Staying #Up2Date 🚨

1. Arm yourself with this knowledge: 

The ARMS crossover trial of 133 adults studied the effect of nonstandard arm positions on BP readings. Arm supported on the lap and arm unsupported at the side each led to significantly higher readings by 4 mm - 6 mm Hg for both systolic and diastolic measurements. Having the arm supported on a desk with the midcuff positioned at heart level is the most appropriate technique.

2. Skip the skin test?

De-labelling patients without true penicillin allergies sometimes requires referral to allergy & immunology for a skin test, which can be resource-draining. This systematic review examined the safety of direct penicillin challenges without preceding skin tests. Since only 3.5% of the 9K+ patients experienced reactions, this study suggests that going straight to the penicillin challenge may be a safe alternative that can be performed in the primary/urgent care setting.

3. A case for population-specific growth curves

This retrospective cohort study found that Inuit children had consistently larger head circumferences across all age points compared to the World Health Organization (WHO) growth curve medians. At 12 months, head circumferences were 1.3 cm (males) and 1.5 cm (females) larger than WHO medians. This raises the possibility of macrocephaly overdiagnosis/microcephaly underdiagnosis if relying on WHO growth curves.

Clinical Fail

Why Canada’s clinical trial industry gets a failing grade

What happened: Participants of Canada’s “exploitative” clinical industry say sometimes they’re encouraged to lie, which can cause Health Canada to approve compromised drugs.

Why it’s interesting: Canada makes up 4% of the world’s clinical trials. Despite being one of the leading countries, the government doesn’t require national monitoring of participant enrolment. Health Canada approves over 1,000 trials a year, but only inspects a small fraction.

While it’s not unethical for researchers and contact research organizations (CRO) to offer compensation for participating, in many cases, participants only get paid in full if they complete the whole trial. This incentive could cause participants to lie about symptoms, so they can still get paid even if they’re experiencing side effects. In 2018, a US study found that 1/3 of 178 research volunteers said they relied on the trials to stay afloat and had no other way to make ends meet. 

Some patients go to great lengths to get accepted into trials — like losing a large amount of weight or not taking personal medications. A bioethicist from Minnesota said the onus is on the researchers and doctors who perform these trials, as they could potentially take advantage of people who live on the “fringes of society.”

But: It is possible for Canada to have better clinical trial programs. The government would first need to implement a national registry to prevent participants from over-enrolling in studies. While some CROs do track their participants, not all do. One doctor said that the government should do a better job in overseeing enrolment to protect participants’ safety and the integrity of the studies.

Bottom line: Clinical trials have helped to create life-saving drugs, but it shouldn’t be at the expense of participants, who should be top priority. 

Hot Off The Press

1: 💨 Canada’s Minister of Mental Health and Addictions, Ya'ara Saks, has confirmed that a national ban on most vape flavours (except mint, menthol, and tobacco) will be implemented soon. It’s meant to curb rising youth vaping rates, but there have been delays while Health Canada studies Quebec's experience with illicit markets following its flavour restrictions.

2: 💊 The death of a beloved piano teacher has sparked calls for better drug monitoring in hospitals after she suffered fatal kidney failure due to a toxic reaction to vancomycin. She showed progress in her battle with metastatic cancer, but her condition worsened after hospital staff failed to properly monitor her medication levels. Her daughter, a hospital pharmacist, urges improved adherence to drug monitoring protocols to prevent similar tragedies.

3: 🧍 A new study from the University of Sydney suggests that standing desks don’t reduce the risk of stroke or heart failure — and may increase the risk of circulatory issues such as deep vein thrombosis and varicose veins. Researchers advise that those who sit or stand for long periods should incorporate regular movement throughout the day to support cardiovascular health.

4: 🧠 A cohort study involving over 6,900 adolescents with obesity found that those treated with glucagon-like peptide 1 receptor agonists (GLP1R) had a 33% lower risk of suicidal ideation or attempts compared to those receiving lifestyle interventions. The study suggests that GLP1R treatment may offer psychiatric benefits for adolescents with obesity, but further research is needed to understand this effect and the mechanisms.

Notable Numbers 🔢

50,000 to 60,000: the number of global rabies fatalities per year — though Canadian numbers are significantly lower. A new rabies case in Ontario marked the province's first domestically acquired case of rabies since 1967, when a Brantford child recently died after contact with a bat.

507: the number of new HIV cases in Alberta last year, which jumped by 73% from the previous year — with over half of the cases acquired outside the country. Experts call for broader outreach and increased resources, especially among younger and diverse communities.

70,500: the number of previously unknown viruses discovered using AI, many of which thrive in extreme environments like salt lakes and hydrothermal vents. This study — led by researchers from the University of Toronto and published in Cell — highlights AI's potential to uncover viral RNA "dark matter"… and may aid in understanding the evolution and origins of viruses.

💬 In Our Community

A physician recently finished paying off their student debts (finally!) and is seeking advice on how to navigate advisors to help with their future wealth and financial well-being. Here are the top responses:

• Some advised that they should first “understand the basics” before meeting with advisors to reduce the chances of “making mistakes that will require more work to fix later.” Beat the Bank was frequently recommended, and was cited as a one-stop shop for info about successful investing.

• Many warned against relying on wealth advisors, suggesting that they often prioritize “selling high-fee proprietary mutual funds” and may not have your best interests in mind. Instead, they recommended learning how to personally invest and manage low-cost index ETFs.

• Several others suggested one-on-one, fee-for-service financial planners, noting their “unbiased advice and effective personalized financial strategies.” In this regard, some stressed the importance of researching advisors’ “track records and portfolio performance” prior to booking an appointment. 

Read the rest of the conversation and contribute your own thoughts here. Link may not work if you’re not already part of the private FB group.

Postcall Picks

😭 Laugh: at the ED classic, “Hey, my colleague also has a couple of admissions they want to discuss with you.” 

🎧 Listen: to this week’s episode of The White Coat Investor to learn more about how to navigate your first attending job.

🎫 Register: for the Better Outcomes Together conference (Oct. 24-25) to learn more about inter-professional comprehensive care and the importance of collaboration for healthier patients and communities. 

🤑 Save: up to 50% off + an additional 25% with code TAKE25 on protein powder and other workout essentials at Myprotein.

Relax

First Question: What is a common childhood virus that causes Clue #7?

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