Summer Replay: Calling Home – Accuracy of The Surprise Question, Medical Assistance in Dying, and SGLT2 Inhibitors & DKA

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This week on The Rounds Table we are focusing on papers that highlight talent at home – here in Toronto! Kieran hosts Dr. James Downar and Dr. Mike Fralick to discuss their recent publications, and Emily and Sheliza bring listeners the final special segment of the year.

The surprise question – Would I be surprised if this patient died within the next 12 months? – is used as an intuitive means for physicians to try to identify patients they think might benefit from a palliative approach. James takes listeners through his recent meta-analysis examining the accuracy of the surprise question in practice for predicting mortality.

Next, the final special segment of the year! Medical Assistance in Dying (MAiD) has received considerable attention in the past year as recent legislation in Canada surrounding it has changed. Emily and Sheliza bring listeners up to speed with an overview of the changes, a framework for implementation developed at the University Health Network in Toronto, and practical considerations for clinicians.

Finally, a patient – on a new diabetes medication – comes into the Emergency Department and their bloodwork suggests diabetic ketoacidosis (DKA). Sound familiar? Mike takes listeners through his recent study examining the risk of DKA after initiation of an SGLT2 inhibitor compared to a DPP4 inhibitor.

Like what you hear? Rate us on iTunes! Chat with us on Twitter @roundstable and tweet at Kieran @kieranlquinn, Mike @FralickMike, James @jamesdownar, Sheliza @sheliza_halani, and Emily @emmy_hughes

The Papers

1. The Surprise Question: http://www.cmaj.ca/content/189/13/E484.abstract

2. SGLT2 inhibitors & DKA: http://www.nejm.org/doi/full/10.1056/NEJMc1701990#t=article

Medical Assistance in Dying (MAiD) Special Segment

1. NEJM article from UHN: http://www.nejm.org/doi/pdf/10.1056/NEJMms1700606

2. Practical Considerations: http://ocfp.on.ca/tools/clinical-tools-and-resources/clinical-tools-and-resources-for-primary-care/clinical-tools-and-resources-for-primary-care/2016/11/18/maid-resource-guide—centre-for-effective-practice

Additional Links:

3. http://www.cpso.on.ca/Policies-Publications/Policy/Medical-Assistance-in-Dying

4. http://www.dyingwithdignity.ca/get_the_facts_assisted_dying_law_in_canada

5. http://www.cpha.ca/uploads/policy/maid_evidence_e.pdf

6. http://www.cbc.ca/news/health/medically-assisted-dying-canadians-rob-rollins-1.4056700

7. http://www.cbc.ca/news/canada/montreal/166-quebeckers-doctor-assisted-death-1.3668500

Music Credits

The Rounds Table Theme Music by Brendan Quinn, Creative Director and Composer, Vapor RMW

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Kieran Quinn


Kieran is a clinical scientist at the Sinai Health System.

Michael Fralick

Co-director of the Rounds Table

Michael Fralick is a general internist at Mount Sinai Hospital in Toronto. He completed a Master of Science in Clinical Epidemiology at Harvard University, including a Research Fellowship in Health Policy at the Program On Regulation Therapeutics and Law (PORTAL). His PhD focused on the intersection between machine learning and pharmacoepidemiology.

James Downar


James Downar is a critical care and palliative care physician at the University Health Network in Toronto, Ontario.

Emily Hughes


Emily is an Internal Medicine Resident at the University of Toronto Department of Medicine.

Sheliza Halani