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28 episodes with Toronto General Hospital
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3 episodes with Toronto General Hospital
Send us a textA recent article in CMAJ entitled Effect of emergency department opioid prescribing on health outcomes examines a key concern facing many clinicians: can a single opioid prescription for acute pain lead to long-term harm? This study aimed to clarify the risks and inform safer prescribing practices.Dr. Grant Innes, the study's senior author, analyzed more than a decade of data from Alberta emergency departments to compare outcomes between patients who did and did not receive an opioid prescription. The study found no significant difference in rates of overdose, opioid use disorder, or death—challenging widely held fears about short-term opioid use. Innes notes that older and opioid-naive patients may be more vulnerable to adverse outcomes and encourages a balanced approach to pain management.Dr. Hance Clarke, director of pain services at Toronto General Hospital, emphasizes the importance of structured follow-up and monitoring, especially for patients at higher risk of persistent use. He outlines practical strategies for safe prescribing and highlights underused and emerging alternatives, including ketamine, IV lidocaine, nerve blocks, and sodium channel blockers now in development. Clarke warns against “opioid phobia” and calls for individualized care supported by systems that can detect early warning signs.The guests encourage physicians to not avoid prescribing opioids when clinically indicated, particularly in cases of severe acute pain. With thoughtful screening and mechanisms for follow-up, opioids can be relatively safe and effective. The goal is not zero prescribing, but safer, smarter prescribing.Join us as we explore medical solutions that address the urgent need to change healthcare. Reach out to us about this or any episode you hear. Or tell us about something you'd like to hear on the leading Canadian medical podcast.You can find Blair and Mojola on X @BlairBigham and @DrmojolaomoleX (in English): @CMAJ X (en français): @JAMC FacebookInstagram: @CMAJ.ca The CMAJ Podcast is produced by PodCraft Productions
In this podcast episode, Dr. Diego Delgado discusses how to manage patients with mixed phenotype hereditary transthyretin amyloidosis over the course of their disease from initial symptoms and clinical suspicion, to monitoring patients on treatment. For additional details, please see the related video publication by Dr. Delgado and colleagues: https://www.sciencedirect.com/science/article/pii/S2589790X25001180Our Guest: Dr. Diego Delgado is the Director of the Cardiac Amyloid Centre and Associate Professor in the Division of Cardiology and Cardiac Transplantation at the University Health Network in Toronto, Ontario. Dr. Diego Delgado graduated in Medicine from the Universidad del Salvador in Buenos Aires, Argentina. He completed his Internal Medicine and Cardiology training in Hospital Espanol in Buenos Aires. Subsequently he completed a research fellowship in cardiac transplantation at Rush Presbyterian St Luke's Medical Center in Chicago, US and a research/clinical fellowship in heart failure and transplantation at the Toronto General Hospital.Dr. Delgado completed his Maters of Science in Clinical Epidemiology at the University of Toronto and the Leadership Development Program at Rotman School of Management in Toronto. He is the author of more than 100 publications in the area of heart failure, transplantation and mechanical assist devices. His interests are immunologic aspects of heart failure and transplantation and cardio oncology.This podcast episode was sponsored by AstraZeneca Canada. For other medical education content, please subscribe to our podcast or visit our website at: https://www.impactmedicom.com (https://www.impactmedicom.com/).
Listen to Vassy's full conversation with newly minted Finance Minister François-Philippe Champagne as they discuss fiscal responsibility, government cuts, and scrapping the carbon tax. On todays show: David Coletto, founder, Chair and CEO of Abacus Data joins host Vassy Kapelos to discuss the new polling from Abacus Data that shows the Conservative lead drop down to 4 as Liberals reach their highest vote share since August 2021. Dr. Isaac Bogoch, infectious diseases physician at the Toronto General Hospital joins host Vassy Kapelos to discuss how Ontario's chief medical officer of health is urging Ontarians to make sure they are immunized against the measles, amid the most severe outbreak in the province in more than a decade. The Daily Debrief Panel with Tom Mulcair, Tim Powers, and Zain Velji. Mike Le Couteur, Senior Political Correspondent, CTV National News joins Vassy to give the latest on Prime Minister Mark Carneys trip to Europe.
Kelsey McEwen, Chief Meteorologist on CTV Your Morning joins host Vassy Kapelos to provide an update on the winter Armageddon that is sweeping through Canada. On todays show: Judy Trinh, CTV National News Correspondent joins Vassy live from Washington D.C to provide an update on Canada’s 13 premieres in DC to negotiate with the Trump administration. Andrew Enns, Executive Vice-President, Central Canada joins host Vassy Kapelos to discuss the recent polling from Leger that shows the Liberals gaining ground on the Conservatives. Dr. Isaac Bogoch, infectious disease physician at the Toronto General Hospital joins for this weeks ‘The Explainer’ segment to discuss the difference between the flu and influenza, and to provide an update on how the flu season is trending. The Daily Debrief Panel with Jeff Ruttledge, Laura D’Angelo, and Joël-Denis Bellavance. Listen to Vassy’s full conversation with Stephen Poloz, Former Governor of the Bank of Canada on what steps Canada should be taking amid Trumps tariff threats.
Jens Lindemann, Canadian living in LA and celebrated Canadian trumpeter joins host Vassy Kapelos to discuss his experience of losing his home in the devastating wildfires that are burning across Los Angeles. On todays show: Listen to Vassy's full conversation with Terry DuguidMinister responsible for Prairies Economic Development Canada on the possibility of Canada cutting off energy exports to the U.S. as retaliation to threatened tariff. Dr. Isaac Bogoch, infectious disease physician at the Toronto General Hospital joins Vassy to discuss the increase of cases of Norovirus and particularly the outbreak at the University of Guelph. The Daily Debrief Panel with Shakir Chambers, Marieke Walsh, and Saeed Selvam. David Adams, President, CEO Global Automakers of Canada and Brian Kingston, President, CEO Canadian Vehicle Manufacturers’ Association join Vassy to discuss the calls from the automotive sector to end the federal EV mandate.
Your stories about the challenges accessing care for dizziness and vertigo with one of Canada's leading experts, Dr. John Rutka. He leads the Centre for Advanced Hearing and Balance Testing at Toronto General Hospital.
Eric Ham, CTV U.S. Political Analyst joins guest host Stefan Keyes to discuss President-elect Donald Trump announcing he is nominating Fox News host and Army veteran Pete Hegseth to serve as his defense secretary and former Director of National Intelligence John Ratcliffe to lead the Central Intelligence Agency. On todays show: Jasmin Guénette, vice-president of national affairs with the Canadian Federation of Independent Business joins guest host Stefan Keyes to discuss the impact on businesses across Canada would feel if Canada Post stops working as of Friday. Richard Crouse, Movie Critic joins guest host Stefan Keyes to answer this weeks 'The Explainer' question. The Daily Debrief Panel with Tim Powers and Sabrina Grover. Drew Dilkens, Mayor of Windsor, Ontario joins guest host Stefan Keyes to discuss the comments from Trumps new border czar Tom Homan who said the Canadian border is an 'extreme' vulnerability. Dr. Isaac Bogoch, infectious diseases physician at the Toronto General Hospital joins guest host Stefan Keyes to discuss the rise of walking pneumonia cases in Canada.
As days get shorter and temperatures drop, flu season is upon us. Dr. Isaac Bogoch, an infectious disease specialist at Toronto General Hospital, tells guest host Susan Ormiston about what to expect this year.
Human cases of rabies are not common in Canada, but experts say people still need to be cautious and avoid infection. Dr. Isaac Bogoch, an infectious diseases specialist at Toronto General Hospital and Dr. Scott Weese, a professor and veterinary internal medicine specialist at the Ontario Veterinary College, explain everything you need to know about rabies from the human, and the animal side.For transcripts of The Dose, please visit: lnk.to/dose-transcripts. Transcripts of each episode will be made available by the next workday. For more episodes of this podcast, click this link.
It was more than four years ago when the World Health Organization declared COVID-19 a pandemic and the world shut down. Now, things have largely returned to the way they were, but the virus still remains. How dangerous is COVID-19 today? And have people forgotten that the disease poses health risks and some are still feeling the effects of poor mental health? For insight, The Agenda welcomes: Isaac Bogoch, an infectious diseases specialist at the Toronto General Hospital; Dawn Bowdish, executive irector at the Firestone Institute for Respiratory Health and professor of medicine at McMaster University; and Kwame McKenzie CEO, Wellesley Institute and director of health equity at the Centre for Addiction and Mental Health (CAMH).See omnystudio.com/listener for privacy information.
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers an introduction to consultation-liaison psychiatry with Dr. Raed Hawa and Dr. Alan Wai, both from the University of Toronto. Dr. Raed Hawa is an esteemed CL psychiatrist and educator. Dr Hawa's interests are in the areas of undergraduate, postgraduate, and continuing medical education. He also practices general sleep medicine with particular clinical interest in the areas of insomnia, co-morbid psychiatric and medical illnesses, and sleep-related movement disorders. He currently serves as the President of the Canadian Academy of Consultation-Liaison Psychiatry (CACLP) and holds the position of Professor at the Faculty of Medicine, University of Toronto. Additionally, Dr. Hawa is the Deputy Psychiatrist-in-Chief at the Centre for Mental Health, University Health Network. Dr. Hawa has earned American Board Certification in Psychiatry, with subspecialty certifications in Sleep Medicine and Psychosomatic Medicine (Consultation-Liaison Psychiatry). His expertise and contributions to the field have been recognized through his designation as a Distinguished Fellow of both the American Psychiatric Association (APA) and the Canadian Psychiatric Association (CPA). Dr. Alan Wai is a psychiatrist at the University Health Network in Toronto and an Assistant Professor in the Department of Psychiatry at the University of Toronto. He provides inpatient CL psychiatry care and mental health and psychiatric care embedded in the Immunodeficiency Clinic at Toronto General Hospital, where he sees both persons living with and at risk of HIV. He received his medical degree from the University of British Columbia and completed his psychiatric residency training at the University of Toronto. The learning objectives for this episode are as follows: By the end of this episode, the listener will be able to… Outline the history and evolution of CL psychiatry Define the role and scope of CL psychiatrists in diverse medical settings Identify and assess common psychiatric disorders in CL settings Provide differential diagnoses and a general approach to a CL patient through a sample case Guests: Dr. Raed Hawa and Dr. Alan Wai Hosts: Annie Yu (PGY3), Sena Gok (MD), and Matthew Cho (CC3) Audio editing by: Sena Gok Show notes by: Sena Gok Interview content: Introduction - 00:13 Learning objectives - 01:09 First guest introduction - 01:36 History of CL psychiatry - 03:18 Subspecialties within CL psychiatry - 10:33 Collaborative care of CL psychiatry - 14:00 Preparation for CL Rotation - 20:03 Bariatric clinic and CL psychiatry - 22:32 Future of CL psychiatry, AFC Certification - 27:45 Second guest introduction - 33:29 Role and scope of CL psychiatry - 34:18 A day in CL psychiatry - 39:32 Cultural competence in CL psychiatry - 44:08 Introduction to patients in CL clinics - 47:53 Resources for CL psychiatry rotation - 50:14 Clinical vignette - 53:08 CL psychiatric assessment approach - 01:00:25 Agitation management in CL psychiatry - 01:09:24 Closing - 01:13:51 End credits - 01:15:05 Resources: Massachusetts General Hospital Handbook of General Hospital Psychiatry: https://www.sciencedirect.com/book/9781437719277/massachusetts-general-hospital-handbook-of-general-hospital-psychiatry Academy of CL Psychiatry (ACLP) educational resources: https://www.clpsychiatry.org/educationcareers/ AFC (Area of Focused Competence) in CL Psychiatry: https://news.royalcollege.ca/en/eligibility-and-exams/areas-of-focused-competence.html Canadian Academy of Consultation-Liaison Psychiatry website: https://www.clpsychiatry.ca Our previous CL psychiatry-related episodes: PsychEd Episode 22: Psycho-Oncology Assessments with Dr. Elie Isenberg-Grzeda PsychEd Episode 35: Pain Psychiatry with Dr. Leon Tourian PsychEd Episode 36: Understanding Eating Disorders with Dr. Randy Staab PsychEdEpisode 37: Treating Eating Disorders with Dr. Randy Staab PsychEd Episode 57: HIV Psychiatry with Dr. Adriana Carvalhal and Dr. Leigh van den Heuvel References: Ali, S., Ernst, C., Pacheco, M., & Fricchione, G. (2006). Consultation-liaison psychiatry: How far have we come? Current Psychiatry Reports, 8(3), 215–222. https://link.springer.com/article/10.1007/s11920-006-0026-y Beran, C., & Sowa, N. A. (2021). Adaptation of an Academic Inpatient Consultation-Liaison Psychiatry Service During the SARS-CoV-2 Pandemic: Effects on Clinical Practice and Trainee Supervision. Journal of the Academy of Consultation-Liaison Psychiatry, 62(2), 186–192. https://pubmed.ncbi.nlm.nih.gov/33288272 Lipowski, Z. J. (1974). Consultation-Liaison Psychiatry: An Overview. American Journal of Psychiatry, 131(6), 623–630. https://doi.org/10.1176/ajp.131.6.623 Lipowski, Z. J. (1992). Consultation-liaison psychiatry at century's end. Psychosomatics, 33(2), 128–133. https://doi.org/10.1016/S0033-3182(92)71988-4 Swenson, J. R., Abbey, S., & Stewart, D. E. (1993). Consultation-liaison psychiatry as a subspecialty. A Canadian survey. General Hospital Psychiatry, 15(6), 386–391. https://doi.org/10.1016/0163-8343(93)90007-b Taylor, G., & Doody, K. (1979). Psychiatric Consultations in a Canadian General Hospital. The Canadian Journal of Psychiatry, 24(8), 717–723. https://doi.org/10.1177/070674377902400803 For more PsychEd, follow us on Instagram (@psyched.podcast), X (@psychedpodcast), and Facebook (PsychEd Podcast). You can provide feedback by email at psychedpodcast@gmail.com. For more information, visit our website at psychedpodcast.org.
In this Leveling Up Episode of the PRS Global Open Deep Cuts Podcast, Dr. John Semple discusses his unusual pathway into medicine, three dimensional thinking, prepectoral breast reconstruction, the use of allograft and synthetic meshes, fat grafting in radiated breasts, some tips to make fat harvest easier, how to be a good mentor and a good leader, and how he got involved in climate science. Read a recent classic PRS Global Open article by Dr. Semple and co-authors, “Patient Outcomes after Fat Grafting to the Radiated Chest Wall before Delayed Two-stage Alloplastic Breast Reconstruction”: https://bit.ly/SempleFatGrafting Dr. John Semple is a Professor in the Department of Surgery at the University of Toronto, and the head of the division of plastic surgery at Women's College Hospital. He is also an adjunct faculty member at the wilderness Medicine Program at Mass General Hospital in Boston, and an adjunct professor at the Ontario College of Art and Design, where was a former chair of the Board of Governors. He trained in art at OCAD and became a fully trained medical illustrator, then went into medicine, training in plastic surgery at the University of Toronto and then completing a microsurgery fellowship at the Toronto General Hospital. He is a past president of the Canadian Society of Plastic Surgeons, and received the Lavina Lickley Lifetime achievement award form the department of surgery at the University of Toronto. He also has a keen interest in mountaineering - and has been to Everest North Col 4 times, and has published numerous papers on the effects of climate change in the Himalayas. Your host, Dr. Puru Nagarkar, is a board-certified plastic and hand surgeon, and Assistant Professor of Surgery at the University of Texas Southwestern Medical Center in Dallas. #PRSGlobalOpen #DeepCutsPodcast #PlasticSurgery #LevelingUp
In this Leveling Up Episode of the PRS Global Open Deep Cuts Podcast, Dr. John Semple discusses his unusual pathway into medicine, three dimensional thinking, prepectoral breast reconstruction, the use of allograft and synthetic meshes, fat grafting in radiated breasts, some tips to make fat harvest easier, how to be a good mentor and a good leader, and how he got involved in climate science. Read a recent classic PRS Global Open article by Dr. Semple and co-authors, “Patient Outcomes after Fat Grafting to the Radiated Chest Wall before Delayed Two-stage Alloplastic Breast Reconstruction”: https://bit.ly/SempleFatGrafting Dr. John Semple is a Professor in the Department of Surgery at the University of Toronto, and the head of the division of plastic surgery at Women's College Hospital. He is also an adjunct faculty member at the wilderness Medicine Program at Mass General Hospital in Boston, and an adjunct professor at the Ontario College of Art and Design, where was a former chair of the Board of Governors. He trained in art at OCAD and became a fully trained medical illustrator, then went into medicine, training in plastic surgery at the University of Toronto and then completing a microsurgery fellowship at the Toronto General Hospital. He is a past president of the Canadian Society of Plastic Surgeons, and received the Lavina Lickley Lifetime achievement award form the department of surgery at the University of Toronto. He also has a keen interest in mountaineering - and has been to Everest North Col 4 times, and has published numerous papers on the effects of climate change in the Himalayas. Your host, Dr. Puru Nagarkar, is a board-certified plastic and hand surgeon, and Assistant Professor of Surgery at the University of Texas Southwestern Medical Center in Dallas. #PRSGlobalOpen #DeepCutsPodcast #PlasticSurgery #LevelingUp
Bill Curry, Deputy Bureau Chief with Globe and Mail joins host Vassy Kapelos to discuss Canada's temporary foreign worker program. On todays show: Bruce Ralston, Minister of Forests for British Columbia joins host Vassy Kapelos to discuss how the U.S has nearly doubled the duty on Canadian softwood lumber. Dr. Isaac Bogoch, infectious diseases physician at the Toronto General Hospital joins Vassy Kapelos to discuss how the World Health Organization has declared the mpox outbreaks in Congo and elsewhere in Africa a global emergency. The Daily Debrief Panel with Robert Benzie, Laura Stone, and Paul Wells. Keir Giles, Russia expert at the Chatham House think tank and author of the forthcoming book ‘Who Will Defend Europe' joins Vassy Kapelos to discuss how Ukrainian forces have attacked a second border region in western Russia.
Shimon Koffler-Fogel, President and CEO of the Centre for Israel and Jewish Affairs joins guest host Robin Gill to discuss the review of online comments made by incoming human rights commissioner Birju Dattani, and that Dattani has "agreed to take a leave" just one day before he was set to begin serving in his new role. On todays show: There is some talk of a "summer Covid wave" ramping up. In the U.S, the Centre's for Disease Control has reported a doubling of prevalence of this new KP3 variant in the last two weeks. Dr. Isaac Bogoch, infectious diseases physician at the Toronto General Hospital joins guest host Robin Gill to discuss if this new variant is something to worry about. Moustafa Ayad, executive director for Africa, Middle East and Asia at Institute for Strategic Dialogue joins guest host Robin Gill to discuss how Taylor Swift's Vienna concerts were cancelled over a suspected terrorist plot. CTV science and technology specialist Dan Riskin joins guest host Robin Gill for the weekly segment Talk Science to Me. The Daily Debrief Panel with Robert Benzie, Marieke Walsh and Hannah Thibedeau. David Phillips, Senior Climatologist with Environment and Climate Change Canada joins guest host Robin Gill to go over the remnants of Hurricane Debby that is set to hit Eastern Canada over the weekend.
Loud, disruptive snoring could be (but isn't always) a sign of sleep apnea, a common condition in which breathing may stop and start many times throughout the night. You may be aware that sleep apnea can disrupt your sleep and cause fatigue, but did you know that it can also impact your heart, your brain – even your sex drive?In today's episode, we discuss the health risks of undiagnosed sleep apnea and why, if you're having trouble sleeping or staying awake during the day, if you're experiencing morning headaches, mood changes or difficulty focusing, you should consider getting a sleep test.Featuring: Dr. Douglas Bradley - Director of UHN's Centre for Sleep Health and Research, at Toronto General Hospital.Dr. Frances Chung - Anesthesiologist and Clinician Investigator with UHN's Krembil Brain Institute; Inventor of the STOP-Bang Questionnaire, a new screening tool for sleep apnea that's being used around the world. Carmen Chu – Fundraising professional and cancer survivor, who was recently diagnosed with sleep apnea. Additional resources: UHN's Centre for Sleep Health and ResearchDr. Frances Chung named UHN Inventor of the YearDr. Douglas Bradley featured in KITE Research spotlight: Use of non-invasive breathing device to alleviate obstructive and central sleep apnea improves quality of life The Your Complex Brain production team is Heather Sherman, Jessica Schmidt, Dr. Amy Ma, Kim Perry, Alley Wilson, Sara Yuan, Meagan Anderi, Liz Chapman, and Lorna Gilfedder.The Krembil Brain Institute, part of University Health Network, in Toronto, is home to one of the world's largest and most comprehensive teams of physicians and scientists uniquely working hand-in-hand to prevent and confront problems of the brain and spine, such as Parkinson's, Alzheimer's, epilepsy, stroke, spinal cord injury, chronic pain, brain cancer or concussion, in their lifetime. Through state-of-the-art patient care and advanced research, we are working relentlessly toward finding new treatments and cures.Do you want to know more about the Krembil Brain Institute at UHN? Visit us at: uhn.ca/krembilTo get in touch, email us at krembil@uhn.ca or message us on social media:Instagram - @krembilresearchTwitter - @KBI_UHNFacebook - https://www.facebook.com/KrembilBrainInstituteThanks for listening!
Dr. Thavendiranathan discusses the HIMILAYAS trial, looking at exercise interventions for cancer survivors and the STOPMEDCTRCD trial addressing the ongoing efficacy of continuing use of cardiovascular medicines after cancer therapy Dr. Paaladinesh Thavendiranathan is a cardiologist at the Toronto General Hospital, University Health Network; Associate Professor of medicine at the University of Toronto and a Clinician Investigator. Learn more about the HIMILAYAS trial here:https://www.himalayastrial.ca/Learn more about the STOPMEDCTRCD trial here:https://classic.clinicaltrials.gov/ct2/show/NCT06183437
Join us for the latest EMJ Podcast episode about PBC, in which leading experts in the field discuss the newest developments and regulatory challenges in advancing treatment. David Jones, Newcastle University, UK; and Gideon Hirschfield, Toronto General Hospital, Ontario, Canada, address the impacts of treatment on patient quality of life, as well as the difficulties of collecting long-term data.
We return to our Canadian Critical Care Forum series with this episode. In this episode, we delve into the world of Extracorporeal Membrane Oxygenation (ECMO) with Dr. Eddy Fan, a leading expert in critical care and ECMO specialist. Eddy Fan is an associate professor in the Interdepartmental Division of Critical Care Medicine and the Institute of Health Policy, Management, and Evaluation at the University of Toronto and a staff intensivist at the University Health Network/Mount Sinai Hospital. Dr. Fan received his undergraduate degree from the University of Toronto, his medical degree from the University of Western Ontario, and a PhD in Clinical Investigation from Johns Hopkins University. He is currently the Medical Director of the Extracorporeal Life Support Program at the Toronto General Hospital, and the Director of Critical Care Research at the University Health Network/Mount Sinai Hospital. Dr. Fan's research has focused on advanced life support for acute respiratory failure and patient outcomes from critical illness. These include investigations on the epidemiology and use of mechanical ventilation and extracorporeal life support in patients with ARDS, as well as on the development of ICU-acquired weakness, early rehabilitation in ICU patients, and long-term outcomes in survivors of critical illness. Join us as we take on this huge topic.
This week we will discuss Multi-Organ transplants with Zachary Colton. Zach is 35 years old and recently underwent a successful 5 organ multivisceral intestinal transplant surgery at the Toronto General Hospital in his home country of Canada. The organs he received were: stomach, small intestine, colon, liver, and pancreas. In 1954, the kidney was the first human organ to be transplanted successfully. Liver, heart and pancreas transplants were successfully performed by the late 1960s, while lung and intestinal organ transplant procedures were begun in the 1980s. From the mid-1950s through the early 1970s, individual transplant hospitals and organ procurement organizations managed all aspects of organ recovery and transplantation. If an organ couldn't be used at hospitals local to the donor, there was no system to find matching candidates elsewhere. Many organs couldn't be used simply because transplant teams couldn't locate a compatible recipient in time. Since that time UNOS was created in order to provide guidance to patients and physicians in the US with a goal of providing a more equitable base for individuals in need of transplanted organ(s). The United Network for Organ Sharing (UNOS) is a non-profit scientific and educational organization that administers the only Organ Procurement and Transplantation Network (OPTN) in the United States, established (42 U.S.C. § 274) by the U.S. Congress in 1984 by Gene A. Pierce, founder of United Network for Organ Sharing. Located in Richmond, Virginia, the organization's headquarters are situated near the intersection of Interstate 95 and Interstate 64 in the Virginia BioTechnology Research Park. United Network for Organ Sharing is involved in many aspects of the organ transplant and donation process: Managing the national transplant waiting list, matching donors to recipients. Maintaining the database that contains all organ transplant data for every transplant event that occurs in the U.S. Bringing together members to develop policies that make the best use of the limited supply of organs and give all patients a fair chance at receiving the organ they need, regardless of age, sex, ethnicity, religion, lifestyle, or financial/social status. Monitoring every organ match to ensure organ allocation policies are followed. Providing assistance to patients, family members and friends. Educating transplant professionals about their important role in the donation and transplant processes. (CREDITS: Wiki) Educating the public about the importance of organ donation.
In this episode, host Helen Angus, CEO of AMS Healthcare, speaks with Dr. Lisa Richardson. Dr. Lisa Richardson practises General Internal Medicine at the Toronto General Hospital and is the Associate Dean, Inclusion and Diversity; as well as Acting Vice Dean, Strategy, at the University of Toronto's Temerty Faculty of Medicine. She is an education researcher at the Wilson Centre with a scholarly focus on how to integrate Indigenous and critical perspectives from the social sciences into medical education. Dr Richardson is the Strategic Lead in Indigenous Health for Women's College Hospital where she founded Ganawishkadawe – The Centre for Wise Practices in Indigenous Health. She is on Council of the Royal College of Physicians and Surgeons of Canada and co-chairs the Royal College's Indigenous Health Committee. Lisa is also a founding executive member of the National Consortium for Indigenous Medical Education and belongs to the Indigenous Physicians Association of Canada. www.amshealthcare.ca
Depression. Addiction. Anxiety. OCD. Anorexia. Psilocybin, the active ingredient in magic mushrooms, is being used to treat a wide range of mental-health disorders, with some very promising results. But what is the experience like in these sessions that can last as long as eight hours? And what exactly does it offer people? And why does a single dose help 80 per cent of people quit smoking or 6 per cent of people recover from severe depression? Producer Eric Bombicino visits "the most beautiful room" in Toronto General Hospital and finds out how this psychedelic is changing people's minds.See omnystudio.com/listener for privacy information.
In this episode, Dr. Zanotti is joined by Dr. Eddy Fan for a discussion about Respiratory Support in ARDS. Dr. Fan is an associate professor in the Interdepartmental Division of Critical Care Medicine and the Institute of Health Policy, Management, and Evaluation at the University of Toronto. He is also a staff intensivist at the University Health Network/Mount Sinai Hospital. Dr. Fan is currently the Medical Director of the Extracorporeal Life Support Program at the Toronto General Hospital and the Director of Critical Care Research at the University Health Network/Mount Sinai Hospital. Dr. Fan's research has focused on advanced life support for acute respiratory failure and patient outcomes from critical illness. He is a co-author of the ESICM ARDS Clinical Guidelines. Additional Resources: ESICM guidelines on acute respiratory distress syndrome: definition, phenotyping, and respiratory support strategies. Intensive Care Med 2023: https://pubmed.ncbi.nlm.nih.gov/37326646/ An Update on Management of Adult Patients with ARDS. Official ATS Clinical Practice Guideline. Am J Respir Crit Care Med 2024; https://www.atsjournals.org/doi/full/10.1164/rccm.202311-2011ST Prone Positioning in Severe Acute Respiratory Distress Syndrome. PROSEVA Clinical Trial. N Engl J of Med 2013: https://www.nejm.org/doi/full/10.1056/nejmoa1214103 Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome. The EOLIA Trial. N Eng J of Med 2018: https://www.nejm.org/doi/full/10.1056/NEJMoa1800385 Books mentioned in this episode: A Portrait of the Artist as a Young Man. By James Joyce: https://bit.ly/49kzmtn
Traumatic injuries or cancer resection can result in large soft tissue loss which can lead to severe functional impairments, including difficulties with mobility and performing daily activitiesDr. Siba Haykal from the University Health Network and the Toronto General Hospital, Canada specialises in tissue-engineered techniques for tracheal reconstruction of breast and head and neck. Check out the team's website and publications for more.
Vincent Santiago's research interests include eating behaviors, body image, and bariatric surgery. Vincent's doctoral dissertation explores the use of an intervention for food addiction (the concept that individuals can be addicted to foods, particularly highly processed foods). This intervention combines Adapted Motivational Interviewing, a person-centered counseling approach, and Cognitive Behavioural Therapy (CBT) skills for eating-related issues and will be tested in a randomized controlled trial. Vincent's Master's thesis explored psychosocial factors (i.e., adult attachment style, emotion regulation, and psychopathology) related to cigarette smoking following bariatric surgery. For his undergraduate thesis, he studied the influence of video messages on healthier eating among students who engaged in restrained and unrestrained eating. He previously worked in research positions at Toronto Western Hospital's Bariatric Surgery Program and the Centre for Addiction and Mental Health. Clinical Interests Vincent's clinical interests include the assessment and treatment of various mental health issues, including eating disorders, anxiety disorders (e.g., social anxiety disorder), and obsessive-compulsive disorder (OCD). Vincent is particularly interested in using approaches from CBT, Dialectical Behaviour Therapy, and Motivational Interviewing. Vincent has completed practicum placements at 1) the Psychology Training Clinic within the Department of Family and Community Medicine at St. Michael's Hospital; 2) the Intensive Residential and Day Treatment Program for OCD at Sunnybrook Health Sciences Centre; and 3) the Day Hospital Treatment, Eating Disorder Program at Toronto General Hospital. Vincent is also involved as a study therapist in clinical trials providing CBT related to post-bariatric surgery issues, as well as social anxiety disorder, substance use, and HIV sexual risk behavior. Professional and Community Involvement Vincent is committed to fostering the growth of psychology and those interested in the field. He is involved in mentorship programs with undergraduates, graduate students, and early career psychologists as part of the Ryerson Psychology Graduate Students' Association (PGSA), the Canadian Psychological Association (CPA), and the American Psychological Association (APA). He is also serving a 2-year term as a Student Representative in the Psychologists in Hospitals and Health Centres section of the CPA. Vincent co-organized the inaugural “Diversifying Psychology Recruitment Event” at Ryerson in 2020. The goal of this event was to provide more information about applying to graduate school for students from traditionally underrepresented groups, particularly students identifying as Black, Indigenous, and a Person of Colour. Vincent also volunteers in LGBTQ+ organizations that offer peer support, workshops, and social activities in the community. The content of our show is educational only. It does not supplement or supersede your healthcare provider's professional relationship and direction. Always seek the advice of your physician or other qualified mental health providers with any questions you may have regarding a medical condition, substance use disorder, or mental health concern.
The political, professional, and cultural implications of using cannabinoids remain controversial despite its increased prevalence over the last 20 years. The American Society of Regional Anesthesia and Pain Medicine established a working group in November 2020 to review the evidence and knowledge gaps around cannabis use in the perioperative period and develop clinical recommendations for the management of patients using cannabis in this setting. Authors Shalini Shah, MD, MBA, and Hance Clarke, MD, FRCPC, PhD, joined RAPM Editor-in-Chief Brian Sites, MD, to discuss committee's findings, which were published in the article “ASRA Pain Medicine consensus guidelines on the management of the perioperative patient on cannabis and cannabinoids” in January 2023 (https://rapm.bmj.com/content/48/3/97). The committee used a Delphi method with > 75% consensus to answer nine clinical questions. The members concluded that all surgical patients should be screened for cannabinoid use prior to surgery, heavy users be counseled on the negative effects on postoperative pain control, and surgery be postponed for patients who present with acute cannabis intoxication. They also advised that pregnant patients be educated on the risks of maternal cannabis on the fetus/neonate. Dr. Shalini Shah is a professor and vice chair for the department of anesthesiology and director of perioperative services at the University of California at Irvine School of Medicine. She completed her residency in anesthesiology from Cornell University and a combined fellowship in adult and pediatric chronic pain at Harvard Medical School. She is the founder of the Pediatric Pain Program at UC Irvine and has previously served as associate program director for the pain medicine fellowship. Dr. Shah is the recipient of the ASRA Pain Medicine Chronic Pain Research Grant Award in 2017 for her landmark work in onabotulinumtoxinA (BOTOX®) use in pediatric migraine pain. Dr. Hance Clarke is the director of pain services and the pain research unit at the Toronto General Hospital in Toronto, Canada. He is the knowledge translation chair for the University of Toronto Centre for the Study of Pain and an associate professor in the department of anesthesiology and pain medicine at the University of Toronto. Dr. Clarke has authored more than 150 peer-reviewed publications and has been invited to speak on pain control, cannabis, and the opioid crisis to the House of Commons in Ottawa, Canada, and elsewhere around the world. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner's judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. Podcast and music produced by Dan Langa. Find us on Twitter @RAPMOnline.
NACI (National Advisory Committee on Immunization) is recommending all Canadians who haven't had a Covid booster get one for the fall if it has been at least six months since their last vaccine shot or since last getting infected with Covid. NACI focused particularly on those over 65, residents of long-term-care homes, if you're pregnant and/or at high risk due to an underlying medical condition. Also strongly recommends the booster for First Nations, Metis and Inuit communties, members of racialized communities and essential workers. Guest: Dr. Isaac Bogoch. Infectious diseases specialist at Toronto General Hospital and associate professor of medicine at the University of Toronto. Learn more about your ad choices. Visit megaphone.fm/adchoices
Today's podcast: NACI (National Advisory Committee on Immunization) is recommending all Canadians who haven't had a Covid booster get one for the fall if it has been at least six months since their last vaccine shot or since last getting infected with Covid. NACI focused particularly on those over 65, residents of long-term-care homes, if you're pregnant and/or at high risk due to an underlying medical condition. Also strongly recommends the booster for First Nations, Metis and Inuit communties, members of racialized communities and essential workers. Guest: Dr. Isaac Bogoch. Infectious diseases specialist at Toronto General Hospital and associate professor of medicine at the University of Toronto. Bank of Canada raises interest rate to 5%, highest in 22 years. Impact on Canadians, on Canadian homeowners, on economy, - Office of Superintendant of Financial Institutions considering regulatory changes to help financial institutions under mortgage lending stress. - Let's add increased taxes and inflation to the stress scale, but this time on Canadian families. Guest: Professor Eric Kam. Macroeconomics. Toronto Metropolitan University. Global News: An Amsterdam court needs more specifics before sentence in Aydin Coban on his guilty conviction of cyberbullying of Amanda Todd which led to the then 15 year old B.C. teen's suicide. Amanda's mother is very angry. Guest: Carol Todd. Amanda's mother. Let's look at the Online News Act which Canadians have been commenting on. Let's cut to the chase. Where do you get your news, sports, social commentary today? Then a bit of nostalgia. What did you grow up with? Radio, television, newspapers? What do you miss? And frankly, who needs the tech "giants?" Just go to the websites of the individual Canadian news outlets and forget about Meta and Google. Guest: Joe Warmington. Columnist. PostMedia. --------------------------------------------- Host/Content Producer – Roy Green Technical/Podcast Producer – Tom McKay Podcast Co-Producer – Matt Taylor If you enjoyed the podcast, tell a friend! For more of the Roy Green Show, subscribe to the podcast! https://globalnews.ca/roygreen/ Learn more about your ad choices. Visit megaphone.fm/adchoices
Early in the COVID-19 pandemic, Ontario saw a 5600% increase in virtual visits to health care practitioners, while in-office visits decreased by 79% from the previous year. In 2018, only 4% of family physicians in Canada were offering video visits while, at the peak of the pandemic, about 80% of primary care visits were being delivered virtually in Ontario.Media reports at the time suggested patients were substituting emergency department (ED) visits when in-person consultations were unavailable, leading to additional strain on already stretched ED resources.A research paper published in CMAJ looked at whether this shift in care was in fact taking place. Dr. Hemant Shah is an internal medicine physician and hepatologist at Toronto General Hospital and co-author of the study entitled Association between virtual primary care and emergency department use during the first year of the COVID-19 pandemic in Ontario, Canada.On today's episode, Dr. Shah discusses the study's surprising findings with hosts Dr. Blair Bigham and Dr. Mojola Omole. Drs Omole and Bigham then speak with Toni Leamon, the CMA's patient voice chair, a member of CMA's Virtual Care Taskforce and a co-author of the CMA's Virtual Care Companion for Patients. She offers the patient's vision of high quality virtual care.Join us as we explore medical solutions that address the urgent need to change healthcare. Reach out to us about this or any episode you hear. Or tell us about something you'd like to hear on the leading Canadian medical podcast.You can find Blair and Mojola on Twitter @BlairBigham and @DrmojolaomoleCMAJTwitter (in English): @CMAJ Twitter (en français): @JAMC FacebookInstagram: @CMAJ.ca The CMAJ Podcast is produced by PodCraft Productions
A new strain of the COVID Omicron variant has begun to spread in the United States. Guest: Dr. Isaac Bogoch, Infectious Disease Specialist at Toronto General Hospital
That's Cool News | A weekly breakdown of positive Science & Tech news.
Porsche's synthetic gasoline factory comes online today in Chile | Ars Technica (01:07) A Chilean startup called Highly Innovative Fuels officially opened its first synthetic gasoline production facility. Result of a collaboration between the automaker Porsche, Siemens Energy, Exxon Mobil, Enel Green Power, the Chilean state energy company ENAP, and Empresas Gasco. What is synthetic fuel or synfuel? A feedstock is a raw material that is used as a source of energy or as a starting material for the production of a product. A type of fuel that is made from synthetic hydrocarbons Typically produced from coal, natural gas, or biomass through a process known as the Fischer-Tropsch process. Synthetic fuel is a direct drop-in for pump gasoline Initially, the site will produce around 34,000 gallons (130,000 L) a year, Scaling up to 14.5 million gallons (55 million L) a year by 2024. Plans to increase that tenfold to 145 million gallons (550 million L) a year by 2026. The site, located in Punta Arenas in Southern Chile, will use wind to power the processThe area sees high winds roughly 270 days a year, and a wind turbine can expect to produce up to four times as much energy as one in Europe. Conversion process of the plant:The e-fuel plant will use wind power to electrolyze water into hydrogen and oxygen. The hydrogen is then combined with carbon captured from the air or industrial sources to synthesize methanol. The methanol in turn can then be converted into longer hydrocarbons to be used as fuel. HIF has long-term plans to build out 12 synthetic fuel plants worldwide, including locations in the US and Australia, with a goal of each site capturing 2 million metric tons of CO2 per year.Could be an incentive for CO2 capture! It is NOT CHEAPAt current prices, it works out to around $8 per gallon ($2/L), although that obviously doesn't include any taxes or duties NASA Discovers Pair of Super-Earths With 1,000-Mile-Deep Oceans | SciTechDaily (08:24) Astronomers have uncovered a pair of planets that are water worlds unlike any planet found in our solar system.Slightly larger than Earth, they don't have the density of rock, but they are denser than gas giants in our solar system What are they made of? The best answer is that these exoplanets have global oceans at least 500 times deeper than the average depth of Earth's oceans, which simply are a wet veneer on a rocky ball. They orbit the red dwarf star Kepler-138, located 218 light-years away in the constellation Lyra.Called Kepler-138 c and Kepler-138 d Planets were initially found in 2014 with NASA's Kepler Space Observatory. But with follow-up observations with the Spitzer and Hubble space telescopes they found that the planets must be composed largely of water. The discovery was made by a team of researchers at the University of Montreal lead by Caroline Piaulet.By comparing the sizes and masses of the planets to models, the astronomers concluded that a significant fraction of their volume should be made of materials that are lighter than rock but heavier than hydrogen or helium. Most common being water. The closest size comparison, say researchers, would be some of the icy moons in the outer solar system (i.e. Europa, Enceladus) that are also largely composed of water surrounding a rocky core. But don't expect the water to be the same as the water you see here. According to Piaulet:“The temperature in Kepler-138 d's atmosphere is likely above the boiling point of water, and we expect a thick dense atmosphere made of steam on this planet. Only under that steam atmosphere there could potentially be liquid water at high pressure, or even water in another phase that occurs at high pressures, called a supercritical fluid.” A supercritical fluid is a substance that is in a state between a gas and a liquid and exhibits unique properties that are intermediate between the two phases. (Not a pressure to be solid) Gene therapy cures kids with rare “bubble-boy” disease in new trial | New Atlas (12:18) A rare genetic disease, called Severe combined immunodeficiency (SCID), renders children without a functioning immune system from birth has been effectively cured by an experimental gene therapy. SCID is a collection of genetic diseases that result in impaired immune functions. Informally known as the "bubble-boy" disease The study is reporting on the first 10 children treated with the therapy, all of whom are now healthy and living normal lives. The two most common forms of SCID – X-SCID and ADA-SCID – have been successfully treated with an experimental gene therapy.The patient's bone marrow stem cells are harvested, modified with a healthy copy of the targeted gene, and then infused back into their bodies. This form of gene therapy uses a modified virus to deliver its healthy gene payload. Sometimes cancerous side effects. Because those viruses can only enter a cell's nuclei when it's dividing they can potentially generate adverse side effects. Many researchers have shifted to using modified lentiviruses as the optimal viral vector for gene therapies.Enter the nuclei of non-dividing cells meaning they should be safer and more effective. In 2021, a more long-term study tracking 50 children with ADA-SCID treated with lentiviral gene therapy found every subject was alive and healthy three years later. The 10 children in this latest study were treated for ART-SCID, which is an extremely rare version of SCID and difficult to treat. Over two years after the initial treatment all 10 children are reported as healthy and living normal lives. Jennifer Puck, co-lead investigator on the study, discusses the results:“All of the results are better than those previously seen with Artemis-SCID patients who received donor bone marrow transplants … Having patients in the trial achieve full T-cell immunity is outstanding. B-cell recovery takes longer, but so far it looks as if the patients also have a far better chance for B-cell reconstitution than they would with a regular bone marrow transplant. Successfully using less chemotherapy is also a big win, minimizing the harmful side effects of full dose busulfan in small infants.” Larger studies are needed (as always), but the results are extraordinarily promising, pointing to a future where this genetic disease can be cured soon after birth. Proof-of-concept drone flight delivers transplant lung to patient in Toronto | TechXplore (17:37) A team of researchers have demonstrated the feasibility of using drones to carry human organs for transplantation to nearby locales. A drone carried a human lung donated by a deceased patient at one hospital in downtown Toronto, Canada, to another patient needing a new lung waiting in another hospital, also in downtown Toronto. This feasibility study was meant to test the use of drones for carrying donated organs on a regular basis.Drone used was the Chinese-made M600 Pro Added new electronics designed specifically for strong connectivity—the drone is steered on its path by a human pilot. Added a parachute, lights, several cameras, GPS trackers and a recovery system. Finally, they removed the landing gear and replaced it with a container box specifically designed to keep organs cool during transport. They had the drone carry objects from point to point, testing all of its features. After 400 such test flights, they deemed their drone ready The proof-of-concept flight:Took off from Toronto Western Hospital with the drone carrying a donated lung Flew to Toronto General Hospital, just two kilometers away The lung was delivered and safely implanted into the waiting patient. The researchers suggest their approach can be used for short-distance transfers in densely populated areas, such as across a city, greatly reducing delivery time.Ground vehicles can take a lot of time due to congestion and unforeseen tie-ups. Blood test detects 'toxic' protein years before Alzheimer's symptoms emerge | ScienceDaily (22:55) Seeds of Alzheimer's are planted years -- even decades – before the cognitive impairments surface that make a diagnosis possible. Amyloid beta proteins that misfold and clump together, forming small aggregates called oligomers. Those oligomers through a process scientists still do not understand become “toxic,” which then are thought of to cause Alzheimer's. University of Washington researchers have developed a laboratory test that can measure levels of amyloid beta oligomers in blood samples. Detected in the blood of patients with Alzheimer's disease But did not detect them in most members of a control group who showed no signs of cognitive impairment Their test, known by the acronym SOBA, did detect oligomers in the blood of 11 individuals from the control group.10 of these individuals had follow-up examinations where all were diagnosed years later with mild cognitive impairment or brain pathology consistent with Alzheimer's disease. Senior author professor Valerie Daggett stated:“What clinicians and researchers have wanted is a reliable diagnostic test for Alzheimer's disease -- and not just an assay that confirms a diagnosis of Alzheimer's, but one that can also detect signs of the disease before cognitive impairment happens. That's important for individuals' health and for all the research into how toxic oligomers of amyloid beta go on and cause the damage that they do … What we show here is that SOBA may be the basis of such a test." In the study, the team also showed that SOBA easily could be modified to detect toxic oligomers of another type of protein associated with Parkinson's disease and Lewy body dementia. Dagget stating:"We are finding that many human diseases are associated with the accumulation of toxic oligomers that form these alpha sheet structures … Not just Alzheimer's, but also Parkinson's, type 2 diabetes and more. SOBA is picking up that unique alpha sheet structure, so we hope that this method can help in diagnosing and studying many other 'protein misfolding' diseases."
The Thought Leader Revolution Podcast | 10X Your Impact, Your Income & Your Influence
People like doing business with people they know and trust. So building strong relationships through networking is essential. These days, a lot of networking can be done using technology alone, but is that enough to get to know people people and earn their trust? There's so much to be said for presence and a handshake. Sharon Mah-Gin has been networking in the recruiting industry for over 20 years. She started her career with Korn Ferry Global Search Firm, working with companies like Starbucks, Manlike, and the Toronto General Hospital. Later she helped found the boutique entrepreneurial executive search firm, Executive Search Alliance. Expert action steps: Do something that you're passionate about. Do in-person networking as often as you can. True networking is not about you. It's about “How can I help you?”. Be genuine and kind and the Universe will pay you back. For more information, go to https://www.execsearchalliance.com/. You can also contact Sharon on LinkedIn at https://ca.linkedin.com/in/sharonmahgin. Also in this episode: Book: Joy by Debbie Travis is on Amazon.
2022 year-ender interview concerning this year's experiences with the Covid coronavirus and its variants. As well, vaccination and boosters, the wearing masks or not wearing masks. Also, the Respiratory Sycitial Virus and its impact particularly on children. The annual flu and its impact this year. Measles spreading globally. What may lie ahead in 2023? Guest: Dr. Isaac Bogoch. Infectious diseases specialist, Toronto General Hospital and associate professor of medicine at the University of Toronto. Learn more about your ad choices. Visit megaphone.fm/adchoices
Today's podcast: Danielle Smith won byelection in Brooks-Medicine Hat earlier in the week and now will sit in the Alberta legislature as premier. Plans and priorities between now and the May 29, 2023 provincial election. Guest: Danielle Smith. Premier. Alberta. In March of 2023, mental illness may qualify for medical assistance in dying (MAID). Increasingly Canadians are engaging or considering engaging MAID. Today the facts, the fallacies concerning MAID. Guest: Dr. Stefanie Green. Co-founder and president, Canadian Association of MAID Assessors and Providers (CAMAP). - Medical advisor to the BC Ministry of Health MAID oversight committed, moderator of CAMAP's national online forum. Clinical faculty, UBC and University of Victoria. Author: This Is Assisted Dying. Winter virus season. Covid and more. Pediatric ICU's over capacity in Ontario with rising numbers of viral respiratory infections. Ontario's Chief Medical Officer of Health will tomorrow call for masks to be worn indoors, but no mandate issued. Questions about vaccinations and booster shots. Combining vaccines (Covid, annual flu, shingles, etc). Guest: Dr. Isaac Bogoch. Infectious diseases specialist, Toronto General Hospital and associate professor of medicine, University of Toronto. Indigenous Nexus: Bringing Common Sense and Sensible Environmentalism to Natural Resouce Development. A Constructive Way Forward with Indigenous People. January 25, 2023, Indigenous leaders, the energy and mining industry and governments will gather in Calgary for af first-of-its-kind conference on responsible and inclusive resource development. 65% of Indigenous people support or strongly support natural resource development (polling) say the organizers. Guest: Calvin Helin. CEO of IndSight Advisers. Calvin Helin is the son of a British Columbia Hereditary Chief, was named to B.C's Top Forty, Under Forty, is a lawyer and international best-selling author. --------------------------------------------- Host/Content Producer – Roy Green Technical/Podcast Producer – Tom McKay Podcast Co-Producer – Matt Taylor If you enjoyed the podcast, tell a friend! For more of the Roy Green Show, subscribe to the podcast! https://globalnews.ca/roygreen/ Learn more about your ad choices. Visit megaphone.fm/adchoices
Winter virus season. Covid and more. Pediatric ICU's over capacity in Ontario with rising numbers of viral respiratory infections. Ontario's Chief Medical Officer of Health will tomorrow call for masks to be worn indoors, but no mandate issued. Questions about vaccinations and booster shots. Combining vaccines (Covid, annual flu, shingles, etc). Guest: Dr. Isaac Bogoch. Infectious diseases specialist, Toronto General Hospital and associate professor of medicine, University of Toronto. Learn more about your ad choices. Visit megaphone.fm/adchoices
Welcome to Season Two of What Your GP Doesn't Tell You This week's story is so extraordinary that the best selling spy writer John Le Carré used it as the inspiration for one of his novels. And indeed if it was a work of fiction it would be dismissed as too fantastical or improbable. To tell this remarkable tale, I am talking to whistleblower Dr Nancy Olivieri, who became concerned during a trial about the effectiveness of a drug that she was using to treat thalassemia – an inherited form of anaemia. Nancy was threatened with legal action by the drug company Apotex - who were part funding the trial -and told it would be a breach of contract if she mentioned her concerns to patients. This would spark decades of legal action, vitriol and intrigue during which time many careers including Nancy's would be destroyed, investigations would be launched, private detectives be hired and an academic found guilty of sending anonymous letters finally tracked down by his DNA. Dr Nancy F. Olivieri is a professor of pediatrics, medicine and public health services at the University of Toronto, a senior scientist at Toronto General Hospital and the executive director of Hemoglobal® You can sign up to the mailing list to the podcast and be first to know when a new episode is published at whatyourgpdoesnttellyou.com and also find out more about the pod there. The host of the podcast, Liz Tucker is an award winning medical journalist and former BBC producer and director. You can follow Liz on Twitter at @lizctucker and read her Substack newsletter about the podcast at liztucker.substack.com If you would like to support this podcast you can do so at patreon.com/whatyourgpdoesnttellyou or via PayPal at patreon.com/whatyourGPdoesnttellyou What Your GP Doesn't Tell You has been selected by Feedspot as one of the top 20 UK Medical Podcasts https://blog.feedspot.com/uk_medical_podcasts/
Dr. Theresa Tam worries about a "worst case Covid" season. Will Canadians listen and opt for another vaccination (or more)? Guest: Dr. Isaac Bogoch. Infectious diseases. Toronto General Hospital. Learn more about your ad choices. Visit megaphone.fm/adchoices
Today's podcast: Dr. Theresa Tam worries about a "worst case Covid" season. Will Canadians listen and opt for another vaccination (or more)? Guest: Dr. Isaac Bogoch. Infectious diseases. Toronto General Hospital. Canadians are going hungry increasingly as food inflation rises. According to Food Banks Canada, 7 million Canadians reported going hungry between March of 2020 and March of 2022. Guest: Kirstin Beardsley. CEO. Food Banks Canada. RGS has been added to the course outline for Professor Eric Kam's macroeconomics students at Toronto's Metropolitan University. RGS is also required listening for professor Kam's students so they, according to Dr. Kam, "learn about the real world." Guests: Professor Eric Kam and 2 of his students: Eileen and Tyler. Students of professor Kam engaged in listening to and discussing content of RGS in class. Blacklock's Reporter's Ottawa stories/developments including the Rouleau Commission on the Emergencies Act. Guest: Tom Korski. Executive editor, Blacklock's Reporter. --------------------------------------------- Host/Content Producer – Roy Green Technical/Podcast Producer – Tom McKay Podcast Co-Producer – Matt Taylor If you enjoyed the podcast, tell a friend! For more of the Roy Green Show, subscribe to the podcast! https://globalnews.ca/roygreen/ Learn more about your ad choices. Visit megaphone.fm/adchoices
Health Canada approves the Pfizer-BioNTech COVID-19 booster vaccine that targets the BA.4 snd BA.5 strains of the Omicron Covid variant. This is for those 12 years of age and older. Guest: Dr. Isaac Bogoch. Infectious diseases specialist, Toronto General Hospital and associate professor of medicine, University of Toronto. Learn more about your ad choices. Visit megaphone.fm/adchoices
Today's podcast: Hockey Canada wobbles badly at parliamentary committee hearing. Testimony by board chair Andrea Skinner, defending HC management does not go over well. Tim Hortons, Bank of Nova Scotia and Telus have withdrawn their HC sponsorships, Hockey Quebec is withholding player registrations fees from Hockey Canada and the Ontario Hockey Federation is poised to do the same. Guest: Anthony Housefather. Liberal MP, Montreal. Member parliamentary committee investigating Hockey Canada. Described Skinner's support of Hockey Canada management team as "Trump like." Remember what the Hockey Canada scandal began with? A secret fund to pay settlements to victims of sexual abuse by players on national teams. Some $8.9 million had been paid already and in recent days the news became more concerning. Guest: Allison Forsyth. Former Olympic skier (2002), Board member at AthletesCAN (Cdn national teams athletes). Partner/COO at ITP Sport. Safe sport consulting and programming agency. She was sexually assaulted by former national ski team coach Bertrand Charest, who was eventually sentenced to 12 years in prison for sexual assaults on numerous skiers, but had his sentence reduced because he was judge "low risk" to reoffend. Health Canada approves the Pfizer-BioNTech COVID-19 booster vaccine that targets the BA.4 snd BA.5 strains of the Omicron Covid variant. This is for those 12 years of age and older. Guest: Dr. Isaac Bogoch. Infectious diseases specialist, Toronto General Hospital and associate professor of medicine, University of Toronto. Danielle Smith wins UCP leadership race and is Alberta premier-designate. Guest: Professor Duane Bratt. Political science, Mount Royal University, Calgary. Author Blue Storm: The Rise and Fall of Jason Kenney. --------------------------------------------- Host/Content Producer – Roy Green Technical/Podcast Producer – Tom McKay Podcast Co-Producer – Matt Taylor If you enjoyed the podcast, tell a friend! For more of the Roy Green Show, subscribe to the podcast! https://globalnews.ca/roygreen/ Learn more about your ad choices. Visit megaphone.fm/adchoices
This week we caught up with Dr. Elijah Dixon, a liver and pancreas surgeon at the University of Calgary, to talk about mindfulness and meditation. Dr. Dixon really opened our eyes to how those practices might help us both inside and outside the operating room. We also asked Dr. Dixon about what it was like to be the president of the Americas Hepato-Pancreatico-Biliary Association as well as the Canadian Association of General Surgeons. Links: 1. Eckhart Tolle: https://eckharttolle.com/ 2. Waking Up app: https://www.wakingup.com/ 3. One Blade of Grass: Finding the Old Road of the Heart, a Zen Memoir by Henry Shukman. https://www.amazon.ca/One-Blade-Grass-Finding-Memoir/dp/1640092625 4. Jillian Horton interview: https://soundcloud.com/cjs-podcast/e83-jillian-horton-on-writing-burnout-and-the-quest-for-a-better-culture-in-medicine 5. Stroke of Insight TED talk: https://www.ted.com/talks/jill_bolte_taylor_my_stroke_of_insight?language=en Bio (taken from https://cumming.ucalgary.ca/sites/default/files/teams/236/april-2016-newsletter.pdf): Dr. Dixon is a Professor of Surgery, Oncology and Community Health Sciences with the University of Calgary. He is a practicing General Surgeon at Foothills Hospital with a focus in Hepatobiliary/Pancreatic Surgery. Dr. Dixon completed his Undergrad in General Science and Medical School at the University of Manitoba, and then Surgical Residency at the University of Calgary. From there he went to the University of Toronto and did a Fellowship in Hepatobiliary/Pancreatic Surgery and GI Transplantation at the Toronto General Hospital. He then proceeded to the Harvard School ofPublic Health and did a Masters in Epidemiology. Dr. Dixon's research interests include the development of quality indicators of care for patients undergoing hepatic resection for metastatic colorectal cancer. He conducts clinical research, particularly in the area of hepato-pancreatico-biliary surgery.
Two of the co-authors (Dr Jameel Abdulrehman and Dr Leslie Skeith) of the recently published review and meta-analysis, "Recurrence after stopping anticoagulants in women with combined oral contraceptive-associated venous thromboembolism: A systematic review and meta-analysis" (https://doi.org/10.1111/bjh.18331) discuss the clinical relevance of the results and implications for managing risk for women who have experienced a VTE while on combined oral contraceptives. Dr. Jameel Abdulrehman is a Hematologist and clinician investigator with specialization in Thrombosis and Hemostasis at the Toronto General Hospital within the University Health Network and assistant professor at the University of Toronto. He completed medical school at the University of Alberta, Internal Medicine residency at Western University, Hematology residency at the University of Alberta, a fellowship in thrombosis and hemostasis at the University of Toronto, and a masters in clinical epidemiology at McMaster University. He is an early career investigator with research interests in clinical studies in the use anticoagulation in special populations. He is also the regular co-host of this podcast. And Dr Leslie Skeith:Dr. Leslie Skeith is a Associate Professor in the Division of Hematology & Hematological Malignancies at the University of Calgary. She completed her medical school and Hematology residency training at the University of Calgary, and completed a 2-year fellowship in Thrombosis Medicine at the University of Ottawa. Dr. Skeith's research interest is in the area of pregnancy and venous thromboembolism, as well as medical education. She is currently completing a Master of Health Professions Education (MHPE) degree at the University of Chicago at Illinois (UIC).Follow us:@thrombosiscan@leslieskeithReference:Abdulrehman J, Elbaz C,Aziz D, Parpia S, Fazelzad R, Eischer L, et al. Recurrence after stopping anticoagulants in women with combined oral contraceptive-associated venous thromboembolism: A systematic review and metaanalysis. Br J Haematol. 2022;00:1–13. https://doi.org/10.1111/bjh.18331Support the showhttps://thrombosiscanada.caTake a look at our healthcare professional and patient resources, videos and publications on thrombosis from the expert members of Thrombosis Canada
This week, please join authors John McMurray and David Cherney, editorialist Kausik Umanath, as well as Associate Editors Ian Neeland and Brendan Everett as they discuss the original research articles "Initial Decline (Dip) in Estimated Glomerular Filtration Rate After Initiation of Dapagliflozin in Patients With Heart Failure and Reduced Ejection Fraction: Insights from DAPA-HF" and "Renal and Vascular Effects of Combined SGLT2 and Angiotensin-Converting Enzyme Inhibition" and editorial ""Dip" in eGFR: Stay the Course With SGLT-2 Inhibition." Dr. Carolyn Lam: Welcome to Circulation On the Run, your weekly podcast summary and backstage pass to the Journal and its editors. We're your co-hosts, I'm Dr. Carolyn Lam, Associate Editor from the National Heart Centre and Duke National University of Singapore. Dr. Greg Hundley: I'm Dr. Greg Hundley, Associate Editor and director of the Pauley Heart Center at VCU Health in Richmond, Virginia. Dr. Carolyn Lam: Greg, it's the season of double features. Except this time, we're having a forum discussion of two related articles and an editorial that discusses both. What is it on? SGLT2 inhibitors. In the first paper, an analysis from the DAPA-HF trial, looking specifically at that initial dip in GFR that follows initiation of dapagliflozin in patients with HFrEF. Then we will discuss further, in a mechanistic way, the renal and vascular effects of combining SGLT2 inhibition on top of ACE inhibition. Lots and lots of good learning and insights, but let's go on first to the other papers in today's issue. Shall we? Dr. Greg Hundley: You bet, Carolyn, and I'm going to grab a cup of coffee. Carolyn, in this issue, wow, so many exciting original articles. In fact, there are two more articles that were going to pair together, both clinical and pertaining to TAVR procedures. In the first one, it was a group of authors led by Dr. Duk-Woo Park from the Asan Medical Center at the University of Ulsan College of Medicine. They conducted a multicenter, open-label randomized trial comparing edoxaban with dual antiplatelet therapy or DAPT, aspirin plus clopidogrel, in patients who had undergone successful TAVR and did not have an indication for anticoagulation. Now in this study, Carolyn, the primary endpoint was an incidence of leaflet thrombosis on four-dimensional computed tomography, CT, performed at six months after the TAVR procedure. Key secondary endpoints were the number and volume of new cerebral lesions on brain magnetic resonance imaging or MRI and the serial changes of neurological and neurocognitive function between six months and that time immediately post the TAVR procedure. Dr. Carolyn Lam: Oh, interesting. What did they find? Dr. Greg Hundley: Right, Carolyn. In patients without an indication for long-term anticoagulation after successful TAVR, the incidence of leaflet thrombosis was numerically lower with edoxaban than with dual antiplatelet therapy, but this was not statistically significant. The effect on new cerebral thromboembolism and neurological or neurocognitive function were also not different between the two groups. Now because the study was underpowered, the results should be considered really as hypothesis generating, but do highlight the need for further research. Dr. Greg Hundley: Carolyn, there's a second paper pertaining to transcatheter aortic valve prosthesis. It's led by a group directed by Dr. Paul Sorajja from the Minneapolis Heart Institute Foundation and Abbott Northwestern Hospital. Carolyn, these authors prospectively examined 565 patients with cardiac CT screening for HALT, or what we would define as hypoattenuating leaflet thickening, at 30 days following balloon-expandable and self-expanding TAVR. Now, deformation of the TAVR prosthesis, asymmetric prosthesis leaflet expansion, prosthesis sinus volumes, and commissural alignment were analyzed on the post-procedural CT. For descriptive purposes, an index of prosthesis deformation was calculated, with values greater than 1 representing relative midsegment underexpansion. A time-to-event model was also performed to evaluate the association of HALT with the clinical outcomes. Dr. Carolyn Lam: Oh, interesting. What did they find? Dr. Greg Hundley: Right, Carolyn. Nonuniform expansion of TAVR prosthesis resulting in frame deformation, asymmetric leaflet, and smaller neosinus volume was related to the occurrence of HALT in patients who underwent TAVR. What's the take home here, Carolyn? These data may have implications for both prosthesis valve design and deployment techniques to improve clinical outcomes in these patients. Now, Carolyn, both of these articles are accompanied by an editorial from Dr. Raj Makkar from the Smidt Heart Institute at Cedars-Sinai's Medical Center. It's a very lovely piece entitled Missing Pieces of the TAVR Subclinical Leaflet Thrombosis Puzzle. Well, how about we check what else is in this issue? My goodness, this was a packed issue. First, Carolyn, there are three letters to the editor from Professors Ennezat, Dweck, and then a response from Dr. Banovic pertaining to a follow-up from a previously published study, the AVATAR study, in evaluating valve replacement in asymptomatic aortic stenosis. There's also a Perspective piece from Dr. Wells entitled “Treatment of Chronic Hypertension in Pregnancy: Is It Time For A Change?” There's a Global Rounds piece from Professor Berwanger entitled “Cardiovascular Care in Brazil: Current Status, Challenges, and Opportunities.” Then there's also a Research Letter from Professor Eikelboom entitled “Rivaroxaban 2.5 mg Twice Daily Plus Aspirin Reduces Venous Thromboembolism in Patients With Chronic Atherosclerosis.” Dr. Carolyn Lam: There's another Research letter by Dr. Borlaug on longitudinal evolution of cardiac dysfunction in heart failure with normal natriuretic peptide levels. There's also a beautiful Cardiology News piece by Bridget Kuehn on the post-COVID return to play guidelines and how they're evolving. Well, that was a great summary of today's issue. Let's hop on to our feature forum. Shall we? Dr. Greg Hundley: You bet, Carolyn. Can't wait. Dr. Carolyn Lam: Today's feature discussion is actually a forum because we have two feature papers in today's issue. They all surround the cardiorenal interaction, should I say, of the SGLT2 inhibitors. For the first paper, discussing that initial decline or that dip in the GFR following initiation of dapagliflozin would be Dr. John McMurray, who's the corresponding author of this paper from DAPA-HF. Dr. John McMurray's from the University of Glasgow. Now next, we have also the corresponding author of another paper, really going into the mechanistic insights of the renal and vascular effects of combined SGLT2 and ACE inhibition. Dr. David Cherney is from Toronto General Hospital, University of Toronto. Dr. Carolyn Lam: We have the editorial list of these two wonderful papers, Dr. Kausik Umanath from Henry Ford Health in Michigan. Finally, our beloved associate editors, Dr. Ian Neeland from Case Western Reserve and Dr. Brendan Everett from Brigham and Women's Hospital, Harvard Medical School. Thank you, gentlemen. Now with all of that, what an exciting forum we have in front of us. Could I start by asking, of course, the respective authors to talk a little bit about your papers? I think a good place to start would be with Dr. McMurray. John, please. Dr. John McMurray: Thanks, Carolyn. I think our paper had three key messages. The early dip in eGFR that we saw was, on average, very small in patients with heart failure, about 3 mLs/min or about 5%. Very few patients had a large reduction in the eGFR. It was around 3%. Dapagliflozin-treated patients had a 30% or greater decline compared to about 1% of placebo patients. Finally, very few of those patients had a decline in the eGFR below a critical threshold, which for cardiologists might be around 20 mLs/min. We saw that in only five patients; that's 0.2% of the dapagliflozin-treated patients. Second message was that that early decline partially reverses. The nadir in our study was about 14 days. But by 60 days, on average, eGFR had increased again. Hold your nerve if you see an early decline in eGFR. Dr. John McMurray: Maybe the most important message was that that decline in the eGFR is not associated with worse cardiovascular or renal outcomes. In fact, if anything, the opposite. If you look at the patients in the dapagliflozin group with a 10% or greater decline in eGFR, then compare it to patients who didn't have that decline, these individuals were about 27% less likely to experience the primary composite outcome of worsening heart failure and cardiovascular death. If you look at the placebo group, we saw exactly the opposite. Amongst those who had a greater than 10% decline in eGFR compared to those who didn't, those people with the early decline in eGFR were 45% more likely to experience the primary composite endpoint. The same is true for other cardiovascular outcomes for worsening kidney function. In the dapagliflozin group, decline in eGFR was not associated with more adverse events, not associated with more treatment discontinuation. That small decline in the eGFR is not a bad prognostic sign. If anything, it might be the opposite. Dr. Carolyn Lam: Thank you so much. That was really clear. David, are you going to tell us why this decline occurs? Dr. David Cherney: Yeah. Perhaps the paper that we published gives some insights into the mechanisms that are responsible for some of those changes in GFR that are thought to be acute hemodynamic effects. In the between trial, which is the trial that we published examining the effect of ACE inhibition followed by SGLT2 inhibition in patients with type 1 diabetes, we also saw that there was an expected effect of adding SGLT2 inhibition on top of an ACE inhibitor in people with uncomplicated type 1 diabetes. This acute dip in GFR was seen in this cohort of patients. We included only 30 patients in this small mechanistic study. At the same time, along with that dip in GFR, we also saw an increase in measures of proximal natriuresis. That proximal sodium loss is linked with changes in sodium handling in the kidney, which then causes changes in both probably afferent and efferent tone, which causes this dip in GFR primarily through natriuresis in this phenomenon called tubuloglomerular feedback. That was one major observation that gives insight into what we see in larger trials around the dip in GFR. Dr. David Cherney: In our mechanistic study, we also saw an additive effect on blood pressure. Blood pressure went down further with the addition of empagliflozin on top of an ACE inhibitor. In terms of the mechanisms that are responsible for the reduction in blood pressure, natriuresis certainly may be in part responsible, but we also saw a novel observation whereby there was a reduction in peripheral vascular resistance using noninvasive measures. There are likely several mechanisms that are responsible for the reduction in blood pressure. Then finally, we also saw reductions in markers of oxidative stress, which may also account for some of the effects that we see in blood pressure, as well as potentially some of the anti-inflammatory and anti-fibrotic effects that we see at least in experimental models that may have some clinical translatability to humans as well around the clinical benefits. I think the blood pressure, the renal hemodynamic effects, and some of the neurohormonal mechanisms are the major observations that we saw that may in part explain some of the really nice changes that were seen in Dr. McMurray's study. Dr. Carolyn Lam: Right. Thanks, David. But these were patients with type 1 diabetes and no heart failure. John, do you have any reflections or questions about how that may apply? By the way, what a beautiful study. Thank you, David. Dr. David Cherney: Pleasure. Thank you. Dr. John McMurray: Yes, David. I really enjoyed your study. In fact, I think, Carolyn, it does shed some insights perhaps to what's going on. As David pointed out, the reduction in peripheral arterial resistance, reduction in blood pressure, that may play some role in that early dip in eGFR as well as autoregulation in the kidney. Then the other interesting thing is that the distal nephron seems to adapt to that effect in the proximal tubule. Again, that may account for some of that recovery in eGFR, that reversal in the early dip that I spoke about, and which I think is very clinically important because, of course, physicians should make sure that they recheck eGFR if they see that early dip. Because they may find that few weeks later that that dip is much smaller and of much less concern. Dr. Carolyn Lam: Thank you, John. In fact, you're saying, stay the course, right- Dr. John McMurray: I have. Dr. Carolyn Lam: ... with the SGLT2 inhibitors. I'm actually stealing the words of the title of the editorial, a beautiful editorial by Kausik. I love that. Stay the course. Kausik, please, could you frame both papers and then with an important clinical take home message for our audience? Dr. Kausik Umanath: Sure. I think the analysis by John and his group was really relevant with the large sample size. What's impressive? Similar to a lot of these other SGLT2 studies that have come out, both in heart failure and in kidney disease progression and so on, it's remarkable how the other analysis, like the analysis of EMPA-REG and CREDENCE and so on, of similar dips. All show more or less the same magnitude, the same relative proportions of this GFR trajectory. I think the mechanistic study only highlights that though it's working with a slightly different population of type 1 patients and much earlier in their course in terms of where their GFRs are. Dr. Kausik Umanath: The other piece is that ultimately we need to understand this dip and know to monitor for it and so on. But I think the general clinician should really understand that a dip of greater than 10% really occurs in less than half the population that takes these agents. That dip, if it occurs, certainly doesn't do any harm. That said, if they see a bigger dip in the 30% range, monitor more closely and consider making sure that there aren't any other renal issues out there for that patient because they are a much smaller proportion of patients in these large trials that generate that level of dip. They should be monitored. Dr. Kausik Umanath: The other thought that we had, and thinking through this in a practical sense, is because you expect this dip, many of our cardiologists or even the nephrologists when we titrate these drugs, they're on a suite of other drugs. It's probably best to not adjust their Lasix or their loop diuretic, or their RAAS inhibitor at the same time as you're adjusting the SGLT2 inhibitor or starting it because then you may just introduce more noise into the GFR changes that you see over the next several weeks. It may be a sequential piece or at least holding those other agents constant while this gets titrated and introduced is a prudent course of action, so you don't misattribute changes. Dr. Carolyn Lam: Thanks so much. What clinically relevant points. In fact, that point about the diuretic especially applies in our heart failure world. You see the dip. Well, first, make sure the patient's not overdiuresed. Remember, there's more that the patient's taking. Thank you. That was a really great point. Brendan and Ian, I have to get you guys to share your views and questions right now. But before that, can I take a pause with you and just say, aren't you just so proud to be AEs of Circulation when we see papers like these and we just realize how incredible the data are and the clinical implications are? I just really had to say that. All right. But with that, please, what are your thoughts, Brendan? Dr. Brendan Everett: Yeah, sure. Thank you, Carolyn. Hats off to all three of our authors today for doing some amazing science. Thank you for sending it to Circulation. I think, in particular, I handled David's paper. I'm not a nephrologist and I'm probably the furthest thing from a nephrologist. Had to do my best to try and understand these concepts that I'm not sure I ever even was exposed to in medical school many years ago. I think it shows the breadth of the interest in our readership. The fact that these changes in eGFR have become a primary focus for our cardiovascular patients and that the clinical implications are really important. I guess my question, David, is... In your paper, you talked a little bit about this hypothesis of hyperfiltration and the role that hyperfiltration plays in setting patients with diabetes up for kidney disease. Is that playing a role in John's observation or not? Again, as a non-nephrologist, I have trouble connecting the dots in terms of that hypothesis and John's observation of the clinical benefit for patients that have a reduction in eGFR as opposed to no change. Dr. David Cherney: Yeah. It's a great question. It's very difficult to know with certainty in a human cohort because we can't measure the critical parameter, which is intraglomerular pressure, which we think these changes in GFR are a surrogate for. But if we go along with that train of thought, along reductions in glomerular hypertension, it very much makes sense that the patients who dip are those who have the... They're taking their medication, number one. Number two, they respond physiologically in the way that you expect them to, which is that their GFR dips at least transiently and then goes back up again through some of the compensatory mechanisms that John mentioned earlier. As was mentioned not only in this paper, but also in previous analyses from CREDENCE and previous analyses from VERTIS CV and others have shown that indeed that dip in GFR is linked with longer term renal benefits, at least. That is reflected in a reduction in the loss of kidney function over time. Dr. David Cherney: The patients who are on an SGLT2 inhibitor and those who dip by around 10% or less, those patients tend to do the best over time in terms of preserving GFR, not losing kidney function compared to patients who are on an SGLT2 inhibitor but do not dip, or those patients who actually have an increase in GFR. That is consistent with this idea that there may be a reduction in glomerular pressure, which is protective over the long term. That ties back into your question around hyperfiltration that this may indeed be due to a reduction in glomerular pressure, which is linked with risk over the long term. Dr. Carolyn Lam: Ian? Dr. Ian Neeland: I wanted to echo Brendan's comments about the excellent science. When I read these papers, it really speaks to the existential struggle that cardiologists have between kidney function and these medications that we know have cardiovascular benefits. How do we manage that practically? It's so clinically relevant, both the observation that John's paper made about the dip in the DAPA-HF trial as well as, David, your mechanistic insights. Dr. Ian Neeland: I wanted to ask John potentially about the most fascinating aspect to me of this paper was that patients with a dip of 10% or more actually ended up doing better in terms of cardiovascular outcomes, specifically hospital heart failure and hospitalizations than people on placebo with a greater than 10% dip. It speaks to the fact that... Is the physiology going on here different between those individuals whose GFR went down on placebo versus those who are on SGLT2 inhibitors? All the mechanistic insight that David's paper had in terms of blood pressure and intraglomerular pressure, how does that feedback and speak to why heart failure is strongly linked to this mechanism? We see this not just with SGLT2 inhibitors, but there are other medications now coming out showing that there's a relationship between this dip in GFR and heart failure. Can you speak to why this heart failure-kidney connection is so important and becoming greater and greater in terms of our understanding? Dr. John McMurray: Well, thank you for asking me the hardest question and one that I truly don't think I have a good answer to. I think it's obvious to all of us that the kidney is central in heart failure and perhaps cardiologists have neglected that fact, focusing more on the other organ. But by definition, almost the fluid retention that characterizes heart failure in terms of signs, and probably is the primary cause of symptoms, that clearly is a renally-mediated phenomenon. The kidney must be central to all of this. I think David right. I think the decline in eGFR that you see with this drug is simply a marker that the drug is having its physiological effect or effects. Whatever those are, they're beneficial. Clearly, patients who have an eGFR decline on placebo are different and they reflect, again, the patients that we see all the time. As our patients with heart failure deteriorate, one of the things that we commonly see, in fact becomes one of the biggest problems that we have to deal with, is that their kidney function declines. As their symptoms get worse, as their cardiac function gets worse, their kidney function also declines. Dr. John McMurray: I think you're seeing two contrasting effects here. One is the background change in eGFR, which is the placebo patients, and we've always known that that's a bad thing. Then we're seeing that early within 14 days marker of the pharmacological or physiological action of the drug. I hope you don't ask me how SGLT2 inhibitors work in heart failure. That's the other most difficult question I can think of, but I think this is just a marker of the fact that they are working. Dr. David Cherney: Yeah. Just to add to that briefly, there is this difficulty in sorting out the mechanisms that are relevant around the acute effects in the kidney that the dip in GFR reflects natriuresis that could keep patients out of heart failure; that the reduction in glomerular pressure reduces albuminuria. Albuminuria reduction is linked with kidney protection. It's linked with heart failure and ASCVD protection. Then there's also this concept of if you dip and then you stay stable afterwards, your GFR stays stable afterwards, those patients with stable kidney function that's not declining, the dippers in other words, those patients are probably able to maintain salt and water homeostasis better than someone who's declining more rapidly. All these things probably tie together in order to reflect, of course, there's a renal protective effect, but that some of those mechanisms may also tie into the heart failure mechanisms that John was mentioning. Dr. John McMurray: But, David, it's hard to imagine if we don't protect the kidney, we won't protect patients with heart failure given how fundamental, as I said, the kidney is, and how fundamentally important worsening kidney function is. Not only because it is a marker of things going badly, but also because it often results in discontinuation or reduction in dose of other life-saving treatments. To Kausik's point, it was very important about the risk of changing background life-saving disease modifying therapy. Actually, we didn't see that in DAPA-HF, which was very intriguing. There was no reduction in use of renin-angiotensin system blockers or mineralocorticoid receptor antagonists. Dr. Carolyn Lam: Thank you so much, gentlemen. Unfortunately, we are running out of time, but I would really like to ask one last question to the guests, if possible. Where do you think the field is heading? What next? What's the next most important thing we need to know? David, do you want to start? Then John, then Kausik. Dr. David Cherney: I think one of the aspects that we need to know in the future is where else can we extend these therapies into novel indications and extend the boundaries of where we currently work with these therapies. People with type 1 diabetes, for example, with either heart failure or with significant kidney disease, patients with kidney transplantation, is there a renal or cardiovascular protective effect? Then another high risk cohorts who have not been included in trials, those on immunosuppressants, for example, who were excluded from the trials. I think those are some of the areas that we need to extend into now that we understand how these therapies work in even very sick patients and that we also know that they likely have at least some benefit through suppressing inflammation, and possibly reducing infectious risks. That would provide a rationale for extending into some of these new areas. I think that's certainly, hopefully on the horizon for us. Dr. Carolyn Lam: John? Dr. John McMurray: Carolyn, obviously I think looking at post myocardial infarction population, that's an obvious place to go. There are a couple of trials there. I suppose the trial that I would love to see, and which I think would address the core question that we've been discussing today, which is: Is this all about the effect in the kidney and how important is the diuretic and natriuretic action of these drugs in heart failure? I think the key study that would address this would be doing a study in patients on dialysis. Because in those patients we could, I think, separate the issue of natriuresis, diuresis, and maybe even the dip in EGR that we've been talking about. If these drugs prove to be effective in end-stage kidney disease, patients on dialysis, that would be really fascinating. Dr. Carolyn Lam: Kausik? Dr. Kausik Umanath: That is a very interesting point. I don't know that we know necessarily outcomes, but I think from working with the DAPA-CKD, we do have a little bit of the safety data because we did continue it. I was the US MLI for that study and we did continue the SGLT2 passed into renal failure. There is a little bit of safety data there. But I don't think once you've declared an outcome, you're not collecting outcomes data after that point. That's a very interesting area to look into. Dr. Kausik Umanath: I also think the other place where this field's heading is trying to better tier and layer the multitude of agents. I think we've been waiting for about 20 to 30 years, at least in the kidney field, for something new to affect the progression of kidney disease after the ACE/ARB trials and so on. This one we've got SGLT2 inhibitors. We've got the new MRA, finerenone, and so on, which also have very beneficial cardiovascular effects. The question becomes: How do we layer these therapies? Which sequence to go in? Some of the others that are in pipeline as well that are out there that have very beneficial cardiovascular effects that may indeed also help kidney function and diabetes control, which do you go with first and so on? Dr. Carolyn Lam: Wow! Thank you so much. We really could go on forever on this topic, but it has been tremendous. Thank you once again. On behalf of Brendan, Ian, Greg, thank you so much for joining us today in the audience. You've been listening to Circulation On the Run. Don't forget to tune in again next week. Dr. Greg Hundley: This program is copyright of the American Heart Association 2022. The opinions expressed by speakers in this podcast are their own and not necessarily those of the editors or of the American Heart Association. For more, please visit ahajournals.org.
In a recent paper, researchers at the Toronto General Hospital described how they were able to effectively change the blood type in donor lungs. They changed it from type A to type O, often described as the 'universal donor' blood type. Dr. Seema Marwaha tells us more.
Aileen Burford-Mason, Ph.D., is a biochemist, immunologist, and cell biologist and a widely recognized expert in the field of vitamins and their appropriate use in health maintenance, healthy aging, and the prevention and treatment of disease. Respected for her balanced and scientifically-based approach, Aileen is known for her ability to take the latest findings in diet and supplement research and translate them into practical evidence-based guidelines for both lay audiences and health professionals. Aileen graduated from University College, Dublin, Ireland, and received a Ph.D. in immunology in the UK. She is formerly an Assistant Professor in the Department of Pathology Faculty of Medicine, University of Toronto, and Director of a Cancer Research Laboratory at the Toronto General Hospital. Her many research papers have been published in leading medical and scientific journals and cover such diverse medical and scientific areas as immunology, pathology, gastroenterology, cancer, AIDS, microbiology, and nutrition. Aileen regularly gives talks to the public and to doctors and other health professionals at universities across Canada. She has a busy private practice where she specializes in personalized supplements and diet regimes. She teaches a popular continuing medical education course for medical doctors and other health care practitioners on the use of diet and nutritional supplements in clinical practice. A go-to person for radio, TV, and print journalists, Aileen is in regular demand for media commentary on the latest research and controversies in the field of dietary supplements. In this episode: What is orthomolecular medicine? We discuss sugar, carbs, and refined carbs and the roles they play in our health Aileen and Vera talk about Food Addiction Obstacles Aileen has faced And so much more! Follow Aileen: Website: https://aileenburfordmason.ca/ Twitter: https://twitter.com/AburfordMason Books: The Healthy Brain The War Against Viruses Eat Well, Age Better ANNOUNCEMENTS: You can still join us in Bristol, UK starting on Friday, May 20th for the International Food Addiction Conference. Stay for the weekend and enjoy the Public Health Collaboration Conference on May 21st and 22nd. Speakers on Friday include Dr. Paul Earley (Episode 29), Bitten Jonsson (Episodes 5 & 23) Dr. Jen Unwin (Episode 11), Clarissa, and myself, along with many colleagues! The PHC weekend includes Zoe Harcombe, Dr. David Unwin, Nina Teischolz, and so many more. BUY TICKETS HERE. The content of our show is educational only. It does not supplement or supersede the professional relationship and direction of your healthcare provider. Always seek the advice of your physician or other qualified mental health providers with any questions you may have regarding a medical condition, substance use disorder, or mental health concern.
Nicole is the President and Founder of Whiteboard Consulting and has been leading large-scale leadership training initiatives with Whiteboard since its inception. Nicole's formal education includes an honors BA from the University of Toronto and an MBA from Wilfrid Laurier University. She is also certified as a Coach and as a practitioner in Meyers-Briggs Type Indicator assessments and training, Method Time Motion studies, and Appreciative Inquiry. She is the creator, designer, and lead facilitator of The Limitless LeaderTM program that creates leaders and teams that feel limitless to create and innovate paired with accountability and grace. Nicole has been designing and delivering online and in-person delivering human skills content for the last 10 years and is a top-rated facilitator for her engagement and passionate approach to delivery. Whiteboard's clientele includes: IMAX, Volkswagon, Mitsubishi, Hain-Celestial, Toronto Hydro, Toronto General Hospital, Canada Council for the Arts, WSIB, The Ontario Public Sector, The University of Toronto, Georgian College, and Humber College. Nicole is a retired fitness instructor who dances on her Peloton, a cottage-country lover, a vegan cook, and can out-karaoke almost anyone.IG: @whiteboardconsult###Your hosts of Are You Waiting for Permission? are Meridith Grundei and Joseph Bennett. They're friends, co-hosts, actors, improvisers and coaches. She lives in NYC and coaches actors, business professionals and presenters to fully engage with their audience, and themselves. She also mentors young actors and directors. He lives in San Miguel de Allende, México and coaches artists and other creative beings about the beautiful business of art — and life. You can find Meridith:Meridith Grundei the performer artist gal Meridith Grundei CoachingYou can find Joseph:Joseph Bennett the artist/coach extraordinaire*Special thanks to Amy Shelley and Gary Grundei of high fiction for letting us use their music for the Are You Waiting for Permission? podcast.And... while the podcast is free, it's not cheap. We'd be thrilled to have your support on PATREONThank you.
There are many options for the treatment for aortic valve disease. Tune in to hear Professor Pieter Kappetein, Chief Medical Officer and Vice President of Cardiac Surgery at Medtronic, Dr. Joseph Bavaria from the Hospital of the University of Pennsylvania, Dr. Bob Kiaii from UC Davis Medical Center and Dr. Maral Ouzounian from the Toronto General Hospital as they discuss the lifetime management of surgical aortic valve replacement patients.
There are many options for the treatment for aortic valve disease. Tune in to hear Professor Pieter Kappetein, Chief Medical Officer and Vice President of Cardiac Surgery at Medtronic, Dr. Joseph Bavaria from the Hospital of the University of Pennsylvania, Dr. Bob Kiaii from UC Davis Medical Center and Dr. Maral Ouzounian from the Toronto General Hospital as they discuss the lifetime management of surgical aortic valve replacement patients.
There are many options for the treatment for aortic valve disease. Tune in to hear Professor Pieter Kappetein, Chief Medical Officer and Vice President of Cardiac Surgery at Medtronic, Dr. Joseph Bavaria from the Hospital of the University of Pennsylvania, Dr. Bob Kiaii from UC Davis Medical Center and Dr. Maral Ouzounian from the Toronto General Hospital as they discuss the lifetime management of surgical aortic valve replacement patients.
In this episode, Dr. Gary Sherman is host to Interventional cardiologist and Critical Care Specialist, Dr. Sanjog Kalra. Dr. Kalra was born and raised in Canada, to parents of India origin. Following graduate studies at the University of Toronto in Clinical Pharmacology, Dr. Kalra completed his (MD) training at the University of Calgary. He returned to the University of Toronto in 2008 for Internal Medicine training before moving to Halifax for his Adult Cardiology Fellowship at Dalhousie University and finally, back to Toronto for Advanced Cardiac Catheterization and Intervention at St. Michael's Hospital. In 2015, Dr. Kalra moved to New York, to train under worldwide leaders in the field, as the first Complex, High-Risk (and Indicated) Patient (CHIP) fellow at Columbia University Medical Center. During his CHIP fellowship, Dr. Kalra gained expertise in complex and high-risk coronary interventions, chronic total occlusion percutaneous Cardiac Intervention, contemporary hemodynamic support implantation and management, and cardiac critical care.Dr. Kalra recently completed his tenure as the Director of Complex Coronary Therapeutics and the Associate Director, of the Interventional Cardiology Fellowship Program at Einstein Medical Center in Philadelphia, Pennsylvania. He has now returned to Canada to take up a position at the world-recognized Toronto General Hospital, where he is focused on helping to build a gold-standard complex Percutaneous Cardiac Intervention program. He is recognized nationally and internationally as an expert in the area of complex coronary revascularization, modern hemodynamic support therapies, and in the management of shock and critically ill heart patients. Dr. Kalra is married with 2 young children. He and his family remain closely connected to their roots in India and return frequently.
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