1: A Breath of Fresh Air for Depression?

An RCT of 193 patients found that a single dose of mebufotenin benzoate nasal spray, a 5-HT₁A and 5-HT₂A agonist, showed promising efficacy, safety, and tolerability in individuals with treatment-resistant depression. As a rapid-acting psychedelic, the spray could offer a more convenient option for refractory depression, potentially improving treatment access by requiring a shorter monitoring period than current psilocybin treatments.

2: A Transient Visit for a Transient Attack

A repeated cross-sectional study found that the probability of discharge after an ED visit for transient ischemic attack (TIA) increased from 45% in 2013 to 66% in 2021. Imaging use among discharged TIA patients also increased substantially: computed tomography angiography (CTA) rose from 4% (95% CI, 3%–4%) in 2013 to 45% (95% CI, 42%–47%) in 2021, while magnetic resonance imaging (MRI) rose from 17% (95% CI, 16%–19%) to 53% (95% CI, 50%–55%) over the same period (P < .001 for trend for both). These trends suggest increased use of the ED to expedite TIA evaluations that previously occurred during brief admissions.

3: Food for Thought

A Global Burden of Disease analysis estimated that 18.1 million people worldwide were living with anorexia nervosa or bulimia nervosa in 2023. Burden was highest in high-income regions, and the number of cases increased by 71% from 1990 to 2023. These findings suggest that the burden of anorexia and bulimia is increasing globally, emphasizing the need for earlier detection and better integration of appropriate care into mental health systems.

Your adult patient wants to quit smoking, and you're discussing options to help them. Nicotine replacement therapy (NRT) is a core tool in cessation, but what makes it different from smoking a cigarette? The answer goes beyond nicotine itself. It comes down to how it's delivered and what else patients are exposed to along the way.

It starts with the lungs

When a patient inhales cigarette smoke, nicotine is absorbed rapidly through the lungs, reaching the brain within seconds. Both the rapid delivery of nicotine and the behavioural rituals associated with smoking reinforce tobacco use. Simultaneously, combustion exposes the body to thousands of chemicals associated with cancer, cardiovascular disease, and respiratory illness.

A 2024 review published in Addiction examined treatments for tobacco use disorder. It found that nicotine replacement therapy remains an effective smoking cessation option, particularly when patches are combined with faster-acting formulations such as gum. For physicians, the findings reinforce the value of having different NRT delivery options available.

What changes with oral nicotine?

Oral NRT takes a different route. Instead of entering through the lungs, nicotine from products such as gum, lozenges and Health Canada–authorized nicotine pouches is absorbed through the lining of the mouth, known as the oral mucosa.

A 2025 systematic review found that, for the 4 mg nicotine pouches studied, blood nicotine concentrations peaked later and at lower levels than with cigarettes. In the pooled analysis of three trials, total nicotine exposure with the 4 mg pouches was estimated at 92% of that with cigarettes (95% CI 85%–98%). The trials measured nicotine delivery.

Unlike smoking, oral NRT delivers nicotine without exposing patients to the harmful combustion products found in cigarette smoke. Nicotine remains addictive, and NRT should be used according to product-specific instructions.

What does this mean for your patients?

Quitting smoking completely remains the best way to reduce smoking-related harm. But for patients who aren't ready to quit immediately, reducing cigarette consumption may be a step toward eventual cessation.

A Cochrane review published in 2016 involving eight trials and more than 3,000 participants found that NRT (gum, inhaler or a choice of NRT product) nearly doubled the likelihood of cutting cigarette consumption by at least half compared with placebo. Participants were also more likely to eventually quit, although the certainty of the cessation evidence was low, and evidence for long-term health benefits from smoking reduction alone remains limited.

For physicians, this is where pharmacology becomes practical. Nicotine drives dependence, but cigarette smoke is responsible for much of smoking-related disease. Understanding how nicotine delivery differs between smoking and NRT can help physicians address patient concerns and explain why nicotine replacement has a role in smoking cessation, even when patients aren't ready to quit immediately.

As daylight hours shorten and routines shift, patients may report fatigue, low energy, poor sleep or simply that they “don’t feel like themselves.” Some may already be self-managing with melatonin, magnesium or other sleep supplements.

While seasonal changes may affect sleep patterns, persistent fatigue, non-restorative sleep, snoring or worsening sleep quality warrant a closer look. Resolve’s existing clinical materials identify these symptoms, particularly when they persist despite self-management, as reasons to consider further sleep assessment.

When symptoms persist, consider asking about sleep.

Refer to Resolve Sleep Health for further sleep assessment.

1: 💉 Syphilis: an old, treatable disease that refuses to become ancient history. According to a new federal report, infectious syphilis rates more than quadrupled between 2014 and 2023, while congenital syphilis rates more than tripled between 2018 and 2023, with potentially devastating consequences, including stillbirth and infant death. Stigma and barriers to testing and treatment are part of the problem, experts say. They're urging healthcare providers to make sexual-health conversations less judgmental and bring rapid testing directly into communities.

2. 🔥 Where there's smoke, there's no shortage of devastation. A new Lancet Countdown report estimated that deaths associated with wildfire smoke in Canada have surged about 275% since the early 2000s — from roughly 1,050 annually in 2003–12 to 4,000 in 2021–25. Canada also lost 5.2 million hectares of tree cover in 2024, 86% of it to wildfires, leaving more smoke and less natural shade when temperatures soar. Researchers are calling for better cooling, smoke-ready health facilities, and cuts to greenhouse gas emissions.

3: 🌡️ Could Canadians be trading their parkas for light jackets this winter? A massive El Niño, nicknamed “Godzilla,” could bring unusually mild temperatures across much of the country. Temperatures in the eastern tropical Pacific have climbed 3.5 C above average, making this one of the strongest El Niño events on record. Meteorologists predict a warmer, drier winter, with less snow in Ontario, Quebec and the Maritimes. But don't pack away your snow shovel just yet. Extreme cold and heavy snowfall are still possible, while Western Canada could face increased drought and wildfire risks heading into 2027.

4: 🎉 Some good news for patients with type 2 diabetes. A Canadian-led randomized trial published in The Lancet Regional Health – Americas found that 54% of younger adults with type 2 diabetes achieved remission within 6 months through an intensive, medically supervised diet and exercise program, compared with just 4% receiving usual care. The study followed 96 adults aged 18 to 45, with participants in the intervention group also losing body fat while preserving muscle mass and improving fitness. The next question is whether those remission rates hold up over time.

2,500: how many microplastic particles researchers found were released into a single cup of tea from certain plastic tea bags. The new study also detected chemicals including BPA and phthalates. While the health implications remain unclear, the findings might make you think twice about your next tea break.

68: the age at which a Scottish engineer finished building his dream Porsche from scratch, more than 40 years after first falling in love with the car. Unable to afford a Porsche 904, he spent 8 years designing, engineering, even welding his own replica. He called it the 904FF — a 904 "effing fake."

🍳 Make: Comfort food with a protein boost? This cheesy chicken, spinach and Parmesan spaghetti squash gratin packs 28 grams of protein per serving. A cozy fall dinner without the pasta.

✈️ Travel: Dreaming of a getaway between shifts? Condé Nast Traveler has revealed its 50 best resorts in the world for 2026, as voted by readers. From tropical hideaways to luxurious mountain retreats, consider this your excuse to start planning that next vacation.

📚 Learn: Could you be missing patients who need viral hepatitis screening? This free accredited microlearning series explores practical strategies for identifying at-risk patients and making screening part of routine primary care.

💰 Save: Still using an older streaming device? Amazon's Fire TV Stick 4K Max is currently 50% off, bringing the price from $129.99 down to $64.99. Something to consider before your next movie night.

First clue: ___-care

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