Clinical Currents

In this episode, hosts Drs. Peter Gregory and Meredith Chiasson discuss systemic lupus erythematosus (SLE) with Dr. Alexandra Legge – adult rheumatologist at the QEII Health Sciences Centre, assistant professor in the Division of Rheumatology at Dalhousie University, and director of the Dalhousie Lupus Clinic.

Dr. Legge explains why lupus can be so challenging to recognize, including the wide variability in how it presents and the limitations of relying on pattern recognition alone. She explores clinical features that should raise suspicion for lupus, offers practical guidance on interpreting positive ANA results, and discusses how laboratory findings such as cytopenias, complement levels, ESR, and CRP can help clinicians determine when further investigation is warranted.

The conversation also examines organ involvement that can be easy to miss, including lupus nephritis and neuropsychiatric manifestations, as well as when suspected lupus requires urgent rheumatology assessment. Dr. Legge discusses strategies for minimizing the long-term harms of corticosteroid use and highlights recent advances in lupus treatment, including new biologic and cellular therapies and evolving approaches to lupus nephritis.

Listeners of this episode will gain insights into:

• Clinical features that should raise suspicion for lupus, including less-recognized constitutional presentations
• How to approach and interpret a positive ANA in patients with non-specific symptoms
• Practical laboratory investigations for suspected lupus and when additional testing is appropriate
• How ESR and CRP can behave differently in lupus – and when a markedly elevated CRP should raise concern for infection
• Organ manifestations that may require urgent investigation or rheumatology referral, including renal, hematologic and neuropsychiatric disease
• Strategies for reducing cumulative corticosteroid exposure and mitigating its long-term harms
• Recent advances in lupus treatment and the changing approach to lupus nephritis

Timestamps

• 04:16 – Why lupus can be challenging to diagnose early
• 06:21 – Early clinical features that should raise suspicion for lupus
• 11:24 – Making sense of a positive ANA
• 16:16 – Assessing non-specific symptoms and distinguishing lupus from other conditions
• 19:02 – Recognizing inflammatory arthritis in lupus
• 22:06 – ESR, CRP, and other helpful laboratory clues
• 26:00 – When to refer urgently to rheumatology
• 28:21 – A practical approach to the initial lupus workup
• 31:36 – Organ involvement: lupus nephritis, hematologic and neuropsychiatric manifestations
• 37:09 – Steroid stewardship and reducing long-term harm
• 41:18 – Recent advances in lupus treatment
• 44:16 – Changing approaches to lupus nephritis
• 46:31 – Key takeaways for internists

Resources mentioned in this episode:

· American College of Rheumatology Guideline for the Treatment of Systemic Lupus Erythematosus

· American College of Rheumatology Guideline for the Screening, Treatment, and Management of Lupus Nephritis

· American College of Rheumatology – Lupus information and resources

· Lupus Canada – Information and resources on systemic lupus erythematosus

Clinical Currents is produced by the Dalhousie Department of Medicine for internal medicine physicians across the Maritimes. This podcast is for professional education only and should not be taken as personal medical advice. Content reflects Canadian practice unless otherwise noted.

In this episode, hosts Drs. Peter Gregory and Meredith Chiasson sit down with Dr. Alethea Lacas – geriatrician, family physician, and member of the Division of Geriatrics at Dalhousie University and Nova Scotia Health – about frailty, the Clinical Frailty Scale (CFS), and the Palliative and Therapeutic Harmonization (PATH) Program.

Dr. Lacas explains how frailty differs from simply appearing frail, why understanding a patient's baseline function is essential, and how the Clinical Frailty Scale can help clinicians make more informed decisions about prognosis, treatment, and goals of care. She also explores the concept of the frailty cycle, discusses practical strategies for minimizing frailty progression during hospital admissions, and highlights the importance of integrating frailty-informed thinking into everyday clinical practice.

Importantly, the conversation also examines the PATH Program, including when referrals may be appropriate, how comprehensive frailty assessments can support shared decision-making, and why understanding "what matters most" to patients is central to delivering person-centred care.

Listeners of this episode will gain insights into:

• How to accurately assess frailty using the Clinical Frailty Scale
• Why baseline function and collateral history are critical when evaluating frailty
• The relationship between frailty, prognosis, and goals-of-care conversations
• Practical strategies to reduce frailty progression during hospitalization
• Appropriate referrals to the PATH Program and how it supports decision-making
• The 5Ms framework for caring for older adults: Multi-complexity, Medications, Mobility, Mind, and Matters Most

Timestamps

• 04:36 – Understanding frailty and the Clinical Frailty Scale
• 11:14 – Frailty and goals-of-care conversations
• 11:37 – The frailty cycle explained
• 21:33 – Introduction to the PATH Program
• 29:49 – The 5Ms framework
• 30:09 – "What Matters Most" in clinical decision-making
• 37:23 – Measuring success in frailty-informed care
• 40:00 – Key takeaways

Resources mentioned in this episode:

• Canadian Geriatrics Society 5Ms Poster and Clinical Resources: The Canadian Geriatrics Society - Geriatric 5Ms

• Clinical Frailty Scale (Dalhousie University / Dr. Kenneth Rockwood): Clinical Frailty Scale - Geriatric Medicine Research - Dalhousie University

• PATH (Palliative and Therapeutic Harmonization) Program information: Palliative & Therapeutic Harmonization Clinic (PATH clinic) | Nova Scotia Health

Clinical Currents is produced by the Dalhousie Department of Medicine for internal medicine physicians across the Maritimes. This podcast is for professional education only and should not be taken as personal medical advice. Content reflects Canadian practice unless otherwise noted.

In this episode, hosts Dr. Meredith Chiasson and Dr. Peter Gregory speak with Dr. Gordon Gubitz – neurologist, professor of medicine at Dalhousie University, and clinical lead for the Nova Scotia MAiD program – about medical assistance in dying (MAiD) and the role internists can play in supporting patients through these complex and deeply personal conversations.

Dr. Gubitz explains the eligibility criteria and assessment process for MAiD in Canada, addresses common misconceptions, and discusses how conversations about MAiD fit into broader goals-of-care and end-of-life discussions. He also explores the role of internists in initiating conversations, supporting patients and families, participating in assessments, and navigating referral pathways and available resources.

Looking ahead, Dr. Gubitz outlines emerging legislative developments, including MAiD for mental illness as a sole underlying condition and the evolving discussion around advance requests.

Listeners of this episode will gain insights into:

• Common misconceptions about MAiD eligibility and process

• How to approach conversations about MAiD within goals-of-care discussions

• The role internists can play in supporting patients considering MAiD

• Referral pathways and educational resources available in Nova Scotia

• Emerging legislative and ethical developments in MAiD practice

Resources mentioned in this episode:

• Nova Scotia Health MAiD resource page: Medical Assistance in Dying (MAID) | Nova Scotia Health

• Canadian Association of MAiD Assessors and Providers (CAMAP) educational modules: CMC 3.0 Home - CAMAP | ACEPA

• Mental health support for physicians involved in MAiD care: Professional Support Program

• Grief and bereavement support resources for families and clinicians: Life Changes | Nova Scotia Health

• CAMAP clinician forums and peer support: Join CAMAP - CAMAP | ACEPA

• Hospice bereavement support resources: Grief Support Groups in Nova Scotia | Hospice Halifax

• Nova Scotia MAiD referral pathway and contact information: To make a referral, clinicians are encouraged to contact the Nova Scotia Health MAiD Access and Resource Team. Information can be found under "Contact" at Medical Assistance in Dying (MAID) | Nova Scotia Health.

• Nova Scotia Health patient and family guide: https://www.nshealth.ca/sites/default/files/documents/2229-2024.03.13.pdf

Clinical Currents is produced by the Dalhousie Department of Medicine for internal medicine physicians across the Maritimes. This podcast is for professional education only and should not be taken as personal medical advice. Content reflects Canadian practice unless otherwise noted.

In this episode, Dr. Meredith Chiasson and Dr. Peter Gregory speak with Dr. Amanda Vinson – nephrologist and kidney transplant clinician-researcher with Nova Scotia Health and associate professor of medicine at Dalhousie University – about practical approaches to managing acute kidney injury (AKI).

Dr. Vinson shares how the approach to AKI has evolved, with a growing emphasis on early recognition, careful monitoring, and thoughtful follow-up. She outlines what to prioritize in the first 24 hours, when AKI should prompt further investigation or consultation, and how to navigate common challenges like fluid management and medication decisions.

The episode also highlights the importance of follow-up care, emphasizing that even mild or resolved AKI carries long-term risk and requires ongoing monitoring.

Listeners of this episode will gain insights into:

• · Key priorities in the first 24 hours of AKI management
• · When AKI is not following the expected course – and what to do next
• · Practical approaches to fluid management in complex patients
• · How to manage common medications in both acute and outpatient settings
• · Why AKI should be treated as a long-term risk factor

Clinical Currents is produced by the Dalhousie Department of Medicine for internal medicine physicians across the Maritimes. This podcast is for professional education only and should not be taken as personal medical advice. Content reflects Canadian practice unless otherwise noted.

When should you screen for osteoporosis – and what should you do when you find it?

In this episode, hosts Dr. Meredith Chiasson and Dr. Peter Gregory speak with Dr. Vicki Munro, endocrinologist with Nova Scotia Health and assistant professor of medicine at Dalhousie University, about practical approaches to identifying patients at risk for fragility fractures and managing osteoporosis in everyday clinical care.

Dr. Munro explains how clinicians can recognize at-risk patients, when bone density testing is most helpful, and how to interpret risk factors such as glucocorticoid exposure, family history, and comorbid disease. She also reviews current treatment strategies, including when to consider bisphosphonates, anabolic therapies, and referral to specialty care.

Listeners will gain insights into:

• Key clinical clues that should prompt osteoporosis screening
• Risk factors that may warrant earlier testing than age-based screening alone
• Lifestyle and prevention strategies to support bone health
• When to initiate pharmacologic therapy – and when to consider specialist referral

Show notes (timestamps):

• 08:10 – Morin, Suzanne N., Sidney Feldman, Larry Funnell, et al. "Clinical Practice Guideline for Management of Osteoporosis and Fracture Prevention in Canada: 2023 Update." Canadian Medical Association Journal 195, no. 39 (2023): E1333–48. https://doi.org/10.1503/cmaj.221647.

• 14:15 – Khan, Aliya A., Hajar Abu Alrob, Dalal S. Ali, Karel Dandurand, Wendy Wolfman, and Michel Fortier. "Guideline No. 422g: Menopause and Osteoporosis." Journal of Obstetrics and Gynaecology Canada44, no. 5 (2022): 527-536.e5. https://doi.org/10.1016/j.jogc.2021.09.013.

• 18:25 – Humphrey, Mary Beth, Linda Russell, Maria I. Danila, Howard A. Fink, Gordon Guyatt, Michael Cannon, Liron Caplan, et al. "2022 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid‐Induced Osteoporosis." Arthritis Care & Research 75, no. 12 (December 2023): 2405–19

Clinical Currents is produced by the Dalhousie Department of Medicine for internal medicine physicians across the Maritimes. This podcast is for professional education only and should not be taken as personal medical advice. Content reflects Canadian practice unless otherwise noted.

Artificial intelligence is increasingly part of clinical workflows – from documentation to clinic preparation – but how can internists use it safely and effectively? In this episode, hosts Dr. Meredith Chiasson and Dr. Peter Gregory speak with Dr. Islam Eissa, general internist at Nova Scotia Health, assistant professor at Dalhousie University, and experienced AI practitioner, about the realities of AI use in internal medicine.

Dr. Eissa discusses how AI tools can support note generation, clinic efficiency, and medical education, while also highlighting the ongoing need for physician oversight, patient privacy protections, and transparency.

Listeners will gain insights into:

· Where AI can reduce administrative burden

· Common risks, including hallucinations and over-reliance

· Ethical considerations around privacy and consent

· Practical ways to integrate AI into daily practice

Show notes (timestamps): · 00:07 – Artificial Intelligence Glossary: Learn AI Vocabulary · 19:37 – OntarioMD AI Scribe Evaluation (Executive Summary | Full Report PDF) · 22:30 – CMPA - AI Scribes: Answers to frequently asked questions · 23:52 – Royal College of Physicians and Surgeons Canada's position on AI

Reminder: Use AI tools in accordance with institutional policy and patient privacy requirements.

Clinical Currents is produced by the Dalhousie Department of Medicine for internal medicine physicians across the Maritimes. This podcast is for professional education only and should not be taken as personal medical advice. Content reflects Canadian practice unless otherwise noted.

Thrombosis is a frequent – and often complex – part of internal medicine practice. In this episode of Clinical Currents, hosts Drs. Meredith Chiasson and Peter Gregory are joined by hematologists Drs. Erica Kelly and Amye Harrigan for a practical discussion on managing thrombosis in everyday clinical care.

The conversation focuses on real-world decision-making – from referral thresholds and initial workup to managing patients with recurrent thrombosis while on anticoagulation – highlighting when hematology input is most helpful and how to avoid unnecessary testing.

Listeners will gain insights into:

• When to refer patients with venous or arterial thrombosis

• Helpful baseline investigations before referral

• A structured approach to suspected anticoagulation failure

• Key factors influencing anticoagulant choice and dosing

• When thrombophilia testing and cancer screening are appropriate

Produced by the Dalhousie Department of Medicine for internal medicine physicians across the Maritimes. This podcast is for professional education only and should not be taken as personal medical advice. Content reflects Canadian practice unless otherwise noted.

General internal medicine is often described as the glue of the healthcare system – managing complexity, navigating uncertainty, and supporting patients across specialties. In this episode of Clinical Currents, Dr. Meredith Chiasson and Dr. Peter Gregory interview Dr. Allen Tran, general internist, educator, and program director for Dalhousie's GIM subspecialty training program.

Dr. Tran reflects on the rewards and challenges of the specialty, the breadth of practice – from thrombosis care to obstetric medicine – and the future of GIM in Canada. He also shares advice for trainees and insights into the collaborative culture of the division at Dalhousie.

Listeners will gain insights into:

• The variety and scope of a career in general internal medicine
• How GIM physicians manage multimorbidity and "the grey zones" of care
• The role of mentorship, teaching, and leadership in shaping the specialty
• What the next decade may hold for general internal medicine in Canada

Produced by the Dalhousie Department of Medicine for internal medicine physicians across the Maritimes. This podcast is for professional education only and should not be taken as personal medical advice. Content reflects Canadian practice unless otherwise noted.

What makes great teaching memorable? In this debut episode of Clinical Currents, hosts Dr. Meredith Chiasson and Dr. Peter Gregory sit down with Dr. Trudy Taylor, Division Head of Rheumatology at Dalhousie, President of the Canadian Rheumatology Association, and a respected leader in medical education. Together, they explore the "teaching pearls" that transform everyday clinical encounters into powerful learning moments.

Listeners will gain insights into:

· Imparting meaningful teaching pearls in busy settings without losing time

· Tailoring teaching to learners at different levels

· Involving patients in teaching moments to benefit both learners and care

· The role of mentors and role models in shaping careers in medicine

Produced by the Dalhousie Department of Medicine for internal medicine physicians across the Maritimes. This podcast is for professional education only and should not be taken as personal medical advice. Content reflects Canadian practice unless otherwise noted.

Welcome to Clinical Currents, a professional development podcast from the Dalhousie Department of Medicine for internal medicine physicians of all subspecialties across the Maritimes. In this pilot episode, hosts Dr. Meredith Chiasson and Dr. Peter Gregory introduce themselves, explain the purpose of the podcast, and share what listeners can expect in future episodes. They also reflect on their own backgrounds, interests, and perspectives – helping you get to know the voices behind the mic.

Episodes will be released monthly, covering timely topics in internal medicine through interviews and conversations with subject-matter experts. By tuning in, you can claim each episode for 0.5 hours of Section 2 credit through the Royal College's Maintenance of Certification (MOC) program.

Produced by the Dalhousie Department of Medicine for internal medicine physicians across the Maritimes. This podcast is for professional education only and should not be taken as personal medical advice. Content reflects Canadian practice unless otherwise noted.