Cmaj Podcasts

Send us a textIn an effort to reduce the high burden of injury in Canadian youth ice hockey, most associations have restricted bodychecking nationally among leagues for younger players (age 11–12 yr), as well as in certain nonelite divisions of play in older age categories (age 13–17 yr.) This has been shown to be associated with reduced rates of injury, including concussion. However, despite the evidence, some argue that gaining earlier bodychecking experience may protect young players from injuries, including concussions, later on when they progress to play in leagues where bodychecking is allowed.A study published in the CMAJ entitled Bodychecking experience and rates of injury among ice hockey players aged 15–17 years found the opposite, however. Players with more experience in bodychecking had a greater incidence of concussion.On today’s episode, Drs. Omole and Bigham speak with two authors of the study. Paul Eliason is a postdoctoral fellow in the Sport Injury Prevention Research Centre at the Universit

Send us a textDrug shortages are a persistent problem in Canada and around the world. They interfere with patients’ ability to consistently take medication to manage chronic diseases. And they disrupt urgent care as critical drugs like epinephrine and propofol face shortages. The COVID-19 pandemic led to concerns that the pandemic would exacerbate existing issues with drug shortages in Canada. Canadian policy-makers responded with several important measures in March 2020 in an attempt to ensure a steady supply of medication.On this episode, Mina Tadrous discusses the impact of those measures as well as the ongoing challenges to Canada’s supply of pharmaceuticals. Mina Tadrous is coauthor of the paper, “COVID-19 in the prevalence of drug shortages in Canada,” published in CMAJ. He's an assistant professor at the University of Toronto. Drs. Bigham and Omole also speak with Andrew MacIsaac about the role Canadian manufacturing can play in easing the problem of drug shortages. Andrew Maclsaac is the CEO of A

Send us a textThe author of a new study in CMAJ says the risk of suicidality among transgender youth, “is really a crisis.”  Mila Kingsbury and her co-authors found that trans and non-binary teens were as much as 7 times more likely than cishet peers to have thought about or tried suicide. More than half of the trans 15-17 year olds in a nationally-representative Canadian survey said they’d thought about suicide, and about 40% had attempted suicide in their lifetime.The research entitled Suicidality among sexual minority and transgender adolescents drew its data from the 2019 Canadian Health Survey on Children and Youth, a carefully-conducted cross-sectional survey. The researchers used a sub-sample of 6800 15-17 year olds.  On this episode,  Drs. Blair Bigham and Dr. Mojola Omole discuss the implications of the study’s findings with one author, Mila Kingsbury. They then speak with Dr. Tyler Black, medical director of the pediatric psychiatric emergency inpatient unit at British Columbia Children's Hospi

Send us a textPeople who use drugs are at elevated risk of death due to the toxic illicit drug supply. Providing easy access to a supply of safe, clean substances may reduce overdose deaths, decrease harms associated with substance use, and improve users’ trust in addiction care. Safer Alternatives for Emergency Response (SAFER) is a low-barrier, flexible safe supply program that provides several replacement options for people who use illicit drugs, including fentanyl, and is integrated with other healthcare and social services. In this episode, Drs. Omole and Bigham speak with two physicians who work with the SAFER initiative. Dr. Sukhpreet Klaire is the lead author of the article in CMAJ entitled Low-Barrier, Flexible Safe Supply to Prevent Overdose. He is an addiction medicine specialist working in Vancouver. Dr. Melanie van Soeren is a family physician and addiction medicine specialist in Vancouver.Join us as we explore medical solutions that address the urgent need to change healthcare. Reach out to us a

Send us a textDrowning accounts for hundreds of deaths in Canada every year. A study published in CMAJ examines how pre-existing medical conditions contribute to drowning deaths. Drs Mojola Omole and Blair Bigham speak with the study’s lead author Dr. Cody Boone about what the study’s findings mean for physicians and patients.They then speak with Audrey Giles, a professor of human kinetics at the University of Ottawa, about the high rates of drownings experienced by Northern Indigenous communities in Canada. Professor Giles has spent decades working with people in Northern regions to adapt and customize water safety programs so that they meet communities’ specific cultural and practical needs. She discusses issues from cold water drowning to cultural safety. Links:The link between medical conditions and fatal drownings in Canada: a 10-year cross-sectional analysisDecades of water safety training culturally “irrelevant” to First Nation peopleCMAJJoin us as we explore medical solutions that address the urgent n

Send us a textIn this episode, Dr. Kaveh Shonjania argues that despite the billions of dollars spent on clinical and quality improvement research, most of the interventions that are studied are shown not to work and those that do work produce only marginal benefits for some patients.Dr. Shojania is the Vice Chair of Quality and Innovation for the Department of Medicine at the University of Toronto and past Editor-in-Chief of BMJ Quality and Safety. He joins Drs. Blair Bigham and Mojola Omole to discuss a study published in CMAJ recently, entitled Inappropriate Use of Clinical Practices in Canada: A Systematic Review, in which the authors sifted through 174 studies to identify ineffective clinical practices that are either overused, effective practices that are underused, or other practices that are just misused..  Dr. Shojania wrote a short commentary related to the study, entitled What problems in health care quality should we target as the world burns around us? In which he called for health research resour

Send us a textA study of more than 3000 health care leaders in Canada found that while gender parity was present, racialized executives were substantially under-represented. Diversity among health care leaders in Canada: a cross-sectional study of perceived gender and race was published in CMAJ. It found that at the ministry level fewer than 7 percent of health care leaders were racialized. The representation gap between racialized executives in healthcare and the racial demographics of the population it serves ranged from a low of 7.3% for Prince Edward Island to a high of 27.5% for Manitoba. The gap was highest in geographic locations with a greater percentage of racialized residents. On this episode, Drs. Omole and Bigham speak with the lead author of the study Anjali Sergeant, a final year medical student at McMaster University.  She describes how researchers determined race, compares results in different parts of the country and discusses how closely the results of the study reflect what she is seeing in

Send us a textCOVID-19 disrupted the medical licensing examination system in Canada.  During the pandemic,  exams delivered by The College of Family Physicians of  Canada  (CFPC) and the Royal College of Physicians and Surgeons of Canada (RCPSC) were delayed, canceled or adapted, disrupting the lives of hundreds of physicians.However, those challenges prompted many to rethink the historical approach to medical licensure in Canada. In this episode, Drs. Brent Thoma and Teresa Chan discuss their proposal to shift away from all-or-nothing examinations and towards a system of graduated licensure. They are two authors of a recent CMAJ commentary entitled Replacing high-stakes summative examinations with graduated medical licensure in Canada.Dr. Thoma is an emergency and trauma physician in Saskatoon and an associate professor of emergency medicine at the University of Saskatchewan.  Dr. Chan is an associate professor of medicine at McMaster University, where she is the Associate Dean of Continuing Professional Dev

Send us a textPostural orthostatic tachycardia syndrome (POTS) is a disorder that can profoundly affect patients' quality of life. Its main characteristic is tachycardia on standing without a drop in blood pressure. Patients complain of lightheadedness and palpitations when upright, which sometimes leads to syncope. This can cause substantial functional disability, which may be economically devastating.Despite these serious consequences for patients, diagnosis can be delayed up to 6 years.In this episode, Dr. Satish Raj, author of the recent CMAJ narrative review article Diagnosis and management of Postural Orthostatic Tachycardia Syndrome talks to our hosts about difficulties in making the diagnosis of POTS, its complex range of comorbidities, how patients are typically affected by the syndrome and treatment options.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 h

Send us a textPhysicians working in hospitals see the mountains of medical waste generated each day. Meanwhile, the climate crisis challenges the medical system to reduce its contribution to greenhouse gas emissions. Globally, healthcare systems contribute as much carbon dioxide as the airline industry. In Canada, healthcare accounts for 4.6% of our total emissions. The problem is urgent, but potential solutions are both easier and more complex than many might think. Guests on this episode are advocates in the climate and health space. Dr. Samantha Green is the co-author of the CMAJ article, Five Things to Know About Metered Dose Inhalers and their Impact on Climate Change. She's a family physician at Unity Health Toronto and the climate and health lead at the University of Toronto's Department of Family and Community Medicine.In the article, she and her co-authors point out that pressurized metered-dose inhalers (pMDIs) are an important contributor to greenhouse gas emissions.  Dr. Green says measu

Send us a textThe clinical teaching unit is a widely-used clinical training model that requires reform to prepare physicians for practice in the 21st century.In a systematic review in CMAJ, Dr. Brandon Tang and co-authors identified practices in internal medicine clinical teaching units that contribute to improved clinical education and health care delivery.Dr. Tang, a PGY4 in general internal medicine at the University of Toronto, speaks with Drs. Blair Bigham and Mojola Omole about the findings of the review, his experience with CTUs, what inspired him to look into the research, and his thoughts on how CTUs can be reimagined to improve both learner and patient outcomes. Drs. Bigham and Omole then speak with Dr. Lisa Richardson, a clinician-educator in the U of T’s Division of General Internal Medicine, about other aspects of medical training that are due for a rethink.Dr. Richardson, who also practices at the University Health Network and is an Education Researcher at the Wilson Centre, argues that medical

Send us a textReported gonorrhea cases have more than doubled in recent years. Untreated gonorrhea may occasionally cause potentially fatal conditions, such as infective endocarditis. In this episode, Dr. Carl Boodman, infectious disease and medical microbiology fellow at the University of Manitoba, discusses a case of disseminated gonococcal infection in a 54- year old man who presented to ER with a new heart murmur. The case was described in a recent CMAJ article, which explains that the patient had developed an aortic root abscess and a fistula from his right ventricle to the aortic root.Dr. Boodman tells Dr. Blair Bigham and Dr. Mojola Omole that, while severe cases of disseminated gonococcal infection such as this remain relatively rare, he is seeing more of them in Manitoba. He emphasizes the importance of detecting and treating gonococcal infection before it has a chance to progress.Gonorrhea is just one of the bacterial STIs on the rise. Drs. Bigham and Omole also speak with Dr. Jason Wong, a Public H

Send us a textOperative vaginal delivery (OVD) is considered safe if carried out by trained personnel; however, the rate of maternal trauma following OVD in Canada greatly exceeds that of any other OECD country. In Canada, maternal trauma occurred in more than one-quarter of deliveries with forceps, whereas in the UK, the rate is 8%-12%, and in Australia, it sits at ​​9.3%-14.1%.A research study published in CMAJ found that rates of trauma following OVD in Canada are higher than previously reported, irrespective of region, level of obstetric care and volume of instrument use among hospitals. The authors argue these results support a reassessment of OVD safety in Canada. In this episode, Dr. Bigham and Blair and Dr. Mojola Omole speak with Dr. Giulia Muraca, the lead author of Maternal and neonatal trauma following operative vaginal delivery: a national cohort study. They explore possible causes for these troubling findings.They then speak with Dr. Nirmala Chandrasekaran, an OB/GYN and Maternal-Fetal-Medicine

Send us a textPeople with kidney failure who live in rural and remote areas of Canada do not have the same access to the full suite of dialysis modalities as urban dwellers. Many need to relocate for life-sustaining renal replacement therapy. Often this means moving hours away from their home communities for months, sometimes years, at a time.In this episode, hosts Drs. Mojola Omole and Blair Bigham speak with Dr. Aaron Trachtenberg, a nephrologist at the University of Manitoba about his commentary in CMAJ, in which he and coauthors argued that patients who must leave their home communities for dialysis should be prioritized for the allocation of deceased donor kidney transplants.They also speak with Vanessa Tait whose father needed to relocate to Winnipeg, twelve hours away from his home community of O-pipon-na-piwin Cree Nation, for dialysis. Ms. Tait became a living donor to her father in an effort to bring him back home. She talks about the toll relocation takes on patients from remote communities.Comment

Send us a textThe CMAJ podcast is taking a break for one episode as everyone enjoys their holidays and gets prepared for the year ahead. In this brief chat, Mojola and Blair preview some of the upcoming episodes and wish all our listeners a happy and safe holiday.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 textOne simple question can offer clinicians a powerful insight into the lives of their vulnerable patients. Asking, “Do you ever have trouble making ends meet at the end of the month” can help physicians identify significant barriers to restoring the health of their patients.The link between the social conditions in which we live and health outcomes is well-known. However, health provider action to address the social determinants of health is an emerging area of practice innovation and research. This episode looks at what social prescribing looks like in action and what the evidence tells us about its effectiveness.Drs. Mojola Omole and Blair Bigham speak with Janet Rodriguez, a patient at St. Michael’s Family Health Care Clinic in Toronto. She describes the profound impact social interventions had on her physical and mental health.  They also speak with Dr. Gary Bloch, a family physician at St. Michael’s Family Health Care Clinic and a co-author of the analysis published in CMAJ titled “An Evidenc

Send us a textThe pandemic recovery period presents an opportunity to address health inequities that have led to an unfair distribution of the burden and harms of COVID-19. New guidance for policy published in CMAJ  proposes 13 practical ways to address inequities exposed and worsened by COVID-19 in the pandemic recovery period, based on evidence that was accumulating before the pandemic.In this special episode of the podcast, CMAJ interim editor-in-chief Dr. Kirsten Patrick talks to Dr. Nav Persaud, lead author on the new guideline, about its genesis, the evidence underpinning its recommendations, and the importance of positioning equity at the centre of policy-making as Canada emerges from the pandemic.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 Engl

Send us a textPain is one of the most common complaints among patients visiting the ER, and pain management has become a quality of care indicator. But the options available for the treatment of acute pain that isn’t controlled by over-the-counter medications are limited. With the opioid epidemic leading physicians to avoid prescribing narcotics, the anaesthetic drug, ketamine, is being reconsidered for the treatment of pain, as well as other indications. A practice article  in CMAJ argues that ketamine is an underutilized and effective analgesic and a safer alternative to opioids for the management of acute pain, with reported adverse effects at low doses occurring at the same frequency as placebo. In this episode, Blair and Mojola speak to Dr. William Silverstein, a co-author of the practice article “Five things to know about the use of ketamine in the treatment of acute pain” about ketamine’s indications and contraindications, how to prescribe it in the ambulatory care setting, and practical steps physicia

Send us a textOne in four women physicians report a diagnosis of infertility. One reason for this is physicians tend to delay attempts to become pregnant until “the time is right” for their career.  But, in the medical profession, it seems there is really no “good” time to have children. Parenthood, especially motherhood, is seen as an inconvenience during medical training and beyond. In this episode, Dr. Sophia Park speaks with hosts Dr. Mojola Omole and Dr. Blair Bigham about her personal struggle with infertility. And, Dr. Andrea Simpson, the lead author of a commentary in the CMAJ titled, “The inconvenience of motherhood during a medical career”  calls for systemic change in medicine to support parenthood.Dr. Sophia Park is a medical biochemist at Royal Columbian Hospital and a Clinical Associate Professor at the UBC Department of Pathology and Laboratory Medicine.Dr. Andrea Simpson is an obstetrician and minimally invasive gynaecologic surgeon at St. Michael’s Hospital. She is also an assistant professor

Send us a textButton batteries, sometimes called coin batteries, are small round batteries that power various electronic devices such as watches, remote controls or small kid toys. They are small and shiny, which is why young children will sometimes grab them and put them in their mouths. But they can cause severe injury in a child if the button battery becomes lodged in the digestive tract. In this episode, Dr. Savithiri Ratnapalan talks about the dangers of swallowing button batteries, what parents can do immediately at home, and how button battery ingestion is managed in hospital.Dr. Savithiri Ratnapalan is a pediatric emergency physician at the Hospital for Sick Children in Toronto. She co-authored a practice article with Dr. Amy Zipursky. It is published in CMAJ: https://www.cmaj.ca/lookup/doi/10.1503/cmaj.210572Podcast transcript: https://www.cmaj.ca/transcript-210572-----------------------------------This podcast episode is brought to you by Scotiabank Healthcare+. Learn more at: https://mdm.ca/promos/