied cost utility for 12 sequencing strategies with either weekly or biweekly medication adjustments for treatment-naive patients with HFrEF. Simultaneous initiation of all 4 meds with biweekly adjustment had the highest probability of being the most cost-effective strategy.

3. Hypotension in hemodialysis (HD)

This study emulated an RCT to identify drugs associated with hypotension in HD. The unadjusted incidence rates of intradialytic hypotension per person-year were 7.4 with calcium-channel blockers (CCBs), 7.8 with angiotensin-converting–enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs), 14.9 with loop diuretics, and 25.3 with beta blockers.

A Bite From the Past

How providing proper hygiene for people who are unhoused could prevent infectious diseases in the operating room

What happened: A disease from World War I has been found in several patients in Alberta who received organ transplants. 

Why it’s interesting: Bartonella quintana, an infection caused by body lice, was found in 7 organ transplant recipients dating all the way back to 2022. The disease can sometimes affect a patient's heart valve or other major organs. 

Donors had transferred the infection – which presented as skin lesions – to organ recipients. The donors were all unhoused and had been infected prior to surgery. After discovering the outbreak, the infectious disease physician alerted Health Canada and other transplant programs. Thankfully, all 7 patients were treated with antibiotics and have recovered.

Alberta Health Services says their donation and transplant programs prioritize the safety and well-being of the donors and patients. Their new guidelines ensure that donors who are unhoused and their recipients are tested 3, 6, and 12 months post-transplant for diseases – including bartonella quintana.

But: Some Alberta community members aren’t surprised. When people don’t have access to shower spaces or clean clothes, it can be difficult to maintain hygiene. 

Edmonton’s hygiene hub was closed in August, making it even harder for people to get the care they need. The director of a health and healing program in Edmonton said bartonella quintana has been found in unhoused populations before. In fact, in 2013, there was a spread of body lice in Edmonton’s unhoused community.

Bottom line: Although the patients made a safe recovery, until there’s real and consistent effort to help those who are unhoused get access to shelter and hygiene products, hospitals may continue to see infectious diseases spread among patients. 

Hot Off The Press

1: 🏫 In 2026, Ontario will reserve 95% of medical school spots for Ontario residents, and 5% for students from other provinces — which effectively bars international students. Critics of Premier Doug Ford point out that most med school spots were already reserved for Canadian students, with priority given to Ontario residents. Ontario will also cover tuition for over 1,000 students who commit to becoming FPs, aiming to alleviate the province’s family doctor shortage.

2: 💊 A Johns Hopkins study reveals that opioid companies misused scientific studies to back inaccurate claims about opioid safety, like downplaying their addictiveness. These companies selectively referenced research to amplify unverified claims, similar to how the tobacco industry created doubt about health risks.

3: 🩻 Texas breast oncologist Lauren Ramsey has developed the BAT shield — a specialized T-shirt designed to protect medical professionals from radiation exposure — after losing a colleague to breast cancer. The BAT shield has been tested to block 97% of radiation in the breast area and is already used in some Texas hospitals. The BAT shield offers an added layer of protection for those regularly exposed to X-rays in the OR.

4: ⚧ A new study published in JAMA Pediatrics shows that transgender teens who use puberty blockers or hormone treatments report high satisfaction with their gender-affirming care — with only about 4% experiencing any regret. These findings challenge the narrative that regret is common among trans youth, especially in light of rising political debates over access to such care.

Notable Numbers 🔢

30: the number of minutes women wait longer than men in EDs seeking treatment for pain. According to a study that analyzed nearly 22,000 ED discharge notes of patients with a pain complaint, women wait longer — up to 30 minutes longer — for treatment. Also, women are less likely to get prescribed the meds they need.

12.5 million: the number of yearly unnecessary healthcare interactions that could be prevented by calling an end to sick notes. Since over half of Canadian physicians experience burnout, the CMA argues sick notes waste valuable time and worsen care delays. Most Canadians (72%) support this shift to free up healthcare resources and improve access for patients in need.

10.3 million: the number of Canadians living in houses with high radon, a radioactive gas and the 2nd-leading cause of lung cancer in Canada. Radon exposure in Canadian homes is on the rise, with nearly 18% of homes now at dangerous levels, according to a national study.

Postcall Picks

😭 Laugh: at the day in the life of a family doc.

🍪 Indulge: on a cookie (or half a dozen) from the long-awaited Crumbl cookies, coming to The Well in Toronto on Nov. 1st.

🤑 Save: on United economy flights between Nov. 2024 - Feb. 2025 from Ottawa to Tokyo (with one reasonably timed layover) for only $1,200.

❌ Eliminate: redundant paperwork and reclaim your time using PocketMD (Patent Pending). Dr. Badawi saved 3 hours daily already, and Postcall readers can get 25% off here (code: POSTCALL25) **

** sponsored content

Relax

First Question: Memory distortion or fabrication, seen in patients with Wernicke-Korsakoff.

If you enjoyed the puzzle, please share it!

Help Us Get Better