Family Medicine Residency Site: Abbotsford-Mission

“In January 2023, the Elsevier journal Nurse Education in Practice ignited a firestorm when it recognized ChatGPT as a coauthor alongside Siobhan O’Connor [Figure].[1] The piece quickly sparked debate among publishers, editors, and researchers about whether a bot can qualify as an author.[2-4]

ChatGPT is an artificial intelligence (AI) language model developed by the company OpenAI. It uses pre-existing books, websites, and other sources to generate human-like text and can assist with things like writing code, composing essays, and answering questions.

Many writers like AI language models because they free up time to focus on higher-level skills like analysis and creativity rather than structure and grammar. Prominent author and Wharton professor Adam Grant has even stated that his classes are now AI mandatory because he does not want to read bad writing anymore.[5] But how should we recognize ChatGPT’s contributions?”

Read more on Can ChatGPT be your coauthor? via BCMJ.

Registration now open
Oct. 28 (Sat) | 7:45 a.m. – 4:15 p.m. | Virtual Conference
Audience: all health professionals, residents and medical students.
Overview: The climate crisis is at our doorstep. As health professionals, we can help build a healthy planetary future together. On Sat., Oct. 28, hear from experts in their fields who have initiated projects at a local level. Be inspired at this annual conference presented by the Canadian Association of Physicians for the Environment, with lots of opportunities for participants to engage with the speakers and with each other. Everyone is welcome to attend.
Up to 6.75 Mainpro+/MOC Section 1 credits
LEARN MORE & REGISTER

The University of British Columbia Okanagan has been placed under an evacuation order

In a notice posted to social media on Friday, the university said everyone must leave campus immediately.

If anyone is on campus and needs access to transportation, they are asked to make their way to H lot.

Everyone is asked to leave immediately and in a calm manner.

There are a number of other addresses nearby also under evacuation order. Those can be checked on the map.

Read more on UBCO under evacuation order due to aggressive fire behaviour via Global News.

• A state of emergency has been declared in Kelowna after wildfires forced evacuations for residents in the Clifton area north of the downtown early Friday morning.
• The City of West Kelowna and the Westbank First Nation have declared a local state of emergency, with thousands of properties under evacuation orders or alerts.
• There is “structural loss” in West Kelowna, officials say.
• Highway 1 closed overnight in both directions between Hope and Lytton due to wildfire activity Thursday.
• Dozens of other properties around the B.C. Interior have been ordered evacuated, including the Lytton First Nation and an area north of Ulkatcho First Nation
• Officials warn the coming days could be “the most challenging of the summer,” as a volatile cold front sweeps through southern B.C. with high winds and dry lightning.
• New evacuation orders and wildfires are expected throughout Thursday night and into Friday morning. Learn more about how to find the full list of wildfires, highway closures and evacuation orders and alerts.

Thousands of people have been forced from their homes in B.C.’s Okanagan, with evacuation orders issued after a wildfire jumped Lake Okanagan, sparking spot wildfires in Kelowna.

Early Friday morning, evacuation orders were issued for residents of the Clifton Road North and McKinley area of Kelowna, which is north of the downtown, due to the McDougall Creek wildfire.

A state of emergency has been declared by the City of Kelowna, which has a population of almost 150,000.

Read more via CBC.

“Hundreds of wildfires burning in Canada’s Northwest Territories have prompted emergency declarations and the evacuation of the capital city of Yellowknife by road and air.

About 20,000 residents in Yellowknife are being urged to get out of the way of fast-moving flames as more than 230 fires char the territory and smoke creeps south, impacting air quality in the US. Yellowknife accounts for about half of the total population of the remote territory, which sits north of Alberta and east of Yukon.

‘We’re all tired of the word unprecedented, yet there is no other way to describe this situation in the Northwest Territories,’ Premier Caroline Cochrane said in a statement Wednesday night.

‘Residents living along the Ingraham Trail, in Dettah, Kam Lake, Grace Lake and Engle Business District are currently at highest risk and should evacuate as soon as possible. Other residents have until noon on Friday, August 18, 2023 to evacuate,’ Northwest Territories officials said in a news release Wednesday.

The community of N’dilo is also under an evacuation order, officials said in the release. Those unable to leave by vehicle can register for an air evacuation, officials said.

‘If you are able to evacuate by road, obey all warning signs, emergency management officials, traffic control devices and posted speed limits,’ Cochrane added. ‘Do not make any rash decisions that can put other people in danger.'”

Read more here via CNN.
Also see NWT wildfire updates via Environment and Climate Change.

Abstract: This study evaluates the perceptions of preparedness and willingness to work during disasters and public health emergencies among 213 healthcare workers at hospitals in the southern region of Saudi Arabia by using a quantitative survey (Fight or Flight). The results showed that participants’ willingness to work unconditionally during disasters and emergencies varied based on the type of condition: natural disasters (61.97%), seasonal influenza pandemic (52.58%), smallpox pandemic (47.89%), SARS/COVID-19 pandemic (43.56%), special flu pandemic (36.15%), mass shooting (37.56%), chemical incident and bombing threats (31.92%), biological events (28.17%), Ebola outbreaks (27.7%), and nuclear incident (24.88%). A lack of confidence and the absence of safety assurance for healthcare workers and their family members were the most important reasons cited. The co-variation between age and education versus risk and danger by Spearman’s rho confirmed a small negative correlation between education and danger at a 95% level of significance, meaning that educated healthcare workers have less fear to work under dangerous events. Although the causes of unsuccessful management of disasters and emergencies may vary, individuals’ characteristics, such as lack of confidence and emotional distractions because of uncertainty about the safety issues, may also play a significant role. Besides educational initiatives, other measures, which guarantee the safety of healthcare providers and their family members, should be established and implemented.

Learn more here on Emergency Healthcare Providers’ Perceptions of Preparedness and Willingness to Work during Disasters and Public Health Emergencies via Healthcare.

Heat Warnings have been issued by Environment and Climate Change Canada for areas in the following regions of British Columbia (via EmergencyInfoBC):

• 100 Mile
• Boundary
• Cariboo
• Central Coast – inland sections
• East Vancouver Island
• Fraser Canyon
• Fraser Valley
• Greater Victoria
• Howe Sound
• Kootenay Lake
• Metro Vancouver
• North Thompson
• Okanagan Valley
• South Thompson
• Southern Gulf Islands
• Sunshine Coast
• West Columbia
• Whistler

More information:

• Recommended actions
• Cooling centre locations
• Heat safety
• Resources  
• About heat alerts 

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Recommended actions

If you are in the area under a Heat Warning:

1. Know the symptoms of heat-related illness and seek medical care if you or someone you are caring for are unwell:
   • Call 9-1-1 or your local emergency number in case of a medical emergency. 
2. Take steps to keep your home cool or seek cooler locations, such as a community Cooling Centre. 
3. Check on family, friends and neighbours who are at higher risk of heat-related illness, particularly if they live alone. 
4. Drink plenty of water. Be aware that sugary or alcoholic drinks cause dehydration. 
5. If you must be outdoors, take precautions to stay cool like wearing protective clothing and sunscreen, seeking cooler outdoor spaces and staying in shaded areas as much as possible. 
6. Monitor local sources of information and follow all instructions from your municipality, Local Authority or First Nation. 

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Cooling centres

In response to Heat Warnings, local governments and First Nations in affected areas may open Cooling Centres for the public.

Local governments and First Nations can post Cooling Centre locations on Emergency Map BC. If Cooling Centres are not posted in your area, visit your municipality, Local Authority or First Nation website or social media channels for more information.

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Heat safety

Heat stroke is a health emergency. Call 9-1-1 or your local emergency number if you or someone you’re caring for is displaying symptoms.

Heat-related illness 

Overheating can be harmful to your health and potentially deadly. If someone is experiencing symptoms such as rapid breathing, rapid heart rate, extreme thirst, altered levels of consciousness, and decreased urination with an unusually dark yellow colour, take immediate steps to cool down and seek emergency care: 

• Get medical attention or call 911 or your local emergency number. 
• Move to a cooler indoor or outdoor area. 
• Take a cold shower or bath if it is safe to do so. Or, remove clothing and apply ice packs and wet cloths, especially around the neck, armpits, and groin. Replace wet cloths regularly. 

Who is at greater risk? 

Heat affects everyone, but the risks are greater for: 

• Older adults (i.e. over 50) 
• People who live alone or are socially isolated 
• People with pre-existing health conditions such as:
  • Diabetes  
  • Heart disease, or  
  • Respiratory disease 
• People with mental illness such as:
  • Schizophrenia  
  • Depression, or  
  • Anxiety  
• People with substance use disorders  
• People who are marginally housed  
• People who work in hot environments  
• People who are pregnant  
• Infants and young children, and 
• People with other disabilities or limited mobility 

Check on family, friends and neighbours, who are at higher risk, particularly if they live alone. Make sure they have a cool space. For people susceptible to heat, the risk increases at indoor temperatures higher than 26°C, and temperatures higher than 31°C can be dangerous. 

Staying cool indoors 

• If you have air conditioning, turn it on.  
• If you do not have air conditioning, make your home cooler by:
  • Closing shutters, curtains, or blinds during the day (starting around 10am). This traps the cooler air inside and blocks the sun.  
  • Re-open curtains or blinds and windows at around 8 p.m. to let the cooler overnight air into the house.  
  • Place multiple fans around your home to help move cooler air into the home overnight.  
• Take cool baths or showers.

Staying cool outdoors 

• Seek cooler outdoor spaces and stay out of direct sunlight as much as possible.
• Do errands in the morning or late in the day.  
• Never leave children or pets in a parked car.  
• Stay in the shade and wear a hat and protective clothing.  
• Use sunscreen and UV-protective eyewear.  
• Seek cooler, breezier areas when outdoors, such as large parks near trees and water. 

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Resources

To prepare for heat, refer to the following resources:

• BC Centre for Disease Control – Preparing for Heat Events
• PreparedBC – Be Prepared for Heat
• PreparedBC – Extreme Heat Guide (PDF, 9.4 MB)

For heat safety recommendations specific to your area, visit the heat information provided by your local health authority:

• Fraser Health
• Interior Health
• First Nations Health Authority
• Island Health
• Northern Health
• Vancouver Coastal Health

If you suspect heat-related illness, contact a healthcare provider or call HealthLinkBC at 8-1-1. Mild to moderate heat illness can quickly become severe. In case of a medical emergency, dial 9-1-1.

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About heat alerts

There are two kinds of heat alerts issued in BC:

• Heat Warning: daytime and overnight temperatures are higher than usual, but they’re not getting hotter every day. Take the usual steps to stay cool.
• Extreme Heat Emergency: daytime and overnight temperatures are higher than usual, and are getting hotter every day. Activate your emergency plan for heat.

For more information about how Environment and Climate Change Canada determines Heat Warnings in BC, visit the Criteria for Public Weather Alerts.

Importance  Approximately 65% of adults in the US consume sugar-sweetened beverages daily.

Objective  To study the associations between intake of sugar-sweetened beverages, artificially sweetened beverages, and incidence of liver cancer and chronic liver disease mortality.

Design, Setting, and Participants  A prospective cohort with 98 786 postmenopausal women aged 50 to 79 years enrolled in the Women’s Health Initiative from 1993 to 1998 at 40 clinical centers in the US and were followed up to March 1, 2020.

Exposures  Sugar-sweetened beverage intake was assessed based on a food frequency questionnaire administered at baseline and defined as the sum of regular soft drinks and fruit drinks (not including fruit juice); artificially sweetened beverage intake was measured at 3-year follow-up.

Main Outcomes and Measures  The primary outcomes were (1) liver cancer incidence, and (2) mortality due to chronic liver disease, defined as death from nonalcoholic fatty liver disease, liver fibrosis, cirrhosis, alcoholic liver diseases, and chronic hepatitis. Cox proportional hazards regression models were used to estimate multivariable hazard ratios (HRs) and 95% CIs for liver cancer incidence and for chronic liver disease mortality, adjusting for potential confounders including demographics and lifestyle factors.

Results  During a median follow-up of 20.9 years, 207 women developed liver cancer and 148 died from chronic liver disease. At baseline, 6.8% of women consumed 1 or more sugar-sweetened beverage servings per day, and 13.1% consumed 1 or more artificially sweetened beverage servings per day at 3-year follow-up. Compared with intake of 3 or fewer servings of sugar-sweetened beverages per month, those who consumed 1 or more servings per day had a significantly higher risk of liver cancer (18.0 vs 10.3 per 100 000 person-years [P value for trend = .02]; adjusted HR, 1.85 [95% CI, 1.16-2.96]; P = .01) and chronic liver disease mortality (17.7 vs 7.1 per 100 000 person-years [P value for trend <.001]; adjusted HR, 1.68 [95% CI, 1.03-2.75]; P = .04). Compared with intake of 3 or fewer artificially sweetened beverages per month, individuals who consumed 1 or more artificially sweetened beverages per day did not have significantly increased incidence of liver cancer (11.8 vs 10.2 per 100 000 person-years [P value for trend = .70]; adjusted HR, 1.17 [95% CI, 0.70-1.94]; P = .55) or chronic liver disease mortality (7.1 vs 5.3 per 100 000 person-years [P value for trend = .32]; adjusted HR, 0.95 [95% CI, 0.49-1.84]; P = .88).

Conclusions and Relevance  In postmenopausal women, compared with consuming 3 or fewer servings of sugar-sweetened beverages per month, those who consumed 1 or more sugar-sweetened beverages per day had a higher incidence of liver cancer and death from chronic liver disease. Future studies should confirm these findings and identify the biological pathways of these associations.

Sugar-Sweetened and Artificially Sweetened Beverages and Risk of Liver Cancer and Chronic Liver Disease Mortality via JAMA Network

You regale me
with stories
of meals past
seared scallops
fresh snap peas from your garden
— not the peas of my youth
which I shamefully admit
I still cannot tolerate
—more and more your mind wanders
outside the confines of these walls
remember that last
chicken masala?
you don’t trust them anymore
those ghost flavours on your tongue
taunting you
almost bruising your wanting taste buds
You would rather
mine the pure pleasures of food
as you perch on the edge
of your hospital bed
than acknowledge the tube
in your nose
and your rising lipase levels
You’re afraid to eat now
so instead
you ask me to indulge
in some steak salad
and wine and report back
tomorrow

Hunger by Poet Hollis Roth via Ars Medica

About the Poet Hollis Roth is a palliative care physician, graduate student, and writer. She uses narrative medicine and poetry to explore themes of grief, loss, and hope. Hollis lives in Lethbridge, Alberta, with her two beloved cats Iggy and Roy. Email: hollis.roth@dfm.queensu.ca

“We can see physician–physician power dynamics play out in several ways.”

In this issue of Medical Education, Armson et al. report on an ethnographic study of how small groups of family physicians work together in communities of practice to apply new evidence-based information into practice.¹ From these data, the authors developed a ‘change talk’ framework to illustrate the conversational elements which propel the adoption and adaptation of medical and practice knowledge.¹ They conclude that iterative questioning and sharing of practice experiences in small learning groups helps physicians develop feasible and rigorous strategies for incorporating new knowledge and practice changes.¹

The ‘change talk’ framework was identified within the context of mono-professional communities of education practice (CoPs), in this case groups of family physicians centred on continuing medical education. CoPs, often understood as a group of professionals sharing a set of problems and learning and innovating together, are valuable in medicine, particularly for professional development.² CoPs are frequently mono-professional (e.g., family physicians or specialist physicians), as they are in the Armson study, rather than intraprofessional (e.g., a mix of family physicians and specialist physicians). Mono-professional knowledge generation shapes the questions asked, comparators considered and therefore the knowledge generated. As a result, the knowledge may not be seamlessly transferable to other professional groups. We can see this in clinical practice guidelines produced by groups of specialist physicians, often without fulsome involvement from family physicians. These guidelines have the hallmark of focusing on the diagnosis and management of a single illness or organ system, without consideration of how therapeutic options may interact in patients with multiple co-morbidities.^{1, 3} The paper by Armson et al. has provided a testament to the value of mono-professional continuing education CoPs and can be used to consider how additional benefit may be realised within intraprofessional education CoPs and which challenges may be encountered.

It is often assumed that professional learning and working could be enhanced by taking another’s perspective in account. Research has, however, shown that understanding another profession is not made possible by simply taking perspective but by getting perspective.⁴ This means that direct conversations between specialists and family physicians are essential⁴ to the practice of high quality comprehensive care. In order to realise the promise of true intraprofessional collaboration and education, physicians must acknowledge and overcome engrained professional and social hierarchies that manifest in power dynamics.^{5, 6} We can see physician–physician power dynamics play out in several ways; previous research has shown that physicians easily overlook how hierarchy can lead to different perceptions of risks and patterns of silencing.⁵ These intraprofessional power dynamics are also present within medical education settings, where there is a tradition of physicians and trainees hiding their uncertainty to maintain credibility.^{7, 8} This may be exacerbated in specialist–family physician interaction because the intraprofessional hierarchy often places specialists at a higher status than family physicians, such as in educational arrangements which find family physicians being trained by specialists, but seldom reverses that dynamic.⁹

Read more on No Doctor is an Island via Medical Education.