Podcasts about Kingston General Hospital

Many women with violent partners stay in relationships longer than is safe. Even if they escape their situation, it can be a struggle to sustain basic needs. Kingston organization, Resolve Counseling, is looking to help those women thrive on their own. Tara Everitt, Director of Community Programs, told us more about it. An initiative to move patient care online at Kingston General Hospital to a virtual app called SeamlessMD. Instead of walking into an emergency room or waiting for 2 weeks to see your surgeon, you can now turn to an app for bedside care at home. Dr. Steve Mann, an orthopedic surgeon, joined me to discuss the app and its implications. July is Disability Pride Month, although a little less known. It shares a similar spirit of activism and celebration with June's LGBTQ pride but isn't as heavily regarded compared to its June counterpart. CBC Journalist Julianna Romanynk recently attended the disability pride march in Toronto. She shared with me more on the event and the issues it highlighted.

Join us as we discuss Neuroprognostication after Cardiac Arrest with Clinician-Scientist, Dr Gord Boyd. Dr Boyd has dual certification in Neurology and Critical Care Medicine and is a Clinician Scientist at Queens University, Kingston, Canada. He works at the Kingston General Hospital as an Intensivist and heads a research program aimed at understanding the relationship between cerebral perfusion, delirium, and long-term neurological outcomes for ICU survivors. He received his undergraduate degree (Psychology) from Lakehead University in his hometown of Thunder Bay, Ontario. That was followed by his PhD in Neuroscience from the University of Alberta, where he studied the role of growth factors in peripheral nerve regeneration. In 2001 he moved to Kingston to do a post-doctoral fellowship in the Queen's Department of Anatomy and Cell biology, examining the potential of glial cell transplantation to treat spinal cord injury. He stayed in Kingston to do his undergraduate degree in Medicine, which was followed by his residency in Neurology and fellowship in Adult Critical Care. He is an active musician and plays the drums in an all-physician band. In this episode we discuss the importance of admitting uncertainty when it comes to neuroprognostication following cardiac arrest, allowing enough time to pass, some of the best and worst tests for clinical prognostication, usefulness of biomarkers, EEG, seizure treatment and the risk of persistent neurovegetative states. Further Reading: 1. Nakstad ER, Stær-Jensen H, Wimmer H, et al. Late awakening, prognostic factors and long-term outcome in out-of-hospital cardiac arrest - results of the prospective Norwegian Cardio-Respiratory Arrest Study (NORCAST). Resuscitation. 2020;149:170-179. doi:10.1016/j.resuscitation.2019.12.031 https://pubmed.ncbi.nlm.nih.gov/31926258/ 2. Nolan JP, Sandroni C, Böttiger BW, et al. European Resuscitation Council and European Society of Intensive Care Medicine guidelines 2021: post-resuscitation care. Intensive Care Med. 2021;47(4):369-421. doi:10.1007/s00134-021-06368-4 https://pubmed.ncbi.nlm.nih.gov/33765189/ 3. Sandroni C, D'Arrigo S, Cacciola S, et al. Prediction of good neurological outcome in comatose survivors of cardiac arrest: a systematic review. Intensive Care Med. 2022;48(4):389-413. doi:10.1007/s00134-022-06618-z https://pubmed.ncbi.nlm.nih.gov/35244745/ 4. Beuchat I, Novy J, Barbella G, Oddo M, Rossetti AO. EEG patterns associated with present cortical SSEP after cardiac arrest. Acta Neurol Scand. 2020;142(2):181-185. doi:10.1111/ane.13264 EEG patterns associated with present cortical SSEP after cardiac arrest - PubMed (nih.gov)

It’s Wednesday November 9th. Good Morning I’m Karim Mosna with your daily news brief. In the news… Kingston Health Sciences Centre (KHSC) has declared a COVID-19 outbreak on the Connell 9 unit at its Kingston General Hospital site. Currently six patients are associated with the outbreak. Only designated essential care providers who have been approved […]

It's Monday November 7th. Good Morning I'm Karim Mosna with your daily news brief. In the news…    Kingston Health Sciences Centre has declared a COVID-19 outbreak on the Connell 10 unit at its Kingston General Hospital site.  Three patients are associated with the outbreak, and the unit is closed to all but essential visitors […]

It's Thursday November 3rd. Good Morning I'm Karim Mosna with your daily news brief. In the news..,.   Kingston Health Sciences Centre has declared COVID-19 outbreaks on the Connell 3 and Davies 5 units at its Kingston General Hospital site. Four patients are associated with the outbreak on Connell 3 and five patients have now […]

It's Tuesday October 4th. Good Morning I'm Karim Mosna with your daily news brief. In the news..   Kingston Health Sciences Centre has declared a COVID-19 outbreak on the Connell 10 unit at its Kingston General Hospital site. There are currently three COVID positive patients on the unit. Visitor restrictions are in place and only […]

Doctors are raising concerns about an increasing number of residents receiving antipsychotic drugs without a diagnosis. Our guests are Dr. Sudeep Gill, a geriatrician at Providence Care and the Kingston General Hospital; and Dr. Samir Sinha, Director of Geriatrics at the University Health Network and Sinai Health System.

Pressures on the healthcare system were part of the government's speech from the throne yesterday. As hospitals face a staffing crisis, one mother says she had to take some of her daughter's care into her own hands at the Kingston General Hospital. Prince Edward County's Janet Kellough joined us to talk about her book Wishful Seeing, and what it was like watching it come to life at 4th Line Theatre. Arts Jam Studio Sessions are a series of workshops kicking off today for 2SLGBTQ+ artists in Simcoe County.

An interview with Dr. Ishmael Jaiyesimi from Beaumont Health Royal Oak and Oakland University William Beaumont School of Medicine in Royal Oak, MI, and Dr. Andrew Robinson from Kingston General Hospital, Queen's University in Ontario, Canada, authors on "Therapy for Stage IV Non-Small Cell Lung Cancer With Driver Alterations: ASCO Living Guideline." Dr. Jaiyesimi and Dr. Robinson review the latest recommendation updates for therapeutic options for patients with stage IV NSCLC with ALK rearrangement or RET rearrangement. They also discuss new agents on the horizon. Read the full guideline at www.asco.org/thoracic-cancer-guidelines.   TRANSCRIPT Brittany Harvey: Hello and welcome to the ASCO Guidelines podcast series, brought to you by the ASCO Podcast Network, a collection of nine programs, covering a range of educational and scientific content and offering enriching insight into the world of cancer care. You can find all the shows including this one at asco.org/podcasts. My name is Brittany Harvey and today I'm interviewing Dr. Ishmael Jaiyesimi from Beaumont Health Royal Oak and Oakland University William Beaumont School of Medicine in Royal Oak, Michigan, and Dr. Andrew Robinson from Kingston General Hospital at Queen's University in Ontario, Canada, authors on 'Therapy for Stage IV Non-small Cell Lung Cancer with Driver Alterations: ASCO Guideline Update'. Thank you for being here, Dr. Jaiyesimi and Dr. Robinson. Dr. Ishmael Jaiyesimi: Thank you. Dr. Andrew Robinson: It's a pleasure to be here. Brittany Harvey: Great! First, I'd like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO conflict of interest policy is followed for each guideline. The full conflict of interest information for this guideline panel is available online with the publication of the guideline in the Journal of Clinical Oncology. Dr. Jaiyesimi, do you have any relevant disclosures that are directly related to this guideline? Dr. Ishmael Jaiyesimi: None. Brittany Harvey: Thank you. And, Dr. Robinson, do you have any relevant disclosures that are directly related to this guideline topic? Dr. Andrew Robinson: Yes, I have received funding less than $5,000 from AstraZeneca, Merck, and BMS over the past two years. Brittany Harvey: I appreciate those disclosures. So, then Dr. Jaiyesimi, let's talk about the purpose of this guideline. So, what is the purpose of this guideline update, and what clinical scenarios does this guideline address? Dr. Ishmael Jaiyesimi: The purpose of therapy for stage IV non-small cell lung cancer with driver alterations, is to rapidly update the ASCO and Ontario Health guideline on the systemic treatment of patients with stage IV non-small cell lung cancer, last published in February of 2021. The update is a result of potentially practice-changing evidence published since the last publication in February 2021. The update is based on two clinical trials from 2020 to 2021. The clinical scenario this guideline covers are stage IV non-small cell lung cancer with driver alteration with an ALK gene rearrangement and RET gene rearrangements. Brittany Harvey: Great. So, then let's review those two clinical scenarios that you just mentioned. So, there are a few new recommendations regarding ALK rearrangement. So, what are the recommended first-line options for patients with stage 4 non-small cell lung cancer in an ALK rearrangement? Dr. Ishmael Jaiyesimi: In the previous guideline alectinib or brigatinib were recommended as first-line therapy with a strong recommendation and level of evidence in patients with ALK gene rearrangement, and a performance status of zero to two. In the current update, lorlatinib was cited as the first-line ALK inhibitor that may be offered as an alternative first-line therapy. If alectinib, brigatinib, or lorlatinib are not available, ceritinib or crizotinib should be offered. This is based on the CROWN study that showed alectinib was superior to crizotinib in the first-line setting. Unfortunately, we don't have head-to-head comparative data with alectinib or brigatinib, so we cannot conclude that any one treatment is more effective than the other, and decisions should be made on experience, toxicity, and on. Brittany Harvey: Okay, thank you for describing how a clinician should select between those treatments as well. So, then the second clinical scenario that Dr. Jaiyesimi just mentioned, Dr. Robinson, what is recommended for both first-line and second-line treatment for patients with stage IV non-small cell lung cancer and a RET rearrangement. Dr. Andrew Robinson: Thank you. So, for patients with a RET rearrangement and a good performance status of zero to two and previously untreated non-small cell lung cancer, clinicians may offer selpercatinib or pralsetinib as first-line therapy. Selpercatinib was recommended in the 2020 guidelines and pralsetinib has been added to that. As with other driver mutation recommendations for scenarios where randomized studies against standard non-driver mutation treatments have not been done or completed, these recommendations are with a lower level of evidence and somewhat weaker recommendations, an alternative approach of first-line standard non-driver mutation treatment may also be offered. As a guideline group, we listed this approach of non-driver treatment behind the targeted therapies, because there's a belief that the targeted approach may be superior upfront. But we should also continue to, of course, encourage participation in ongoing trials comparing selpercatinib or pralsetinib to standard first-line non-driver mutation treatment to determine whether our assumptions are correct. For patients with a RET rearrangement who've had previous RET targeted therapy, clinicians may offer treatment as per the non-driver mutation guidelines. And for patients with a RET rearrangement who have had previous chemotherapy, chemoimmunotherapy, clinicians may offer selpercatinib or pralsetinib for them. Brittany Harvey: Okay. And then you've just mentioned some ongoing trials as well. So, that leads to my next question of what ongoing trials and new agents is the panel monitoring for the next guideline iteration? Dr. Andrew Robinson: It's really an exciting time with new agents on trials and I think we can divide it into more driver mutations, more lines of therapy, and more certainty with what we're doing. In terms of driver mutations, there are several phase II and III trials with agents such as sotorasib and adagrasib in KRAS-G12C mutated non-small cell lung cancer, trastuzumab deruxtecan in the DESTINY trials in HER-2 mutated lung cancer, mobicertinib and amivantamab in EGFR, exon 20 insertion lung cancer or HER-2 exon 20 insertion lung cancer, etc. So, looking at more driver mutations is all of those agents plus a number of others that will be coming out over the next couple of years at ASCO. We're also interested in more lines of therapy. So, for patients who progress after standard first-line, say osimertinib with EGFR or after progression on ALK therapies such as lorlatinib. So, we're looking forward to studies such as the CHRYSALIS studies of amivantamab and lazertinib in EGFR mutation-positive patients who have progressed after osimertinib, and other studies that are looking at the increasing treatment options for second-line treatment and third-line treatment. And then we're looking at interest to phase three studies that are comparing targeted agents to docetaxel in the second-line setting such as the sotorasib studies in KRAS-G12C patients and capmatinib and MET exon 14 patients, particularly as many of these patients may do well with non-driver mutated guided first-line treatment. There are phase three trials comparing RET inhibitors to standard first-line chemoimmunotherapy which will also be keenly awaited to see if our, and when I say our, I mean, the ASCO guideline panel and also the thoracic oncology community writ large, our assumption that targeted therapy will be superior to first-line therapy is actually borne out with clinical trial evidence. So, there's plenty of evidence that we're excited to keep our eye on and update as soon as possible, which is more driver mutations, more lines of therapy for patients who have established driver mutations, and more certainty, hopefully, regarding the timing of these various interventions. Brittany Harvey: Definitely, there's a lot going on in this space. So, we'll look forward to the results from these ongoing trials and the panel's review of that evidence, and eventually updated recommendations. So, then Dr. Jaiyesimi, in your view, why is this guideline update important and how will it impact practice? Dr. Ishmael Jaiyesimi: This guideline is important because it emphasizes rapid development in the research and treatment in advanced non-small cell lung cancer and that non-small cell lung cancer are heterogeneous. Clinicians need to identify biomarkers of the molecular pathways, including targetable driver mutations, example: epidermal growth factor receptors, the BRAF, the MET, the KRAS, and etcetera, and fusion rearrangement, example: anaplastic lymphoma kinase, c-ROS oncogene 1, RET, and on that drive malignancy in patients with non-small cell lung cancer, especially in those patients with adenocarcinoma histology and a little or never smoking history regardless of histology. Because of the availability of effective targeted agent for many of these cancers, at minimum, determination of epidermal growth factor receptor mutation status and anaplastic lymphoma kinase rearrangement status before initiating therapy because rapid and sensitive tests are available. An initiation of immunotherapy could increase the toxicity of tyrosine kinase inhibitors later in the patient's course. All this, in my opinion, will impact clinical practice. Furthermore, an opportunity for patients with driver mutation to enrolled in ongoing clinical trials targeting the driver mutations. Brittany Harvey: Yes. You've just mentioned that this is not a one size fits all approach for patients. And so, in your view, Dr. Jaiyesimi, how do these guideline recommendations affect patients living with stage IV non-small cell lung cancer with driver alterations? Dr. Ishmael Jaeysimi: I believe along with my associates the improvement in the treatment of stage IV non-small cell lung cancer brings hope to the patient with driver alteration for a possibility to use targeted therapy and no chemotherapy or immunotherapy upfront to some patients and this may enhance their lives, increase longevity with some tolerable side effects, and better quality of life, and a truly wide range of opportunities for patients to participate in clinical trials. Brittany Harvey: Great! Yes, it seems like the data has come fast, and a lot of new results of recent trials have driven these updated recommendations and we're also looking forward to many of the results from upcoming clinical trials that you both mentioned. So, I want to thank you so much for your work on these guideline updates, and thank you for taking the time to speak with me today, Dr. Jaiyesimi and Dr. Robinson. Dr. Ishmael Jaiyesimi: Thank you, Brittany. Dr. Andrew Robsinson: It was a pleasure to be here and I hope that this was educational. Brittany Harvey: And thank you to all of our listeners for tuning in to the ASCO Guidelines podcast series. To read the full guideline go to www.asco.org/thoracic-cancer-guidelines. There's a companion guideline update on therapy for stage IV non-small cell lung cancer without driver alterations available there and on the JCO. You can also find many of our guidelines and interactive resources in the free ASCO guidelines app available on iTunes or the Google Play Store. If you have enjoyed what you've heard today, please rate and review the podcast and be sure to subscribe so you never miss an episode.   The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO the mention of any product, service, organization, activity or therapy should not be construed as an ASCO endorsement.  

An interview with Dr. Ishmael Jaiyesimi from Beaumont Health Royal Oak and Oakland University William Beaumont School of Medicine in Royal Oak, MI, and Dr. Andrew Robinson from Kingston General Hospital, Queen's University in Ontario, Canada, authors on "Therapy for Stage IV Non-Small Cell Lung Cancer Without Driver Alterations: ASCO Living Guideline." Dr. Jaiyesimi and Dr. Robinson review the latest recommendation updates for first-, second-, and third-line therapy in patients with stage IV NSCLC without driver alterations. Read the full guideline at www.asco.org/thoracic-cancer-guidelines.   TRANSCRIPT Brittany Harvey: Hello and welcome to the ASCO Guidelines podcast series, brought to you by the ASCO Podcast Network, a collection of nine programs covering a range of educational and scientific content and offering enriching insight into the world of cancer care. You can find all the shows including this one at asco.org/podcasts.  My name is Brittany Harvey, and today I'm interviewing Dr. Ishmael Jaiyesimi from Beaumont Health Royal Oak and Oakland University William Beaumont School of Medicine in Royal Oak, Michigan, and Dr. Andrew Robinson from Kingston General Hospital, Queen's University in Ontario, Canada, authors on 'Therapy for Stage IV Non-Small Cell Lung Cancer Without Driver Alterations: ASCO Guideline Update'. Thank you for being here, Dr. Jaiyesimi and Dr. Robinson.  Dr. Ishmael Jaiyesimi: Thank you for inviting me.  Brittany Harvey: First, I'd like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO conflict of interest policy is followed for each guideline.  The full conflict of interest information for this guideline panel is available online with the publication of the guideline in the Journal of Clinical Oncology.  Dr. Jaiyesimi, do you have any relevant disclosures that are directly related to this guideline topic?  Dr. Ishmael Jaiyesimi: I do not have any financial disclosures. Thank you.  Brittany Harvey: Thank you. And Dr. Robinson, do you have any relevant disclosures that are directly related to this guideline topic?  Dr: Andrew Robinson: Yes, I do. I have had funding of less than $5,000 from BMS, Merck, and AstraZeneca in the past two years.  Brittany Harvey: Okay. Thank you for those disclosures. So, then let's talk about the content of this guideline update. So, Dr. Jaiyesimi, what prompted this guideline update, and what is the scope of the update?  Dr. Ishmael Jaiyesimi: The purpose of this guideline update is to update the ASCO and Ontario Health guidelines on the systemic treatment of patients with non-driver alteration stage IV non-small cell lung cancer last published in January of 2020.  The update is the result of potentially practice-changing evidence published since the last update. ASCO published the last full clinical practice guideline updates on systemic therapy for patients with stage IV non-small cell lung cancer that included those whose cancer did not have driver alterations in January of 2020.  The scope of evidence for the update guideline is made of ongoing or completed randomized controlled trials for non-driver alterations from 2018 to 2021. These updated algorithms provide recommendations from the ASCO expert panel and emphasized rapid changes in the management of patients with advanced non-small cell lung cancer and the importance of clinical research.  Brittany Harvey: Thank you for that overview, Dr. Jaiyesimi. So, then talking about those changes you just mentioned, I'd like to review the new or changed recommendations for this guideline. So, let's start with for patients with stage IV non-small cell lung cancer without driver alterations, and with high PD-L1 expression and non-squamous cell carcinoma, what are the updated recommendations for first-line therapy?  Dr. Ishmael Jaiyesimi: In addition to 2020 options for patients with high PD-L1, 50% or more expression, non-squamous cell carcinoma, and performance status of zero to one, and absence of targetable oncogenic driver alterations, clinicians may offer a single agent atezolizumab alone, or single agent cemiplimab alone, or a combination of nivolumab and ipilimumab without chemotherapy, or a combination of nivolumab and ipilimumab with two cycles of platinum-based chemotherapy. The number of acceptable options has increased. And each of the recommendations carries a strength of recommendation and quality of evidence with it.  Brittany Harvey: I appreciate you reviewing those options. So, then Dr. Robinson, moving on to the next category of patients addressed in this guideline, for patients with stage IV non-small cell lung cancer without driver alterations and with negative or low positive PD-L1 expression and non-squamous cell carcinoma, what are the updated recommendations for first-line therapy?  Dr. Andrew Robinson: Thank you for that question. So, in addition to the 2020 options for patients with negative, 0%, and low positive PD-L1 expression, with a TPS score of 1 to 49% and I'd add, unknown PD-L1, non-squamous, non-small cell lung cancer and a good performance status, clinicians may offer combination nivolumab and ipilimumab or combination nivolumab and ipilimumab with two cycles of platinum-based chemotherapy.  These are the additional recommendations and this gives an increased number of acceptable options, particularly for patients who cannot or choose not to take cytotoxic chemotherapy.  Brittany Harvey: Understood. Thank you for reviewing those options. So. then the next category of patients this guideline addresses, for patients with stage IV non-small cell lung cancer without driver alterations and with high PD-L1 expression and squamous cell carcinoma, what are those updated recommendations for first-line therapy?  Dr. Andrew Robinson: So, similar to the patients with non-squamous cell carcinoma for patients with stage IV non-small cell lung cancer that is squamous cell and a good performance status of zero to one, clinicians may also offer single agent atezolizumab alone or single agent cemiplimab or combination nivolumab and ipilimumab or combination nivolumab and ipilimumab with two cycles of platinum-based chemotherapy followed by ongoing nivolumab and ipilimumab. So, these are additional recommendations in this group as acceptable options for treatment.  Brittany Harvey: Great thank you for reviewing those options. So, then Dr. Jaiyesimi, what is recommended for patients with stage four non-small cell lung cancer without driver alterations and with negative or low positive PD-L1 expression and squamous cell carcinoma for first-line therapy?  Dr. Ishmael Jaiyesimi: In addition to 2020 recommendations, for patients with negative, TPS 0%, and low positive, with TPS 1% to 49%, PD-L1 expression, squamous cell carcinoma, and performance status of zero to one, clinicians may offer a combination of nivolumab and ipilimumab alone or a combination nivolumab and ipilimumab with two cycles of platinum-based chemotherapy.  Brittany Harvey: Great! So, then we've just reviewed the updates and changes to the first-line therapy recommendations. So, Dr. Jaiyesimi, were there any updates to second- or third-line therapy recommendations for patients with stage IV NSCLC without driver alterations?  Dr. Ishmael Jaiyesimi: For patients with non-squamous cell carcinoma who receive an immune checkpoint inhibitor and chemotherapy as first-line therapy, the clinician may offer paclitaxel plus bevacizumab in the second-line setting.  For the majority of patients with non-squamous cell carcinoma who received chemotherapy with or without bevacizumab and immune checkpoint inhibitor therapy, in either sequence, clinicians should offer the option of single-agent pemetrexed (non squamous cell carcinoma, non-small cell lung cancer), or docetaxel (all histologic types), or weekly paclitaxel plus bevacizumab, (non-squamous cell carcinoma, non-small cell lung cancer) in the third-line setting.  For patients in whom the initial treatment was not a chemoimmunotherapy combination should receive the treatment not given earlier that is platinum doublet chemotherapy (if the initial treatment was monotherapy with an immune checkpoint inhibitor, or dual immune checkpoint inhibitor therapy) and immunotherapy with an approved PD-1 or PD-L1 inhibitor in the second line setting (if the initial treatment was platinum doublet chemotherapy).  Brittany Harvey: Okay, thank you for reviewing those recommendations as well. So, then Dr. Robinson, what is the importance of these recommendation updates for practicing clinicians?  Dr. Andrew Robinson: These updates give an increasing menu of choices for patients and physicians, particularly in the first-line setting. The increased list of acceptable first-line options may help us physicians may run into situations where their preferred first-line option isn't available, or for other reasons shouldn't be given.  Now we recognize that given the increasing variety of options in the first line, it would be really nice if we could have guidelines, that say in this certain patient treatment with nivolumab and ipilimumab is recommended and in that certain patient chemotherapy plus pembrolizumab is recommended, and divide things up that way so that the right patient gets the right treatment.  However, the guideline committee did not feel that this was appropriate at that time as the only comparative data with these different strategies is insufficient, either population-based data or cross trial and network comparisons, that, however well done, do not have a defense against confounders and bias that a randomized study has.  So, the advances in drug development and research in non-small cell lung cancer in the past decade have made available multiple treatment options, particularly for first-line therapy for patients, and to some extent, this has also made the process of decision making in this context challenging for practicing clinicians, especially in the community and for patients and caregivers.  Clinicians need to understand patients' comorbidities as well as other variables that can potentially influence treatment decisions prior to making final therapeutic recommendations for any given patient, and also become comfortable handling a few of these regimens. Each of these are somewhat complex regimens with sometimes subtle and sometimes not-so-subtle differences that require expertise and appropriate treatment and monitoring.  So, with so many options available, it's important that clinicians get familiar with a few of them at least given that all of these regimens are now considered as appropriate standard of care regimens suitable for first-line therapy, it may also help justify physicians, researchers and ethics boards who are participating, designing and overseeing simple clinical trials that pragmatically ask the questions as to what should be used when.  So, physicians should simultaneously become familiar with these guidelines, familiar with different therapies, have expertise in a few of these therapies, and continue to stress cancer clinical trials that may improve outcomes, and also may help us determine which treatment for which patient at which time.  Brittany Harvey: Definitely, that makes sense. Thanks for reviewing these recommendations and also the limitations of the evidence around them. So, finally, Dr. Robinson, how will these guideline recommendations affect patients with stage 4 non-small cell lung cancer without driver alterations?  Dr. Andrew Robinson: Well, there are more options available which should be good but we wish what we meant when we say there are more options for patients, what we meant is that if one option doesn't work that other options are then available.  However, in this case, we mean that there are more options for patients for their initial therapy, particularly including more non-chemotherapy or reduced chemotherapy options.  It's difficult to imagine that many patients and clinicians will now discuss, say 8 options with patients with high PD-L1 lung cancer. Pembrolizumab, cemiplimab, atezolizumab, pembrolizumab with platinum doublet, nivolumab, ipilimumab, nivolumab and ipilimumab chemotherapy, and the majority of patients with high PD-L1 will likely continue to have single-agent PD-1 or PD-L1 inhibitors.  For patients with low PD-L1 lung cancer, the inclusion of nivolumab and ipilimumab without chemotherapy as a potential option may allow some patients to avoid chemotherapy toxicity and trade for other toxicities and choose a different therapy.  Patients who enroll on clinical trials where the comparator arm is any one of these therapies should be comfortable knowing that they are considered acceptable standards. The advancement in non-small cell lung cancer diagnosis and treatment would allow patients with stage IV non-small cell lung cancer without driver mutations who are eligible for immunotherapies with or without chemotherapy, a chance of living longer and the opportunity to participate in ongoing research to further move the ball down the field.  Brittany Harvey: Definitely. And, thank you for reviewing that as well. So, I want to thank you both for all of your work to review the rapid changes in evidence in this field and provide these guideline updates. I want to thank you again for your time today, Dr. Robinson and Dr. Jaiyesimi.  Dr. Ishmael Jaiyesimi: Thank you for having me.  Dr. Andrew Robinson: Thank you. It was a pleasure to be here.  Brittany Harvey: And thank you to all of our listeners for tuning into the ASCO Guidelines podcast series. To read the full guideline, go to www.asco.org/thoracic-cancer-guidelines. There's a companion guideline update on therapy for stage IV non-small cell lung cancer with driver alterations available there and on the JCO.  You can also find many of our guidelines and interactive resources in the free ASCO guidelines app available on iTunes or the Google Play Store. If you have enjoyed what you've heard today, please rate and review the podcast and be sure to subscribe so you never miss an episode.    The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.  Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity or therapy should not be construed as an ASCO endorsement.     

Disclaimer:  The views and opinions expressed during this podcast are those of the physicians participating and do not necessarily reflect the position of the SOGC. In this episode recorded in July 2021, our host Dr. Graeme Smith speaks with Dr. Ashley Waddington about gender and healthcare. Dr. Waddington started a clinic for transgender patients at Kingston General Hospital in 2017 and discusses the inspiration behind starting the clinic, providing support and access to care and what the clinic has accomplished. She shares resources for medical professionals on providing respectful gender affirming healthcare. Additional Resources SOGC website: www.sogc.org Rainbow Health Ontario World Professional Association for Transgender Health About Dr. Ashley Waddington Dr. Waddington is an Assistant Professor in the division of Reproductive Endocrinology and Infertility in the Department of Obstetrics and Gynecology at Queen's University. Dr. Waddington 's clinical practice and research focusses on complicated contraceptive cases, abortion care and access, adolescent gynecology, early pregnancy complications, patient safety and quality improvement, and transgender health.

There is still a lot of misinformation out there about COVID-19.  The struggle continues to find the right answers from the right people.  Here's one of those ‘right' people.  Dr. Gerald Evans is Chair of the Division of Infectious Diseases, as well as a Professor at Queen's University.  He is also an attending physician in Infectious Diseases & Internal Medicine at Kingston General Hospital and Hotel Dieu Hospital located in Kingston.  For over 30 years, Dr. Evans has focused his research, and practice, studying these diseases – and that's makes him well-qualified to help us understand what science has learned, so far, about this coronavirus.

Peggy Frith interviews Jim Holt, former Director of Clinical studies for Oxford Medical School, 1 June 2012. Topics discussed include: (00:00:41) university days at St. Andrews; (00:01:53) going to Canada to work at Kingston General Hospital; (00:03:31) returning to Oxford, Nuffield Professors of Medicine, overview of Oxford career; (00:06:43) interest in lymphoma; (00:08:17) differences between Canadian and British medicine in the 1960s; (00:09:22) experience of arriving and working in Oxford; (00:12:07) time as Director of Clinical studies, challenges and enjoyment; (00:18:36) success of Oxford clinical medical school, Green Templeton college, the Nuffield Foundation; (00:29:00) growth of Oxford Medical School; (00:36:45) Tingewick Society; (00:40:34) Holt family labrador trips to the medical wards in Oxford. Note the following sections of audio are redacted: 00:00:00-00:00:13; 00:18:04-00:18:33; 00:34:07-00:35:30.

Éric Grenier who runs the CBC Poll Tracker outlines how Canadians are feeling and what were thinking about now that the federal Liberals have called an election; It's commonly thought that as we age our metabolism slows. Not so according to new research. Gregory Steinberg of the Centre for Metabolism, Obesity and Diabetes Research at McMaster University explains; Tamara Small, a political scientist at the University of Guelph discusses what she thinks will be unique about the current election campaign; Work is now underway to remove the remains of some 1,400 Irish immigrants from beneath Kingston General Hospital. Tony O'Loughlin of the Kingston Irish Famine Commemoration Association tells us why he thinks this work is vital; Chris Hall, the CBC's National affairs editor, and host of 'The House' on CBC Radio One talks about the issues in this election.

Une nouvelle technologie pour lutter contre les symptômes associés à la vieillesse. Le vieillissement de la population se traduit par une demande accrue des remplacements articulaires. Des chercheurs de la Queen's University travaillent à résoudre ce problème. Chirurgien orthopédiste au Kingston General Hospital et chercheur principal du Human Mobility Research Centre, le docteur John Rudan décrit la technique mise au point. Ce balado est disponible uniquement en anglais.

There is a BIG difference between End Of Life Planning and Serious Illness Planning.If you think estate planning is getting your wills and powers of attorney or healthcare directives set up for taking care of things when you die or are about to die, you might be making a big mistake.If you end up in an ER, the doctors aren't going to look at any end of life planning you might have in place if they think they can still save your life. This requires a whole different way of thinking about planning for serious medical illnesses. On the show today I speak with critical care physician, Dr. Daren Heyland, who is going to give us a look behind the scenes at what really happens when people and their loved ones are making decisions about their medical care when they are seriously ill, or terminal. We’ve talked a bit about estate planning on the podcast before, and my guest recently attended a financial planning seminar where the positioning of how and when certain parts of an estate plan come into place could have used some fine tuning. He’s also going to discuss an initiative he’s been spearheading, called the Plan Well Guide, Plan Well Guide is a FREE tool to help people learn about medical treatments and prepare them for decision-making during a serious illness, like COVID-19 pneumonia for example. Find out more here:Company: https://planwellguide.com/Twitter: https://twitter.com/darenheylandFacebook: @planwellguideTwitter: @plan_well_guideInstagram: @plan_well_guideLinkedIn: https://www.linkedin.com/in/daren-heyland-2b674a185/ Guest Bio: Dr. Daren Heyland is a critical care doctor at Kingston General Hospital and a Professor of Medicine and Epidemiology at Queen’s University. He currently serves as the Director of the Clinical Evaluation Research Unit (CERU) at the Kingston General Hospital. For over a decade he chaired the Canadian Researchers at the End of Life Network (CARENET), which has a focus on developing and evaluating strategies to improve communication and decision-making at the end of life

With an aging population, the need for joint replacements is increasing. Researchers at Queen's University are working to solve this problem. Dr. John Rudan, an orthopaedic surgeon at Kingston General Hospital and a principal investigator at the Human Mobility Research Centre discusses their technique.

Libby Znaimer is joined by Dr. Andrew Morris, an infectious diseases specialist at Sinai Health System and University Health Network in Toronto as well as Dr. Gerald Evans, Chair of the Division of Infectious Diseases at Kingston General Hospital. In the news: Ontario has been seeing a spike in confirmed COVID-19 cases in recent weeks. Today, Ontario Premier Doug Ford is set to unveil the province's response strategy for a second wave. And, what can residents do to ensure that they are best prepared for the worst and continue to practice social distancing effectively?

Libby Znaimer is joined by David Cravit, Vice President of Zoomer Media and Chief Marketing Officer of CARP, Dr. Iris Gorfinkel, a family physician and Dr. Gerald Evans, Chair of the Division of Infectious Diseases at Kingston General Hospital. As we prepare for our kids to head back to school in the fall, the question of safety is a big one. Our panel of health care experts weigh in. Listen live, weekdays from noon to 1, on Zoomer Radio!

Dr. Helen Driver is Somnologist & Adj. Assistant Professor at Kingston General Hospital and Queen's University, Canada. Her focus is on Polysomnography: which is a sleep study where you test and diagnose sleep disorders. How much sleep is enough? What really happens in our bodies and brain when we sleep? Is there a difference between male and female sleep cycles and can we use sleep as a performance enhancement technique? After listening to my conversation with Dr. Helen Driver, you will have all the reason in the world to sleep more, sleep better and use it to optimize your life. Dr. Driver has a way to effortlessly move between deep science, simplified explanations, making jokes, and getting to the deeper questions of life. In this episode we deep dive into: - The different sleep stages - Sleep & memory - Sleep tips - Nostril breathing - Effects of blue light You'll experience my excitement and energy as I deep dive into sleep with Dr. Helen Driver in this episode. It might sound as if you're listening to me on double speed. But hey, I love this stuff! Remember to subscribe to The NovieGuide Podcast to catch the latest episodes as they release. We will also be sharing our new feature on the website soon, visit www.novieguide.com to see what you can expect. Become the best version of yourself and join the TRIBE!

Dr. Helen Driver is Somnologist & Adj. Assistant Professor at Kingston General Hospital and Queen's University, Canada. Her focus is on Polysomnography: which is a sleep study where you test and diagnose sleep disorders. How much sleep is enough? What really happens in our bodies and brain when we sleep? Is there a difference between male and female sleep cycles and can we use sleep as a performance enhancement technique? After listening to my conversation with Dr. Helen Driver, you will have all the reason in the world to sleep more, sleep better and use it to optimize your life. Dr. Driver has a way to effortlessly move between deep science, simplified explanations, making jokes, and getting to the deeper questions of life. In this episode we deep dive into: - The different sleep stages - Sleep & memory - Sleep tips - Nostril breathing - Effects of blue light You’ll experience my excitement and energy as I deep dive into sleep with Dr. Helen Driver in this episode. It might sound as if you’re listening to me on double speed. But hey, I love this stuff! Remember to subscribe to The NovieGuide Podcast to catch the latest episodes as they release. We will also be sharing our new feature on the website soon, visit www.novieguide.com to see what you can expect. Become the best version of yourself and join the TRIBE!

This week I welcome my parents onto the Stories of Starting Podcast. My mom Anne is a retired music teacher who taught cello and piano for many years. She trained as a nurse at Kingston General Hospital and went back to school in her 50's to get her Music degree from Carleton University. My dad is a retired engineer. He worked clearing trails on the ski slopes near Ottawa in his youth and skied into his 80's. He took up violin in his 40's to accompany my mom. They played in amateur orchestras for many years as well as in string quartets with friend. I am so grateful to my parents for their ongoing support of my Art and encouraging me since my days making $3 a day selling jewelry on the streets of Montreal. My mom's love of arts and crafts was instilled in my from a young age and my dad's sense of adventure is reflected in my urban adventures! Both are giving and accepting of others and have influenced my passion for connecting and collaborating with others. I truly believe when one of us succeeds we all succeed. This collaborative mentality was surely planted in my brain from an early age.

In this narrative, Dr. Damon Dagnone shares how helping others with grief can be healing. Dr. Dagnone is an emergency physician at Kingston General Hospital and Associate Professor at Queen’s University School of Medicine in Kingston, Ontario. His Humanities Encounters article is published in the Canadian Medical Association Journal. It is titled "Facing grief." Full article (subscription required): www.cmaj.ca/lookup/doi/10.1503/cmaj.180247 ----------------------------------- For more stories like this one, get your copy of CMAJ’s Encounters Book. This anthology of prose and poetry of some 100 Canadian authors including Drs. David Goldbloom, Shane Neilson, Allan Peterkin and Monica Kidd, has been specially curated and includes a study guide. https://shop.cma.ca/products/encounters ----------------------------------- Subscribe to CMAJ Podcasts on Apple Podcasts, iTunes, Google Play, Stitcher, Overcast, Instacast, or your favourite aggregator. You can also follow us directly on our SoundCloud page or you can visit www.cmaj.ca/page/multimedia/podcasts.

Listen to episode 6 of Cars and Cancer.    It is estimated that as many as half of all cancers in Ontario could be prevented by eliminating known risk factors. In this episode we explore the use of MyCancerIQ in helping raise awareness of risk factors impacting our health. My CancerIQ is a confidential online tool that allows Ontarians to determine their personal risk factors for six types of cancer – melanoma, breast, cervical, colorectal, kidney and lung cancers. We interviewed Dr. Iris Nolan from Brighton Quinte West Family Health Team about how she incorporated www.MyCancerIQ.ca into their practice, resulting in increases in all 3 cancer screening programs. We then had over 25 employees of Kingston General Hospital complete MyCancerIQ and share their thoughts about the tool. Take 5 minutes and complete one of the assessments in MyCancerIQ today!

Discussion of the paper: 'Concurrent psychological stress and infectious colitis is key to sustaining enhanced peripheral sensory signaling'. The contributors in the podcast are as follows: Dr Adam Farmer (Consultant Neurogastroenterologist, The Wingate Institute of Neurogastroenterology, Barts London School of Medicine, London, UK) and Dr. Stephen J. Vanner (Professor and Director, Gastrointestinal Diseases Research Unit, Kingston General Hospital, Kingston, ON, Canada) Read the paper here: http://onlinelibrary.wiley.com/doi/10.1111/nmo.12497/full

A graduate of Trent and Queens Universities, Katelyn was part of the OHRI's RCT titled, "The Age of Red Blood cells in Premature Infants (ARIPI)".  Currently, she works in the Cardiac Program  at the Kingston General Hospital in the role of a Decision Support Analyst.