Cmaj Podcasts

Send us a textOn this episode, Dr. Greg Hundemar, co-author of the practice paper in CMAJ “Screening for primary aldosteronism in primary care” discusses primary aldosteronism, its implications and the need to expand screening guidelines. Primary aldosteronism, also known as primary hyperaldosteronism or Conn's syndrome, is an endocrine disorder where the adrenal glands secrete too much aldosterone, leading to hypertension. This condition was once thought to be a rare cause of hypertension, but recent research shows that it may account for 10-20% of cases.Classic symptoms of primary aldosteronism include hypertension, low potassium, and metabolic alkalosis. Patients with this condition are at a disproportionately high risk for cardiovascular disease, rapid decline in kidney function, and higher mortality, independent of blood pressure. Early diagnosis and targeted treatments can significantly improve outcomes.Dr. Hundemar stresses the importance of screening more people with hypertension for primary aldo

Send us a textAllopurinol hypersensitivity syndrome (AHS) affects approximately 1 in 1,000 patients prescribed allopurinol, with reported mortality rates between 20% and 25%. The risk of AHS is nearly 100 times higher in carriers of the HLA-B*58:01 allele than in noncarriers. Populations with a high allele frequency include Han Chinese (6%-8%), Korean (12%), and Thai (6%-8%) people.In this episode, Drs. Wid Yaseen and Jonathan Zipursky discuss their paper published in CMAJ, titled "Five things to know about…allopurinol hypersensitivity syndrome". Dr. Jonathan Zipursky is a general internist, clinical pharmacologist, and clinician scientist at Sunnybrook Health Sciences Centre. Dr. Yaseen is a second-year internal medicine resident physician at the University of Toronto. They argue that the syndrome's frequency is often underestimated and emphasize the importance of genetic testing in susceptible populations.Next, Dr. David Juurlink broadens the discussion beyond allopurinol to describe other co

Send us a textFragility fractures are a major health concern for older adults and can result in disability, admission to hospital and long-term care, and reduced quality of life. The Canadian Task Force on Preventive Health Care guideline published in CMAJ provides evidence-based recommendations on screening for primary prevention of fragility fractures.In this special episode of the CMAJ podcast, CMAJ editor-in-chief Dr. Kirsten Patrick speaks to Dr. Roland Grad, a family physician and an author of the new guideline, about the evidence reviews conducted by the task force, the main points of the new guideline, and how family doctors can use it in practice. The guideline recommends screening females over 65 using the FRAX tool without bone mineral density (BMD) as a risk assessment first strategy. Dr. Grad emphasizes the importance of shared decision making, which can be facilitated using the Fragility Fracture Decision Aid, which incorporates the FRAX tool. This online, interactive tool helps  guide discussio

Send us a textAn estimated 23%-45% of patients undergoing major surgery have anemia, with the most common causes being iron deficiency anemia and anemia of inflammation or chronic disease.In this episode, Drs. Mojola Omole and Blair Bigham speak with Dr. Clarissa Skorupski and Dr. Yulia Lin, two authors of the practice paper in CMAJ, "Five things to know about preoperative anemia in major elective surgery." Dr. Skorupski is a third-year internal medicine resident at the University of Toronto, and Dr. Yulia Lin is the division head of transfusion medicine and tissue bank at Sunnybrook Health Sciences in Toronto. They highlight the high prevalence of preoperative anemia, its adverse outcomes, and the importance of targeting a preoperative hemoglobin level of 130 g/L for both sexes.Next, Drs. Bigham and Omole take a critical look at the WHO guideline which sets a lower hemoglobin threshold of 120 g/L for female bodies. They speak with Dr. Michelle Sholzberg, the head of hematology-oncology and the dire

Send us a textMany patients report their symptoms of endometriosis are often dismissed by healthcare providers as “normal” dysmenorrhea. This worldwide trend results in delays to diagnosis that are estimated to range from 6 to 11 years from symptom onset. On this episode, Drs. Bigham and Omole speak with Dr. Catharine Allaire, a clinical professor at UBC's Department of Obstetrics and Gynaecology and co-author of the review in CMAJ entitled “Diagnosis and management of endometriosis”. Dr. Allaire discusses the challenges and delays in diagnosing endometriosis, its symptoms and causes, and the different varieties of the condition. She also explains the role of imaging in diagnosing endometriosis and how it can be managed through various treatment options from hormone therapies to surgery.Drs. Bigham and Omole also speak with Hannah Robinson, an emergency department nurse who has struggled with endometriosis for seven years. She describes the challenges she faced receiving a diagnosis and accessing care.Jo

Send us a textClinicians may find diagnosing polyneuropathy challenging due to the vague and insidious onset of symptoms. Identifying signs consistent with polyneuropathy and determining which investigations to conduct and when to be concerned can be daunting.Polyneuropathy involves simultaneous dysfunction of multiple peripheral nerves, with the most common form being distal symmetric polyneuropathy. Symptoms primarily occur distally, mainly at the bottom of the feet, and progress proximally. Sensory symptoms are more frequent than motor symptoms and signs. Patients with distal symmetric polyneuropathy may experience neuropathic pain, impairments in walking, and distal motor function, significantly impacting their quality of life.Dr. Ario Mirian, a fifth-year neurology resident at the University of Western Ontario's Schulich School of Medicine and Dentistry, is the lead author of a review article in CMAJ entitled "Diagnosis and management of patients with polyneuropathy". In this episode, Dr.

Send us a textThe use of electric scooters (e-scooters) has witnessed a substantial surge globally.However, the presence of these motorized vehicles on sidewalks poses a significant risk to pedestrians. A recent practice paper published in CMAJ describes the case of a 68-year-old woman who suffered serious injuries while walking on a city sidewalk after being hit by an e-scooter traveling at approximately 30 km/h. While the authors of the paper recognize e-scooters as a popular, efficient and green form of transportation, they argue effective policies are needed to mitigate risks associated with their use. On this episode, Drs. Blair Bigham and Mojola Omole speak with Zach Williams, the director of policy and government partnerships and Jamie Perkins the director of communications for  Superpedestrian. Superpedestrian is an e-scooter company that spun off from the MIT Sensible City Lab. They discuss the necessary changes to urban infrastructure as well as the responsibilities of e-scooter providers to ensure

Send us a textUptake of the SARS-CoV-2 vaccine for children aged 5–11 years has been lower than anticipated in Canada. Although research has explored parental intentions toward SARS-CoV-2 vaccination for children, the drivers of parents’ decisions to seek vaccination for their children - or not -  have not been studied in-depth. A research paper published in CMAJ,  entitled Parents’ perspectives on SARS-CoV-2 vaccinations for children: a qualitative analysis, sought to explore parents’ decision-making. It was a collaboration between physicians, social scientists and research scientists. On this episode, four of the paper’s authors discuss their findings with hosts, Drs. Omole and Bigham. They emphasize the importance of existing trusting relationships between parents and their primary care providers when it comes to making difficult healthcare decisions for children.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

Send us a textEarly 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 host

Send us a textMigraine is a common condition that affects around 12% of adults, with a higher prevalence in women (18%) than men (6%). Global burden of disease estimates in 2019 found migraine to be the leading cause of disability in women aged 15-49 years and the second leading cause of disability overall. On this episode, Drs. Mojole and Bigham interview three authors of two review articles on the topic published in CMAJ, which focus on diagnosis, acute treatment and prevention of migraine.  Dr. Velina Tzankova is a neurology resident at the University of Toronto; Dr. Werner Becker is a neurologist and the founding director of the Calgary Headache Assessment and Management Program, and currently professor emeritus in the Department of Clinical Neurosciences at the University of Calgary; and Dr. Tommy Chan is a neurologist and director of John H. Kreeft Headache Clinic at University Hospital in London, Ontario. As well, Drs. Bigham and Omole interview two women who have battled severe migraine since childhoo

Send us a textDiagnosing long COVID, or post-acute sequelae of SARS-CoV-2 infection (PASC), is challenging for clinicians. With up to 200 possible symptoms, heterogeneous presentations and no definitive diagnostic test, the diagnosis is a clinical one.In this episode, Dr. Kieran Quinn, a general internist and palliative care physician at Mount Sinai and Bridgepoint Hospitals in Toronto, emphasizes the importance of judicious diagnostic testing in patients with suspected long COVID. Dr. Quinn, who is co-author on three “Five Things to Know…” articles published in CMAJ that cover diagnosing, assessing and treating long COVID, suggests that limited routine blood work and, occasionally, an echocardiogram or pulmonary function test may be sufficient to make the diagnosis without the need for extensive testing and consultations.The episode also features the personal experience of Suzie Goulding, the founder of COVID Long Haulers Canada, a support group for people struggling with long COVID, who shares her journey w

Send us a textOn this special episode, Drs. Blair Bigham and Mojola Omole interview CMAJ editor-in-chief, Dr. Kirsten Patrick, and executive editor, Dr. James Maskalyk. They talk about the journal's accomplishments over the past year and some of the challenges related to its increased focus on social determinants of health and equity.In the year ahead, Drs. Patrick and Maskalyk say the journal will focus on exploring topics related to access to care, and particularly encourage the submission of articles that discuss bold solutions that can bring about wide-reaching systemic change.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

Send us a textA popular theory to explain the crisis in primary care in Canada is that newly graduating physicians simply do not see as many patients as previous generations. But recently published research has thoroughly debunked that myth. David Rudoler is the lead author of research published in CMAJ entitled Changes over time in patient visits and continuity of care among graduating cohorts of family physicians in 4 Canadian provinces that looked at the number of patient contacts for physicians at all career stages. He and his co-authors found no generational differences in family physician practice.On this episode, David Rudoler, who is an assistant professor in the faculty of health sciences at Ontario Tech University, tells Drs. Bigham and Omole that, while his research disproves the ‘lazy millennial physician’ trope, it does show that the number of patient contacts has declined for all primary care physicians over the years.Dr. Tara Kiran,  Fidani Chair in Improvement and Innovation at the University

Send us a textAn “old wives’ tale” has persisted in the treatment of anterior epistaxis. A practice article in CMAJ entitled, "Five things to know about anterior epistaxis" discusses what many are doing wrong and the proper way to treat anterior epistaxis. On this episode, co-author and rhinologist Dr. Leigh Sowerby elaborates on the causes and the full suite of options for treating this common cause for emergency department visits.Next, Drs. Bigham and Omole speak with Dr. Michelle Sholzberg, a hematologist and medical director of the coagulation laboratory at St. Michael's Hospital about how to determine if a patient may have a  bleeding disorder and needs investigation. Dr. Sholzberg discusses the usefulness of the INR and PTT and then goes on to call out structural sexism in hematology, and in the diagnosis of bleeding disorders, in particular. "Five things to know about anterior epistaxis"CMAJJoin us as we explore medical solutions that address the urgent need to change healthcar

Send us a textA practice article in CMAJ presents 8 images of monkeypox mucocutaneous lesions presenting in Canadian patients from May to July 2022.  The images show a spectrum of common lesions seen in patients with human monkeypox during the 2022 outbreak in non-endemic countries. On this episode, Dr. Sharon Sukhdeo and Dr. Darrell Tan, two co-authors of the article discuss their intention that the image atlas be a necessary corrective to the proliferation of images from endemic countries seen early in the outbreak that primarily featured Black patients, often children. Host Dr. Mojola Omole speaks with these guests about the current epidemiology of human monkeypox in Canada, lessons learned from the 2022 outbreak, the importance of accurately describing who is at risk, and how generating awareness of monkeypox transmission in communities at risk may have slowed its spread.Dr. Sukhdeo is an infectious disease fellow at the University of Toronto, and Dr. Darrell Tan is an infectious disease physician at St.

Send us a textArtificial intelligence, such as computer-aided detection and computer-aided diagnosis or differentiation uses complex algorithms to identify and characterize polyps in situ during screening for colorectal cancer.  Emergent evidence suggests that the performance of AI models is superior to current standards of practice.On this episode, Drs Bigham and Omole speak with Dr. Michael Byrne, co-author of a practice paper in CMAJ entitled Artificial intelligence in colorectal cancer screening. He argues that while artificial intelligence will not replace physicians, physicians who use AI will eventually replace physicians who don’t.Next they speak with Zayna Khayat, a future strategist and Vice President of Growth & Client Success at digital health solutions firm, Teladoc Health. She's also adjunct faculty at the Rotman School of Business. Zayna says that AI’s biggest impact on medicine will come from reducing costs and increasing the number of patients that can be guided through the system.Jo

Send us a textEfforts to combat anti-Black racism in Canadian healthcare are underway but much remains to be done to dismantle the ideas, systems and implicit biases that underpin this specific form of discrimination.On this special one-hour episode, Drs Omole and Bigham explore the history of anti-Black racism in Canada’s medical schools, in particular at Queen’s University, where a ban on Black students was only formally lifted in 2018.They also explore solutions, including the development of a curriculum at Queen’s aimed at addressing anti-Black racism. Drs. Omole and Bigham speak with Dr. Sabreena Lawal, a co-author of a paper in CMAJ entitled: Anti-Black racism and medical education: a curricular framework for acknowledging and learning from past mistakes.They then explore the broad set of challenges still facing medicine in Canada and the efforts still needed to address anti-Black racism, with two Black physician leaders, Dr. Onye Nnorom and Dr. Kannin Osei-Tutu.Dr. Osei-Tutu is an acute-care hospitalis

Send us a textBlack and immigrant populations are disproportionately underrepresented in regular screening for cancer. Race-based data from Canada are minimally-available, but research from the United States and Europe has shown that the lifetime risk of developing prostate cancer is much higher among Black people compared to white people and Black people who do get the disease tend to have more aggressive tumors and to present at a later stage.On this episode, Drs Omole and Bigham speak with Kikachukwu Otiono, lead author of an analysis in CMAJ titled, Prostate cancer screening in Black men in Canada: a case for risk-stratified care.  Ms. Otiono is a final-year medical student at McMaster University in Hamilton. She argues that Black patients should be understood to be at a potentially higher risk for developing prostate cancer and physicians should screen them earlier than guidelines currently recommend, based on evidence from other jurisdictions.They also speak with Dr. Doreen Ezeife, the author of another

Send us a textSeveral hospitals are known for providing particularly excellent care to people experiencing a sickle cell crisis.  For example, the ER at UHN meets a key recommendation from the 2017 Ontario Clinical Handbook that patients receive analgesia within  30 minutes of triage. The handbook also recommends that centres support patients’ individual coping strategies through ready access to food, phone chargers and blankets.Many ERs are not meeting this standard. A general lack of awareness about sickle cell disease among physicians, misplaced suspicion about drug-seeking and other biases lead to lengthy delays in patients receiving treatment.On today’s episode, Drs Bigham and Omole speak with Dr. Jennifer Bryan, a founding member of the UHN Emergency Department Sickle Cell Working Group, an emergency physician at UHN and the co-chair of the 2022 Sickle Cell Summit being organized by the Sickle Cell Awareness Group in Ontario.They also speak with Lance Archer, a patient and sickle cell disease advocate a

Send us a textHereditary angioedema (HAE) is a rare autosomal dominant disorder characterized by recurrent episodes of painful swelling without urticaria that leads to substantial morbidity and even mortality if left untreated.On this episode, Dr. Victoria Cook, an immunologist working in Victoria, BC, describes the case of a woman who had 6 emergency department presentations, 1 hospital admission and saw 5 different specialists over 11 months before finally being diagnosed with HAE.Drs. Bigham and Omole, then speak with Dr. Ed Etchells about how physicians can work to strip away biases and cognitive obstacles that can prevent timely diagnoses of rare and challenging conditions. Dr. Etchells works in the division of General Internal Medicine at Women's College Hospital in the University of Toronto.Article discussedTranscriptCMAJ 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&apos