Pomegranate Health

Despite filling more than half of places in Australian medical schools, women represent 45 per cent of all medical practitioners and just 36 per cent of specialists. Female representation dwindles further in many areas of clinical leadership, prompting what has been termed a “leaky pipeline”. It has been reported that women would progress at similar rates to men, and achieve similar remuneration, were it not for the time taken out from the profession to raise children. In this podcast we discuss what it would take to mitigate this so-called “motherhood penalty” through policy, workplace culture and better distribution of labour in the home. This discussion is important because it relates not just to the wellbeing and rights of individual medics, but also to the depth and diversity of the workforce.acity struggles to keep up with demand.  Chapters1:38 Better support of returning mothers in return to work 9:09 How leave and part-time work affects the medical workforce and the benefits of flexibility19:56 The “motherhood penalty” on career progression of women to senior positions 33:52 Broader biases in society not just around gender roles but a health work-life balance CreditsGuestsAssociate Professor Kara Allen FANZCA (Royal Melbourne Hospital; University of Melbourne) Dr Jenny Proimos FRACP (Royal Children's Hospital Melbourne; Monash Centre for Health Research and Innovation; ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Melting Places' by Andres Cantú, ‘Not Blue' by Kylie Dailey. Music courtesy of Free Music Archive includes ‘Good Days' by Cody Francis, ‘Planting Flags' by Blue Dot Sessions,  ‘Helice' by Monplaisir, ‘Feeling Minnesota by Gavin Luke, and ‘Maybe This Time' by Major Tweaks. Image by George Peters licenced through Getty Images. Editorial feedback kindly provided by RACP physicians Zac Fuller, Aidan Tan, Joseph Lee, David Skalicky, and Stella Sarlos. Thanks also to RACP staff Arnika Martus and Kathryn Smith. Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health' in Apple Podcasts, Spotify, Castbox or any podcasting app.

ST elevation is clearly a worrying finding that can herald life-threatening conditions, such as ST elevation myocardial infarction. But not all ST-elevations are created equal, and Trainees would benefit from considering a broader number of causes for this presentation. In today's podcast the team will discuss a case of ST elevation observed in a 65-year-old female during the routine elective procedure of atrial fibrillation ablation. A range of pathophysiologies is discussed that can help listeners work though the differentials in a systematic way. Guests Assoc Prof Pramesh Kovoor FRACP FACC PhD (Westmead Hospital; the University of Sydney) Dr Neil Warwick FANZCA (Westmead Hospital) HostsAssociate Professor Stephen Bacchi FRACP (University of Adelaide)Dr Joshua Kovoor (Ballarat Base Hospital)ProductionProduced by Stephen Bacchi and Mic Cavazzini. Music licenced from Epidemic Sound includes ‘Rockin' for Decades' by Blue Texas and ‘Brighton Breakdown' by BDBs. Game show music courtesy of Waderman. Image created and copyrighted by RACP. Editorial feedback kindly provided by RACP physicians Aidan Tan, Aafreen Khalid, Hugh Murray and medical student Nivida Dixit.Key Reference (Spoiler Alert)* * * * *Metaraminol-induced coronary vasospasm masquerading as ST-elevation myocardial infarction during general anaesthesia [Br J Anaesth. 2024] Please visit the Pomegranate Health web page for a transcript and supporting references.Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health' in Apple Podcasts, Spotify,Castbox or any podcasting app.

There is evidence that six months or more off the job leads to some loss of practical skills and knowledge and certainly, many doctors a loss of self-confidence. People take time out from medical practice for many different reasons but career breaks to raise children are more common than ever before. Paediatrics is one specialty where female representation exceeds 70 percent and it is also becoming more common for new fathers to take leave as primary carers. Senior staff at Sydney Children's Hospital have developed a day-long workshop to help medics brush off the cobwebs before they return to practice. It involves rehearsal of specific skills, refreshers on calculation and interpretation tasks and a high-fidelity critical care simulation. Just as importantly, there is open discussion and mentorship to support the transition back to work. The program is called Paediatric Returnees after Maternity or Extended Leave (PRAM) this podcast was recorded during a live workshop at the Kids Simulation Centre, Randwick.  GuestsWorkshop participants: Elodie, Eliza, Emma, April, Stephanie, Lucy and Paula. PRAM creators:Dr Josephine Goodyer FRACP (Sydney Children's Hospital, Randwick) Dr Sasha Symonds FRACP FACEM (Sydney Children's Hospital, Randwick) Renee Byrne (Sydney Children's Hospital, Randwick) ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Elm Lake' by Elm Lake, ‘Quiet Waters' by Walt Adams, ‘Illuminations 4' by Johannes Bornlöf, ‘Feeling Minnesota by Gavin Luke, and ‘Maybe This Time' by Major Tweaks. Image by Maskot licenced through Getty Images. Editorial feedback kindly provided by RACP physicians Sasha Taylor, Stephen Bacchi,Simeon Wong, Zac Fuller, Hugh Murray, Aidan Tan, Sern Wei Yeoh, Sasha Taylor and Stella Sarlos. Thanks also to RACP staff Arnika Martus and Kathryn Smith. Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity.  

In this episode we hear about an emergency presentation to a South Australian hospital, of a 74-year-old male with shortness of breath. The curve ball is that he had undergone ablation for drug-refractory atrial fibrillation less than two weeks prior. This discussion gives an overview of developing technologies for AF treatment and developing knowledge about the possible complications. We also have some multiple choice questions to test your understanding.Guest Dr Shaun Evans, FRACP (Royal Adelaide Hospital; University of Adelaide) HostsAssociate Professor Stephen Bacchi (Massachusetts General Hospital; University of Adelaide)Jasmine Le (University of Adelaide) ProductionProduced by Stephen Bacchi and Mic Cavazzini. Music licenced from Epidemic Sound includes ‘Rockin' for Decades' by Blue Texas and ‘Brighton Breakdown' by BDBs. Image created and copyrighted by RACP. Editorial feedback kindly provided by RACP physicians Hugh Murray, Aidan Tan, Aafreen Khalid, Sebastiaan Lambooy, Amy Hughes and Lauren Gomes.  Key Reference (Spoiler Alert)*****Delayed cardiac tamponade from pericarditis following pulmonary vein cryo-balloon ablation [IMJ. 2020] Please visit the Pomegranate Health web page for a transcript and supporting references.Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health' in Apple Podcasts, Spotify,Castbox or any podcasting app.

In Aotearoa-New Zealand, the proportion of doctors identifying as Māori has doubled from where it was a decade ago to over 5 percent. But there is still a long way to go before the workforce is representative of the broader population which is 17 percent Māori.The Auckland and Otago Medical Schools have in recent years turbocharged their intake of Māori and Pasifika students but these graduates don't seem to have trickled through to the RACP in great numbers. Just 3.5 percent of general physicians and 4.8 percent of paediatricians identify as Māori, and Pasifika doctors make up a further 1 and 2 percent respectively.In this podcast, three Māori medics discuss how the culture of training environments can be made more welcoming to junior doctors with diverse ethnic backgrounds. This discussion takes place in light of an independent review into the clinical examination for paediatrics in Aotearoa-New Zealand which found issues with standardization, transparency and cultural safety. 2024 was a tough year for Māori Health more broadly, as it saw the disestablishment of a dedicated Health Authority, Te Aka Whai Ora, after just twelve months of operation. Guests Dr Danny de Lore FRACP (Rotorua Hospital; University of Auckland)Dr Matthew Wheeler FRACP (Tauranga Hospital; University of Auckland)Dr Ngaire Keenan PhD (Sydney Children's Hospital, Westmead; University of Otago)ProductionProduced by Mic Cavazzini DPhil. Music provided courtesy of FreeMusicArchive includes ‘Periodicals', ‘In Paler Skies' by Blue Dot Sessions and ‘Wake Up' by Kai Engel. Music licenced from Epidemic Sound includes ‘Subdivision of the Masses' by Philip Weigl and ‘Abyss' by Luwaks. Image of Dr Danny de Lore property of RACP  Editorial feedback kindly provided by RACP physicians Zac Fuller, Aidan Tan, Hugh Murray, Sasha Taylor, Anne-Marie Juengling and Simeon Wong. Thanks also to RACP staff Nick McCurdy and Sarah Millar. Please visit the Pomegranate Health web page for a transcript and supporting references.Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health' in Apple Podcasts, Spotify,Castbox or any podcasting app. 

This case report comes to you from Brigham and Women's Hospital in Boston, a huge teaching hospital that serves the Harvad Medical School. The 52-year-old female presented with clumsiness and paresthesia of the right hand that had persisted for several days. She also had a headache and three weeks prior to presentation had undergone a suboccipital craniotomy for a Chiari I malformation. To complicate things, there was a past medical history of migraines and a family history of a Factor V Leiden mutation. The identified diagnosis is one in which evidence is limited for aspects of management, and the topics of uncertainty and mentorship in medicine also arise in this discussion.Guest Galina Gheihman, MD D (Brigham and Women's Hospital; Harvard Medical School) HostsAssociate Professor Stephen Bacchi (Massachusetts General Hospital; University of Adelaide)HaeLynn Gim (Harvard Medical School) ProductionProduced by Stephen Bacchi and Mic Cavazzini. Music licenced from Epidemic Sound includes ‘Rockin' for Decades' by Blue Texas and ‘Brighton Breakdown' by BDBs. Image created and copyrighted by RACP. Editorial feedback kindly provided by Dr Sebastiaan Lambooy.Key Reference (Spoiler Alert)* * * * *Isolated Cortical Vein Thrombosis [Neurohospitalist. 2023]  Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health' in Apple Podcasts, Spotify,Castbox or any podcasting app.

Professor Gary Lee established the first dedicated pleural service in the southern hemisphere in 2009, at the Sir Charles Gairdner Hospital in Perth. He says that pleural disease has finally come to be regarded as an area of subspeciality interest in its own right, not just a complication of other comorbidities. In this podcast he presents a potted history of key developments in the management of pleural effusion in particular. This is diagnosed in about 60,000 people every year in Australia, mainly as a result of infection or malignancy. With mentors in the UK, Professor Lee conducted some of the earliest trials on fibrinolytics and DNAses to break down purulent effusions. They also put to the test protocols for pleurodesis via talcum insufflation that date back to the 1930s. Professor Lee's more recent clinical research has focused on the use of indwelling pleural catheters that a patient can use to drain pleural effusate when feeling breathless. He has also a made an important contribution to conservative management guidelines for primary spontaneous pneumothorax. This story is great example of how clinical practice emerges imperfectly from a soup of evidence, accidents, human biases and system. Guest Prof Gary Lee PhD FRACP FRCP FCCP (Pleural Service, Sir Charles Gairdner Hospital in Perth; University of Western Australia).Co-hostDr Marion Leighton FRACP (Wellington Hospital).ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Reconstruct' by Amaranth Cove, ‘Nagba Algooah' by Ebo Krdum. ‘Vittoro' by Borrtex provided courtesy of FreeMusicArchive. Image by ilbusca licenced through Getty Images.   Editorial feedback kindly provided by RACP physicians Aidan Tan, Maansi Arora, Simeon Wong, Hugh Murray and Vanessa Wong.Please visit the Pomegranate Health web page for a transcript and supporting references.Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health' in Apple Podcasts, Spotify,Castbox or any podcasting app.

This case report describes a 42-year-old male from Arizona with a complex course characterised by fever following an orthotopic liver transplant. A general approach to fever in the post-transplant patient is discussed, along with specific considerations regarding travel in post-transplant patients or those on immunosuppressants for other indications. A/Prof Camille Kotton and Dr Simran Gupta from the Massachusetts General Hospital and Brigham and Women's Hospital take listeners through the case and related issues in a step-by-step manner at a level targeted for trainees and generalists.Guest A/Prof Camille Kotton (Massachusetts General Hospital, Harvard University)Dr Simran Gupta (Brigham and Women's Hospital, Harvard University) HostsAssociate Professor Stephen Bacchi FRACP (Fulbright Fellow, Mass General Brigham; University of Adelaide)Christina Gao (University of Adelaide)ProductionProduced by Stephen Bacchi and Mic Cavazzini. Music licenced from Epidemic Sound includes ‘Rockin' for Decades' by Blue Texas and ‘Brighton Breakdown' by BDBs. Image created and copyrighted by RACP. Editorial feedback kindly provided by doctors Maansi Arora, Brandon Stretton, Matt Lim and Ben Cook.Key Reference (Spoiler Alert)* * * * *Coccidioidal Meningitis after Liver Transplantation in a Nonendemic Region: A Case Report [Transplantation 2006]Please visit the Pomegranate Health web page for a transcript and supporting references.Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health' in Apple Podcasts, Spotify,Castbox or any podcasting app.

In the previous episode we heard how some rationally-designed therapies work on almost any cancer with the right molecular signature. Tumour-agnostic medications could be godsend for patients with rare cancers which have classically been overlooked by drug developers, and those with advanced cancers of unknown origin. 15,000 such patients have undergone comprehensive genome profiling of their tumours through the organisation, Omico. In this podcast, Omico's founder explains that while the majority have received recommendations about matched therapies, clinical trials are typically the only way to enable access. Professor David Thomas discusses why Australia's Health Technology Assessment process appears to be so conservative and how the market price of next-generation oncotherapies might be brought down by changes across the local ecosystem. Guest Prof David Thomas FRACP PhD (Director, Centre for Molecular Oncology UNSW; Founder and Chief of Science, Omico)  Professor Thomas or Omico have received grants, consultancies or research support from Roche, Astra Zeneca, Pfizer, Eisai, Illumina, Beigene , Elevation Oncology, RedX Pharmaceuticals, SunPharma , Bayer, George Clinical, Novotech , Merck Sharpe and Dohme, Boehringer Ingelheim, Hummingbird, Microba , BioTessellate , PMV Pharma, Australian Unity and Foundation Medicine. ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes  ‘Multicolor' and ‘Pulse Voyage' by Chill Cole. ‘Impulsing', ‘the City of Hope' ‘Over Again', and ‘Going Undercover' by Borrtex provided courtesy of FreeMusicArchive. Image by Guido Mieth licenced through Getty Images.  Editorial feedback kindly provided by RACP physicians Simeon Wong, Stephen Bacchi. Thanks also to Kym Bramich and Arnika Martus on staff with Omico and RACP respectively.  Please visit the Pomegranate Health web page for a transcript and supporting references.Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health' in Apple Podcasts, Spotify,Castbox or any podcasting app.

The genomic understanding of cancer has transformed a tissue-based classification model that had been dominant for 150 years or more. The last three decades have seen highly targeted therapies developed at blistering pace, and unprecedented improvements in patient outcomes. To date, these advances have been focused on more common cancers. The financing model for drug development means that rare cancers get overlooked, given the small pool of potential buyers relative to the costs and risks of investment. However, the molecular targets characterised in more common cancers are often found in cancers of a different histotype. As such, precision therapies will sometimes have tissue-agnostic efficacy and offer a lifeline for patients with neglected diseases or cancers of unknown origin. Professor David Thomas has founded an NGO called Omico to enable such patients to undergo profiling for hundreds of potential molecular targets. In this interview he explains the rationale for the most promising pan cancer therapies, and in the next episode we discuss changes to the regulatory and funding model required to sustain this screening program. Guest Prof David Thomas FRACP PhD (Director, Centre for Molecular Oncology UNSW; Founder and Chief of Science, Omico) Professor Thomas or Omico have received grants, consultancies or research support from Roche, Astra Zeneca, Pfizer, Eisai, Illumina, Beigene , Elevation Oncology, RedX Pharmaceuticals, SunPharma , Bayer, George Clinical, Novotech , Merck Sharpe and Dohme, Boehringer Ingelheim, Hummingbird, Microba , BioTessellate , PMV Pharma, Australian Unity and Foundation Medicine. ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘the Orchard' by Jakob Ahlbom, ‘Dusty Electronics' and ‘Pulse Voyage' by Chill Cole, ‘Tam' by LJ Kruzer, ‘See you soon' and ‘Going Undercover' by Borrtex. Image by filo licenced through Getty Images. Editorial feedback was kindly provided by RACP physicians Nichola Ball, Stephen Bacchi, Aafreen Khalid, Simeon Wong, Maansi Arora and Aidan Tan.Please visit the Pomegranate Health web page for a transcript and supporting references.Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health' in Apple Podcasts, Spotify,Castbox or any podcasting app.

This case report describes a 35-year-old Caucasian male presenting with 5 weeks of progressive weakness in the proximal limbs and trunk and associated changes to the skin. The man was previously well and not taking any regular medications. There are many pathways this undifferentiated patient could go down. Consultant physician, Professor Josephine Thomas demonstrates a systematic way to work through the differential diagnoses as would be expected in a long-case presentation for basic physician training exams. She's the Clinical Dean for the Adelaide Medical School at the Northern Adelaide Local Health Network.GuestProf Josephine Thomas FRACP FRACGP FANZAPHE PhD (Northern Adelaide Local Health Network; University of Adelaide)HostsAssociate Professor Stephen Bacchi (Massachusetts General Hospital; University of Adelaide)Dr Caleb Chong (Northern Adelaide Local Health Network) ProductionProduced by Stephen Bacchi and Mic Cavazzini. Music licenced from Epidemic Sound includes ‘Rockin' for Decades' by Blue Texas and ‘Brighton Breakdown' by BDBs. Image created and copyrighted by RACP. Editorial feedback kindly provided by Dr Brandon Stretton and Ben Cook.Key Reference (Spoiler Alert)*****A case of haemorrhagic myositis with concurrent anti-Ro52 and anti-NXP-2 antibodies treated with plasmapheresis [Rheumatology. 2020]Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health' in Apple Podcasts, Spotify,Castbox or any podcasting app.

In 2019 a man was referred to Royal Adelaide Hospital with worsening breathlessness and a productive cough. He was a 47 year old electrician with a history of tobacco smoking who'd been well before the onset of symptoms. Over a couple of admissions the patient's condition progressed to type 2 respiratory failure. While the ultimate explanation for this presentation was a bit of a unicorn, the dramatic escalation of examinations and interventions runs through some textbook respiratory medicine; ECMO, infectious diseases, bronchoscopy, CT, interpretation of blood gases and the alveolar gas equation, stenting and ultimately transplantation. This is discussed in the careful manner expected of a long-case presentation in the physician training exams.GuestDr Thomas Crowhurst FRACP (Northern Adelaide Local Health Network)HostsAssociate Professor Stephen Bacchi (Lyell McEwin Hospital; University of Adelaide)Dr Brandon Stretton (Central Adelaide Local Health Network)ProductionProduced by Stephen Bacchi and Mic Cavazzini. Music licenced from Epidemic Sound includes ‘Rockin' for Decades' by Blue Texas and ‘Brighton Breakdown' by BDBs. Image created and copyrighted by RACP. Editorial feedback kindly provided by RACP physicians Aidan Tan and Fionnuala Fagan.Key Reference (spoiler alert)*****Case report of severe bronchial web-like stenoses after 'surviving the unsurvivable' [BMC Pulm Med. 2019] Please visit the Pomegranate Health web page for a transcript and supporting references.Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health' in Apple Podcasts, Spotify,Castbox or any podcasting app.

Thrombectomy for acute ischaemic stroke has undergone great advances in the last decade, but the expertise and technology is restricted to tertiary hospitals. Outside of large metropolitan centres, thrombolytic treatment can buy a patient time, but for almost 30 years the first line agent has remained unchanged. Alteplase is an analog of the human tissue plasminogen activator which activates plasmin to dissolve fibrin blood clots. For many years it was assumed that alteplase should be administered within 3 hours of symptom onset, thus it was a big deal when in 2008, research showed that that window could be safely broadened out to four and a half hours.Today's guests have over the intervening years been pushing the envelope even further, in an effort to help the more than two thirds of stroke patients who present after that threshold. In this podcast, Professors Bruce Campbell and Mark Parsons discuss a trial of the relatively novel agent, tenecteplase. The publication in the New England Journal of Medicine showed that tenecteplase could improve patient outcomes even if administered up to 24 hours out from a large vessel occlusion. The researchers explain the steps that led up to their study, and the importance of perfusion imaging to identify candidates with salvageable brain tissue. Key ReferenceTenecteplase for Ischemic Stroke at 4.5 to 24 Hours without Thrombectomy [NEJM. 2024]GuestsDr Duncan Austin PhD FRACP MRCP (Cabrini Health) Professor Bruce Campbell PhD FRACP (Cabrini Health; Royal Melbourne Hospital; University of Melbourne) Professor Mark Parsons PhD FRACP, FAAHMS (Sydney Neurointerventional Specialists; Consulting in Neurology, Maitland). ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Things to Sort Out' by Walt Adams and ‘the Appalachian Trail' by Hunter Quinn. Image produced and copyrighted by RACP.Editorial feedback kindly provided by RACP physicians Stephen Bacchi, Aidan Tan, Courtney Dowd, Saion Chaterjee and David Arroyo.  Please visit the Pomegranate Health web page for a transcript and supporting references.Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health' in Apple Podcasts, Spotify,Castbox or any podcasting app.

This podcast follows the case of a 48-year-old male with a 3-month history of diarrhoea and associated lymphadenopathy. A complex constellation of symptoms accompanies this presenting complaint, along with a key radiological finding that enabled the treating team to arrive at the correct diagnosis. Can you arrive at the correct diagnosis before the treating team? This case was managed at the Queen Elizabeth Hospital and is presented by Dr Andrew Vanlint from the Northern Adelaide Local Health Network and University of Adelaide.CreditsDr Andrew Vanlint FRACP AFRACMA (Northern Adelaide Local Health Network and University of AdelaideAssociate Professor Stephen Bacchi (Lyell McEwin Hospital; University of Adelaide) ProductionProduced by Stephen Bacchi and Mic Cavazzini. Music licenced from Epidemic Sound includes ‘Rockin' for Decades' by Blue Texas and ‘Brighton Breakdown' by BDBs. Image created and copyrighted by RACP. Editorial feedback kindly provided by RACP physician David Arroyo.Key Reference (Spoiler Alert)* * * * *Lessons from practice: Low attenuation lymphadenopathy on computed tomography leading to diagnosis of Whipple disease [Vanlint; Med J Aust. 2020] Please visit the Pomegranate Health web page for a transcript and supporting references.Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health' in Apple Podcasts, Spotify,Castbox or any podcasting app.

This recording comes from the launch of the 2nd Monitoring and Evaluation Report on Hepatitis C Elimination in NSW. The work was conducted through the Kirby Institute under the guidance of infectious diseases specialist, Professor Greg Dore. As presented in this seminar, data show that the state is on track to meet the 2025 target set by NSW Health, and the national target for 2030, but there have been surprises along the way that have required an adaptable approach to surveillance and intervention. This is particularly true in correctional settings which typically have high rates of hep C transmission due to the amount of injecting drug use that takes place coupled with an absence of needle exchange programs. Presenting on this theme was Colette McGrath, who is General Manager of Population and Preventative Health for Justice Health NSW. Her very pragmatic approach is informed by almost a decade of experience working with this population.  Key ReferenceHepatitis C Elimination in NSW: Monitoring and Evaluation Report, 2024 [Kirby Institute]Video Recording from launch eventGuestsProf Greg Dore FRACP (Kirby Institute, Viral Hepatitis Clinical Research Program Head; St Vincent's Hospital). Colette McGrath (Population and Preventative Health, General Manager, Justice Health NSW)ProductionRecorded by Kirby Institute staff. Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Southern Sun' and ‘Quiet Waters' by Walt Adams, ‘Train Ride' by Alex Kehm and ‘The Appalachian Trail' by Hunter Quinn. Image produced and copyrighted by RACP.Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health' in Apple Podcasts, Spotify, Castbox or any podcasting app. 

Dr Karan Singh loves his job as a registrar in nuclear medicine but he thinks there isn't enough exposure to the specialty during medical school and basic training. In this podcast we spend a day in his department at Prince of Wales Hospital Sydney and get a taste of the many different referrals that come his way; a bone scan for a young man experiencing leg spasms after recovering from a car crash; myocardial perfusion imaging for an elderly gentleman with coronary artery disease; staging for prostate and breast cancer; and radiation therapy for a toxic multinodular goiter. The “reality audio” format gives a good sense of the daily tasks and responsibilities involved in this career pathway.CreditsDr Karan SinghStaff and patients at Prince of Wales Nuclear Medicine and PET DepartmentProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Salty Sails' and ‘Nuna' by Sindrandi, ‘Between Four Eyes' by Czar Donic, ‘Organic Textures 2' by Johannes Bornlöf and ‘Punjabi Swag' by Aks and Lakshmi. Image by JohnnyGreig licenced through Getty Images. Editorial feedback kindly provided by RACP physicians Jamie Bellinge, Joseph Lee, Sern Wei Yeoh, Zac Fuller and Stephen Bacchi.Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity. 

The LACE index is a prognostic algorithm for predicting the likelihood that a newly discharged patient will come back into hospital within 30 days because of complications. Today's IMJ paper describes a validation of the LACE index in a regional Victorian setting. Identifying patients who are at risk could allow for better targeted care at the first admission, reducing harm to patients and inefficient use of healthcare resources.  The researchers also tested a novel classification tool for scoring which readmissions are avoidable and which are just an unfortunate outcome of the patient's illness. This could help more accurately track quality of care within and between healthcare service providers.GuestsProf Christian Gericke PhD FRACP FAFPHM AFRACMA FRCP Edin FEAN FAAN (Calvary Mater, Newcastle; University of Newcastle; University of Queensland) Dr Reinhardt Dreyer (South West Medicine ; University of Stellenbosch) Dr James Gome FRACP (South West Medicine, Clinical Director General Medicine) ProductionProduced by Mic Cavazzini. Music licenced from Epidemic Sound includes ‘Treetops' by Autohacker and ‘The Cold Shoulder' by Kylie Dailey. Image created and copyrighted by RACP. Editorial feedback kindly provided by RACP physicians Aidan Tan, Joseph Lee, David Arroyo and Stephen Bacchi.Key ReferenceCauses for 30-day readmissions and accuracy of the LACE index in regional Victoria, Australia [IMJ. 2024]Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health' in Apple Podcasts, Spotify,Castbox or any podcasting app.

This podcast follows the case of a 58 year old man who presented to the haematology department at Flinders Medical Centre with intravascular coagulation and leukocytosis. He was diagnosed with acute myeloid leukaemia and treated on standard cytarabine and daunorubicin combination therapy. Nine days after initiation, the patient developed painless diplopia and ptosis, and the story is picked up with a referral to the neurology department. GuestsAssociate Professor Stephen Bacchi (Lyell McEwin Hospital; University of Adelaide)Dr James Triplett FRACP (Flinders Medical Centre, consultant neurologist) ProductionProduced by Stephen Bacchi and Mic Cavazzini. Music licenced from Epidemic Sound includes ‘Rockin' for Decades' by Blue Texas and ‘Brighton Breakdown' by BDBs. Image created and copyrighted by RACP. Editorial feedback kindly provided by RACP physicians Aidan Tan and Brandon Stretton.Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity.Key Reference and Learning Points (Spoiler Alert)********Painless progressive mononeuritis multiplex secondary to AML associated neuroleukemiosis [J Neuroimmunol. 2023]  (1) Chemotherapy can have neurological complications, including chemotherapy induced peripheral neuropathy (e.g., oxaliplatin).(2) A third (oculomotor) cranial nerve palsy has multiple possible causes, which can be divided into painful vs painless causes, and compressive (classically with pupillary involvement) vs non-compressive (can spare pupil, as with microvascular insult) causes.(3) Conduction block is shown by a significant reduction in compound muscle action potential, between proximal and distal stimulation, the criteria for which varies by nerve.(4) Ascertaining whether conduction block occurs at compressible vs non-compressible sites can be a useful distinguishing feature for the various possible causes e.g. including compression, demyelination, and ischaemia, and (5) Mononeuritis multiplex, while classically associated with a vasculitic neuropathy, has a number of causes, including leukaemia. This is the very rare condition known as neuroleukemiosis.

The RACP Congress in May this year was opened by a fascinating lecture on mental health in the medical workforce, which has been trimmed down for audio. Professor Neil Greenberg is an occupational psychiatrist with more than 23 years in the UK Armed Forces. His extensive research within defence and health settings has informed a very pragmatic understanding of the impact of trauma and relationships in the workplace. Professor Greenberg overturns some entrenched beliefs we have about the presentation and management of mental illness, as does guest host Dr David Beaumont from the College Member Health and Wellbeing Committee. He reflects on the role of the Committee and how his own understanding of health has shifted in response to personal distress.GuestsProfessor Neil Greenberg FRCPsych, FHEA, MFMLM, MInstLM, MEWI, MFFLM (Kings College, London; March on Stress) Dr David Beaumont FAFOEM (Positive Medicine, Director; RACP Member Health and Wellbeing Committee)ProductionProduced by Mic Cavazzini. Music licenced from Epidemic Sound includes ‘Blacklight' by John B. Lund and ‘Lukas Got Lucky' by Rate 44. Image by Richard Drury licenced through Getty Images.Editorial feedback kindly provided by RACP physicians David Arroyo, Stephen Bacchi, Nele Legge, Ronaldo Piovezan, Rachel Murdoch, Aidan Tan and Rachel Bowden.Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health' in Apple Podcasts, Spotify,Castbox or any podcasting app.Counselling SupportCollege EAP Member service provided by TELUS Health Australia: 1300 361 008Aotearoa-NZ: 0800 155 318 (Aotearoa New Zealand). See also the TELUS wellbeing app.Doctor's Health Advisory Service HelplineAotearoa-NZ:  800 471 2654NSW/ACT: 02 9437 6552VIC:      03 9280 8712TAS:     03 9280 8712SA:       08 8366 0250NT:       08 8366 0250QLD:    07 3833 4352WA:     08 9321 3098 LifelineAustralia: 13 11 14. Aotearoa-NZ: 0800 54 33 54

Starting in 2023, the Medical Board of Australia and the Medical Council of New Zealand brought in what were called “Strengthened CPD” requirements. These put more focus on reviewing performance through self-reflection and peer feedback described in the RACP's MyCPD Framework as a Category 2 activity. To help synchronise CPD seamlessly with practice, the value of supervision as a reflective activity has been recognised in the 2024 framework. Time spend supervising trainees can now be counted towards Category 2 CPD “Reviewing Performance” rather than Category 1. In this short and insightful podcast, two of the RACP's most passionate medical educators explain the rationale for this shift, and how to use MyCPD tools to streamline the process of planning and recording CPD. GuestsAssociate Professor Kudzai Kanhutu FRACP GAICD (College Dean; Royal Melbourne Hospital; University of Melbourne)Professor Martin Veysey FRACP, FRCP (Gastro Healthcare; Australian National University) Production CPD OnDemand project production by Rebecca Lewis and David Tarr. Audio editing by Mic Cavazzini. Music licenced from Epidemic Sound includes ‘Bookies' by Jones Meadow and ‘Love Thing' by Paisley Pink. Image created and copyrighted by RACP.For more podcasts that you can credit to Category 1 CPD , please visit the Pomegranate Health web page. And there are many more educational videos and eLearning resources at RACP Online Learning.    

This case report has been developed by Trainees, to assist their peers with preparation of long-case presentations. It is not a fully-vetted Education resource but a “passion project” from editors of the Pomegranate Health podcasts.  The case is that of a 32-year-old woman presenting with constant and dull abdominal pain that had been sudden in onset. The pain is accompanied by nausea and vomiting but bowel habits were unchanged. The patient has a history of type 1 diabetes and a simultaneous pancreas-kidney transplant two years prior to the presentation. There is no history of rejection of pancreatitis and serum creatinine appears normal.  The attending nephrologist walks through the elimination of differential diagnoses typical of any patient and also of particular relevance to a transplant patient.  GuestsDr Chiang Sheng Lee FRACP (Lyell McEwin Hospital; University of Adelaide)Dr Stephen Bacchi (Lyell McEwin Hospital)Dr Amitjeet Singh (Lyell McEwin Hospital)ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Rockin' for Decades' by Blue Texas and ‘Brighton Breakdown' by BDBs. Image created and copyrighted by RACP. Editorial feedback kindly provided by RACP physicians Aidan Tan, Brandon Stretton, David Arroyo, Keith Ooi and Fionnuala Fagan. Thanks also to Adelaide medical students Benjamin Cook, Srishti Sharma and Prakriti Sharma.Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity. Key Reference (Spoiler Alert)*********Gadolinium-Induced Acute Graft Pancreatitis in a Simultaneous Pancreas-Kidney Transplant Recipient [Case Rep Nephrol. 2022]

Australia is a big continent and sparsely populated continent. 28 percent of Australians live in areas classified regional, rural or remote and their access to health services is much more limited. It's estimated that between 2009 and 2011 there were 19,000 excess deaths in regional and remote areas as compared to the major cities. No doubt, socioeconomic disadvantage is factor in that mortality gap, but inequitable access to healthcare is also a major driver. In this podcast we focus specifically on the shortage in health practitioners in the regions. Even in regional centres, the density of physicians by population count is two thirds what it is in the major cities. By the time you get to large rural towns it's just over a third that baseline. In this podcast we discuss opportunities to lift recruitment and retention. This means improving the experience for trainees and the esteem for rural medicine in the eyes of the profession at large.Guests​Adjunct Professor Graeme Maguire PhD FRACP MHM MPHTM (President Adult Medicine Division, RACP and Director of Medical Education, WA Country Health Service)Dr Sarah Straw FRACP (WACHS Kimberley Regional Physician Team; Northern Hospital, Melb; Rural, Regional and Remote Working Group, RACP)​Associate Professor Matthew McGrail PhD (Head Regional Training Hub Research, University of Queensland)ProductionProduced by Mic Cavazzini DPhil. Music courtesy of FreeMusic Archive includes ‘The Envelope', ‘Cast in Wicker' and ‘Planting Flags' by Blue Dot Sessions. Music licenced from Epidemic Sound includes ‘The Mission' by J. F. Gloss. Photo by Pearshop on behalf of RACP. Editorial feedback kindly provided by RACP physicians Steve Flecknoe-Brown, Zac Fuller, Aidan Tan, Sasha Taylor, Jia Wen Chong, Joseph Lee, Fionnuala Fagan, Stephen Bacchi, Chris Leung, David Arroyo, Nele Legge, Li-Zsa Tan and Thazin Thazin.Please visit the Pomegranate Health web page for a transcript and supporting references.Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health' in Apple Podcasts, Spotify,Castbox or any podcasting app. 

Pomegranate [Case Report] is a Q&A style podcast developed by trainees, for trainees. In our debut episode, we hear about w a who man presented to the emergency department reporting sudden onset vision loss in his right eye lasting several hours. He was 68 year old with a history of type 2 diabetes mellitus. Three differential diagnoses being considered were optic neuropathy, vitreoretinal disease, or corneal oedema following from potential uveitis. In this podcast consultant ophthalmologist, Dr Sumu Simon, walks through an approach to this presentation and an exploratory therapy.GuestsDr Sumu Simon FRANZCO (Queen Elizabeth Hospital; Royal Adelaide Hospital) Dr Brandon Stretton (Royal Adelaide Hospital) Dr Stephen Bacchi (Lyell McEwin Hospital)ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Rockin' for Decades' by Blue Texas and ‘Brighton Breakdown' by BDBs. Image created and copyrighted by RACP. Editorial feedback kindly provided by RACP physicians Aidan Tan and Fionnuala Fagan. Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity. Key Reference and learning points (spoiler alert)The Role of Tocilizumab in Glucocorticoid Resistant Giant Cell Arteritis: A Case Series and Literature Review [J Neuroophthalmol. 2023;43(1)] 1.      This case underscores the critical nature of timely diagnosis and aggressive treatment in conditions like giant cell arteritis (GCA), where delayed treatment can lead to irreversible complications such as vision loss. Thorough history taking and clinical acumen are still key elements in establishing a diagnosis of GCA.2.      The patient's initial response and subsequent decline in vision illustrate the need for ongoing monitoring and readiness to adapt the treatment approach. It also shows the necessity of close monitoring of inflammatory markers and clinical symptoms.3.      Amaurosis fugax warrants urgent referral to an ophthalmologist.4.      High index of suspicion for GCA and prompt referral of GCA suspects will ensure best outcome for patients.5.      Progressive visual loss and elevated inflammatory markers should alert the clinician to glucocorticoid-resistant GCA.6.      The effectiveness of tocilizumab in this case highlights its role as a valuable treatment option for refractory GCA, especially when traditional therapies are not sufficiently effective. Targeted biologic agents may open up new treatment approaches in the future particularly in patients with progressive visual loss despite administration of intravenous methylprednisolone. 7.      Managing complex cases like GCA often requires a collaborative approach involving rheumatologists, ophthalmologists, and other specialists to ensure comprehensive care and optimal outcomes.8.      There is often value in case reports to start the evidence cascade that is required to bring new, life altering treatments to the forefront. 

Type 1 diabetes has a very high treatment burden in terms of direct costs, inconvenience and lost productivity for patients and their carers. Further, all the glucose checking, hormone replacement and consults don't abolish the vascular complications associated with poor glycaemic control. Only in the last few years has it been possible to pharmacologically alter the course of type 1 diabetes and other auto-immune diseases without generating intolerable side effects.Teplizumab is an antibody to CD3 which was presented to the world in 2019 as delaying the onset of type 1 diabetes in high-risk individuals thanks to its protective effect on pancreatic β-cells. It has not yet been registered by the Therapeutic Goods Administration but another immunomodulatory drug called baricitinib has. Baricitinib is an inhibitor of Janus Kinases indicated for the for the treatment of rheumatoid arthritis, alopecia areata, atopic dermatitis and even COVID-19.  In December of last year the results of a Phase 2 trial in patients with new-onset type 1 diabetes were published in the New England Journal of Medicine. After almost a year of taking the oral therapy, patients were found to have better glycaemic control and evoked C-peptide levels than those taking placebo, indicating a preserved ability to secrete insulin. In today's episode, Pomegranate's in-house endocrinologist interviews two of the study authors.   Key ReferenceBaricitinib and β-Cell Function in Patients with New-Onset Type 1 Diabetes [NEJM. 2023. 7;389(23)]GuestsProf Jenny Couper FRACP FAHMS (Women's and Children's Hospital, University of Adelaide) Dr Michelle So FRACP (Royal Melbourne Hospital, Northern Hospital) Guest HostDr Rahul Barmanray FRACP (Royal Melbourne Hospital)ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Things to Sort out' and ‘Quiet Waters' by Walt Adams and ‘The Appalachian Trail' by Hunter Quinn. Music courtesy of FreeMusic Archive includes ‘I am a Man Who Will Fight For Your Honor' by Chris Zabriskie. Image produced and copyrighted by RACP.Editorial feedback kindly provided by RACP physicians Amy Hughes, Stephen Bacchi, Fionnuala Fagan and Aidan Tan.  Please visit the Pomegranate Health web page for a transcript and supporting references.Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health' in Apple Podcasts, Spotify,Castbox or any podcasting app.

Today's guests are the hosts of This Medical Life, a wonderful podcast that delves into the archives of medical history. Dr Travis Brown describes the period after World War I when the Spanish Flu was killing tens of millions around the world. In the USA, whiskey was thought to be a powerful prophylactic but distribution was not an easy thing. Later in the episode (22min) is the equally unlikely tale of how the pomegranate made its way from ancient myth onto this podcast by way of Henry VIII and some mystical symbolism.GuestsDr Travis Brown MBBS, FRCPA (ClinPath Pathology) Steve Davis MBA FAMI CPM (Talked About Marketing) ProductionProduced by Mic Cavazzini DPhil. Music courtesy of FreeMusic Archive includes ‘Mendo Mulcher' by Polyrhytmiques, ‘Bach's March fur die Arche' by The United States Army old Fife and Drum Corps and ‘Notre Dame' by Jahzzar. Music licenced from Epidemic Sound includes ‘Salat Alsabah' by Feras Charestan and ‘Savannah Nights 1' by Martin Gauffin. Image courtesy of Wikimedia Commons. Recording of Allegri's Miserere from Trinity College under Creative Commons licence from archive.org.Editorial feedback kindly provided by RACP physicians Chris Leung, Aidan Tan, David Arroyo, Ronaldo Piovezan, Rahul Barmanray and Ian Woolley. Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health' in Apple Podcasts, Spotify,Castbox or any podcasting app.

Last November an NHS Hospital Trust in Nottingham sought permission from the UK High Court to withdraw life support from a seven-month old girl called Indi Gregory. The devastated parents did not want to give up on her although they were advised there was no hope of treatment for her profound developmental disability. The family and the medical teams returned to court two more times, right up to the day that Indi was to be extubated. Conflicts over care have always existed but their frequency has increased as medicinal advances present more options for intervention even in the sickest patients. Added to that, the online media environment allows advocacy campaigns to grow until they spill onto the streets outside hospitals and courtrooms. This heightened tension causes moral injury both to parents and healthcare staff looking after child patients. The Medical Mediation Foundation has developed a conflict management framework to help avoid or de-escalate such disputes and keep attention focused on the best interests of the patient. In this podcast we hear from the director of the foundation, as well as three staff from the Starship Hospital, Auckland who have undertaken this training. GuestsSarah Barclay (Director, the Medical Mediation Foundation)Dr Louise Webster MBChB RANZCP FRACP (Paediatric Consult Liaison Team, Starship Hospital)Dr Fiona Miles FRACP FFICANZCA (Paediatric Intensivist, Starship Hospital)Fiona McIver (nurse specialist, Starship Hospital)ProductionProduced by Mic Cavazzini DPhil. Recording assistance in Auckland from Dinesh Kumar. Music courtesy of FreeMusic Archive includes ‘December' by Kai Engel. Music licenced from Epidemic Sound includes ‘Ikigai' by Twelwe and ‘Pulse Voyage by Chill Cole. Image by Photodisc licenced from Getty Images.Editorial feedback kindly provided by RACP physicians Michael Herd, Rosalynn Pszczola, Rachel Murdoch, Sasha Taylor, Zac Fuller, Rahul Barmanray, David Arroyo, Rachel Bowden, Chris Leung, Fionnuala Fagan, Thazin Thazin and Aidan Tan. Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health' in Apple Podcasts, Spotify,Castbox or any podcasting app.

The theory that certain fatty acids are essential to the diet and associated with reduced cardiovascular risk has been controversial since it was floated in the 1950s.  In 1971 Danish researchers published the results from a cross-sectional study of Inuit people living on the west coast of Greenland. They ate a fish-based diet rich in polyunsaturated fatty acids known as omega-3s, which were found in their tissues along with much lower levels of pre-β-lipoprotein and plasma-triglycerides when compared to controls.   That association between a fishy diet and lowered cardiovascular risk has been replicated in multiple population studies since then and there are several ways omega-3 fatty acids could mediate the effect. They have anti-inflammatory and antithrombotic properties, lower circulating triglyceride concentrations and keep vessels impermeable to plaque forming lipoproteins.For many years now clinical guidelines like those of the American Heart Association and the National Heart Foundation of Australia have explicitly encouraged dietary intake of omega-3s fatty acids for those at high cardiovascular risk. But such recommendations come despite considerable inconsistency in the outcomes from intervention studies on omega-3 supplementation over the past 25 years.From several large RCTs there have been just as many negative or neutral associations as there have been positive ones. Professor Christian Hamilton-Craig has published a viewpoint review in the December edition of the Internal Medicine Journal attempting to explain these inconsistencies. GuestsPaul Bridgman MB ChB MD FRACP FCSANZ FASE (Christchurch Hospital; St George Hospital; University of Otago)Prof Christian Hamilton-Craig MBBS PhD FRACP FCSANZ FSCCT FSCMR FACC (Director, Noosa Hearts Cardiology; Noosa Hospital; Griffith University; University of Queensland) ​Declarations of interest: nilKey Reference ·         Christian Hamilton-Craig, Karam Kostner, David Colquhoun, Stephen J Nicholls. Omega-3 fatty acids and cardiovascular prevention: is the jury still out? IMJ. 2023 Dec;53(12):2330-2335ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Niagara' by Chris Shards and ‘Hollow Head' by Kenzo Almond. Please visit the Pomegranate Health web page for a transcript and supporting references.Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health' in Apple Podcasts, Spotify,Castbox or any podcasting app.

Median survival for patients diagnosed with advanced cirrhosis is around 2 years and quality of life is poor. Fewer than a quarter of such patients receive referrals to palliative care and advanced care plans are also rare. Existing research from abroad suggests that hepatology staff aren't familiar with referral criteria and assume that palliative services become involved only at the very end of life.  To try and reduce barriers to referral, clinicians at Royal Brisbane Hospital developed a model called Hepatocare. They adapted a palliative care referral algorithm to include cirrhosis specific markers and continuity of care between the teams was provided by a clinical nurse consultant. The model was piloted model in 30 consecutive patients to the liver clinic, and its impact was assessed on rate of referrals, incidence of unplanned admissions, length of patient stay and rates of polypharmacy. GuestsProfessor James O'Beirne FRCP FRACP (Sunshine Coast Hospital and Health Service; University of the Sunshine Coast)Dr Richard Skoien MBBS FRACP (Royal Brisbane and Women's Hospital; University of Queensland)Dr Alison Kearney FRACP MRCP (Royal Brisbane and Women's Hospital; University of Queensland)Olivia Cullen (Royal Brisbane and Women's Hospital)Key Reference Alison Kearney, Neha Tiwari, Olivia Cullen, Amy Legg, Ismail Arbi, Carol Douglas, Barbara Leggett, Mary Fenech, Joanne Mina, Paris Hoey, Richard Skoien. Improving palliative and supportive care in advanced cirrhosis: the HepatoCare model of integrated collaborative care. Intern Medicine Journal. 2023 Nov;53(11):1963-1971ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘After the Freak Show' by Luella Gren and ‘The Cold Shoulder' by Kylie Dailey. Image by sturti licenced from Getty Images. Editorial feedback kindly provided by RACP physicians Aidan Tan and David Arroyo.Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health' in Apple Podcasts, Spotify, Castbox or any podcasting app.

Semaglutide, branded as Ozempic or Wegovy, is an analogue of glucagon-like peptide 1 which has glucose-dependent effects on insulin secretion. In this episode we discuss how semaglutide performs as an antihyperglycaemic agent compared to previous GLP-1 analogues and the soon-to-be launched tirzepatide. This dual agonist also binds receptors to glucose-dependent insulinotropic polypeptide, GIP.GLP-1 and GIP are incretin hormones, secreted after food intake and involved in regulating gastric motility and appetite. The analogue therapies have resulted in weight loss of 10 to 20 percent in trials on patients with obesity or other weight-related comorbidities. For various reasons, however, they remain unsubsidised by the Pharmaceutical Benefits Scheme. This hasn't stopped social media influencers driving up off-label demand from the wider public, creating a problem for regulators and the diabetic patients most in need.GuestsProfessor Chris Rayner MBBS PhD FRACP (Gwendolyn Michell Professor, Adelaide Medical School; Consultant Gastroenterologist, Royal Adelaide Hospital) Professor Gary Wittert MBBch, MD, FRACP (Mortlock Professor, Adelaide Medical School; Senior Consultant Endocrinologist, Royal Adelaide Hospital)ProductionProduced by Mic Cavazzini DPhil. Music courtesy of Free Music Archive includes ‘Mister S' by Tortue Super Sonic. Music licenced from Epidemic Sound includes ‘Multicolor' and ‘Flower Fountain' by Chill Cole, ‘Blacklight' by John B Lund, and ‘Habitual' by Ava Low. Image by Ketut Subiyanto courtesy of Pexels. Editorial feedback kindly provided by RACP physicians Stephen Bacchi, Aidan Tan, David Arroyo, Joseph Lee, Jia-Wen Chong, Li-Zsa Tan, Fionnuala Fagan, Stella Sarlos and Marion Leighton.Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health' in Apple Podcasts, Spotify, Castbox or any podcasting app.

We've known for a decade that about 50 percent of doctors meet the criteria for burnout, and the figure is up to 70 percent among trainees. But organisations have been left to come up with their own solutions to this, the result being that many simply offer band aid solutions rather than systemic ones. Unforgiving work conditions pose a problem for both recruitment and retention of staff to the health workforce. The New Zealand Health Department, Te Whatu Ora, forecasts that within ten years supply of doctors, pharmacists and nurses will fall short of demand by 14 to 18 percent. In response they have establish they have established a national Health Charter that sets the workplace standards to keep staff safe and engaged.Australia is one step behind, but in early September there was a leadership conference aimed at developing a similar wellbeing strategy nationally. It was envisaged that there would be Chief Wellness Officers at every major health service, reporting validated metrics about their workforce to a national taskforce. And as explained in the keynote presentation at the conference, at the organisational level there are different responses appropriate to the three main domains that influence staff wellbeing; these being personal resilience, professional culture and basic administrative efficiency. This podcast captures reflections from wellbeing champions at several different Australasian health jurisdictions. GuestsDr George Eskander MB DCH DRANZCOG FRACGP (Executive Area Director Clinical Services; North Metropolitan Health Service & Sir Charles Gairdner Osborne Park Hospital Care Group) Dr Bethan Richards MB FRACP MMed MSportsMed (Head of Rheumatology, Chief Medical Wellness Officer, Royal Prince Alfred Hospital; Senior Clinical Lecturer, The University of Sydney) Dr Joanna Sinclair MB FANZCA (Senior Medical Officer Wellbeing Lead, Counties Manukau Health) Victoria Hirst (Chief of Knowledge Networks, General Manager of Health Roundtable, Beamtree)Associate Professor Anne Powell BPharm, MBBS, FRACP (Program Director of Physician Education, Alfred Health in Melbourne; Monash University) Professor Jennifer Martin MBChB MA FRACP PhD GAICD (Chair of Clinical Pharmacology, University of Newcastle; John Hunter Hospital)ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Kryptonite' by Blue Steel and ‘Thyone' by Ben Elson. Music courtesy of Free Music Archive includes ‘A Path Unwinding' and ‘The Zepplin' by Blue Dot Sessions and ‘Summer Days' by Kai Engel. Image by sturti licenced from Getty Images. Editorial feedback kindly provided by physicians Aidan Tan and David Arroyo. Thanks also to Sarah Dalton and Fiona Fitzgerald for their coordination support.Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health' in 

This is the final episode in a five-part series about artificial intelligence in medicine. We start by weighing up the costs and benefits of automation in a health system that's increasingly pushed beyond capacity. One of the biggest time sinks for health practitioners is filling out and searching through medical records. Some of this could be performed by natural language processors which are becoming more accurate thanks to deep learning.   The power of large language models has been demonstrated by the meteoritic uptake of ChatGPT and doctors are among those who have used it to summarise literature or draft letters. But professional organisations have raised concerns around the accuracy and privacy of the model and there have also been spooky demonstrations of its capacity for common sense and theory of mind. Guests>Professor Brent Richards MBBS FRACP JJFICM (Gold Coast Hospital and Health Service; Director, IntelliHQ)>Affiliate Associate Professor Paul Cooper PhD FAIDH CHIA AFHEA GAICD (Deakin University) >Associate Professor Sandeep Reddy MBBS PhD IPFPH ECFMG CHIA FAcadTM FAIDH FCHSM SFHEA (Deakin University; Founder, MedAI)ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Kryptonite' by Blue Steel and ‘Thyone' by Ben Elson. Music courtesy of Free Music Archive includes ‘Headway' by Kai Engel, ‘Gramaphone' by Jahzarr and ‘Numbers' by Krowne. Image by VM licenced from Getty Images. Computerised voice from Online Tone GeneratorEditorial feedback kindly provided by physicians David Arroyo, Stephen Bacchi, Aidan Tan, Ronaldo Piovezan and Rahul Barmanray and RACP staff Natasa Lazarevic PhD. Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health' in Apple Podcasts, Spotify, Castbox or any podcasting app. 

This is the fourth part in a series on artificial intelligence in medicine and we try and unpick the causes and consequences of adverse events resulting from this technology. Our guest David Lyell is a research fellow at the Australian Institute of Health Innovation (Macquarie University) who has published a first-of-its kind audit of adverse events reported to the US regulator, the Federal Drugs Administration. He breaks down those that were caused by errors in the machine learning algorithm, other aspects of a device or even user error.   We also discuss where these all fit in to the four stages of human information processing, and whether this can inform determinations about liability. Uncertainty around the medicolegal aspects of AI-assisted care is of the main reasons that practitioners report discomfort about the use of this technology. It's a question that hasn't been well tested yet in the courts, though according to academic lawyer Rita Matulonyte, AI-enhanced devices don't change the scope of care that has been expected of practitioners in the past. Guests>Rita Matuolynte PhD (Macquarie Law School, Macquarie University; ARC Centre of Excellence for Automated Decision Making and Society; MQ Research Centre for Agency, Values and Ethics)>David Lyell PhD (Australian Institute of Health Innovation, Macquarie University; owner Future Echoes Business Solutions) ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Kryptonite' by Blue Steel and ‘Illusory Motion' by Gavin Luke. Music courtesy of Free Music Archive includes ‘Impulsing' by Borrtex. Image by EMS-Forster-Productions licenced from Getty Images. Editorial feedback kindly provided by physicians David Arroyo, Stephen Bacchi, Aidan Tan, Ronaldo Piovezan and Rahul Barmanray and RACP staff Natasa Lazarevic PhD. Key References More than algorithms: an analysis of safety events involving ML-enabled medical devices reported to the FDA [Lyell, J Am Med Inform Assoc. 2023]How machine learning is embedded to support clinician decision making: an analysis of FDA-approved medical devices [Lyell, BMJ Health Care Inform. 2021]Should AI-enabled medical devices be explainable? [Matulonyte, Int J Law Inform Tech. 2022]Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health' in Apple Podcasts, Spotify, Castbox or any podcasting app. 

On the 28th of January 2022 a 75-year-old man was admitted to the regional Albury Wodonga Health Service with a high fever and Parkinsonian symptoms. The patient spent over a week in intensive care, but brain scans did not reveal an obvious aetiology and assays for a range of pathogens came up negative.When serology eventually revealed the presence of antibodies against Japanese encephalitis virus this became only the second ever locally-acquired case on Australia's mainland. Even more startling was the fact that the previous one had been way back in 1998 in Cape York, far north Queensland. The Victorian patient was the first what would become an outbreak of 43 symptomatic human cases that resulted in six deaths. The JE virus would be detected in all mainland states and retrospectively linked to another fatality in March 2021 from the Tiwi islands of the Northern Territory. In this podcast we hear about the confluence of factors that brought a classically tropical disease to the southern states. The story is told from the perspective of the treating clinicians, microbiology specialist and public health physician who started putting the puzzle together from four sentinel cases. Key ReferenceSamuel Thorburn, Deborah Friedman, John Burston, Paul M Kinsella, Genevieve E Martin, Deborah Williamson, Justin Jackson. Sentinel cluster of locally acquired Japanese encephalitis in southern Australia. Internal Medicine Journal. 2023;53(5):835-840Member access to Internal Medicine Journal, Journal of Paediatrics and Child Health and Occupational Medicine JournalGuestsAdjunct Associate Professor Ian Woolley FRACP (Monash Infectious Diseases; Monash University) Dr Justin Jackson FRACP (Albury Wodonga Health)Dr Sam Thorburn (Austin Health)Dr Paul Kinsella (Victorian Infectious Diseases Reference Laboratory, Peter Doherty Institute for Infection and Immunity)Associate Professor Deborah Friedman FRACP (Victorian Department of Health; Deakin University)ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Dusty Delta Day' and ‘Hard Shoulder' by Lennon Hutton. Image from Smith Collection/ Gado licenced from Getty Images. Editorial feedback kindly provided by Dr Aidan Tan. Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health' in Apple Podcasts, Spotify,Castbox, or any podcasting app. 

This is the third part of a series on artificial intelligence in medicine. Previously we explained how to train and test machine learning models that assist in decision-making, and then how to iron out ergonomic friction points in the clinical workflow. We've mentioned how deep learning neural networks are more capable than classical models at dealing with big noisy data sets, but also that the reasoning they use to solve questions asked of them might be inexplainable users.  This creates a certain unease among clinicians and regulators like Australia's Therapeutic Goods Administration. According to some, we just need to test outcomes from use of AI-assisted decision-making with same rigor we do for pharmaceutical interventions, not all of which we fully understand. But despite updates to the SPIRIT and CONSORT for reporting of randomised controlled trials, there hasn't yet been a lot of high quality clinical research into use of AI-based medical devices. Guests>Affiliate Associate Professor Paul Cooper PhD FAIDH CHIA AFHEA GAICD (Deakin University)>Associate Professor Sandeep Reddy MBBS PhD IPFPH ECFMG CHIA FAcadTM FAIDH FCHSM SFHEA (Deakin University)>Professor Brent Richards MBBS FRACP JJFICM (Gold Coast Hospital and Health Service; Director, IntelliHQ)ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Thyone' by Ben Elson, ‘Little Liberty' by Paisley Pink. Music courtesy of Free Music Archive includes ‘Impulsing' and ‘You are not alone' by Borrtex. Image by WestEnd61 licenced from Getty Images.Editorial feedback kindly provided by physician Rahul Barmanray and digital health academic Natasa Lazarevic.Key ReferencesA governance model for the application of AI in health care [Reddy, J Am Med Inform Assoc. 2020]Machine learning in clinical practice: prospects and pitfalls [Med J Aust. 2019] Evidence-based medicine and machine learning: a partnership with a common purpose [BMJ Evid Based Med. 2021] Explainability for artificial intelligence in healthcare: a multidisciplinary perspective [BMC Med Inform Decis Mak. 2020] Please visit the Pomegranate Health web page for a transcript and supporting references.Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health' in Apple Podcasts, Spotify,Castbox, or any podcasting app.  

The allure of having devices and tasks assisted by artificial intelligence is that they will help overcome some of the natural limits of human cognition with regards to working memory and attention. And in helping with the mundane tasks, AI can buy clinicians back time to spend with the complex patients who really need it. But the way all this pans out will really depend on how seamlessly the machine learning devices fit in with the clinical workflow. Which aspect of clinical decision-making do they support and how are the consequences of error mitigated? Only a small fraction of research projects make it all the way to implementation, and in this podcast we discuss the ergonomic factors that need to be solved to effectively use AI in clinical decision support. GuestsAssociate Professor Clair Sullivan MBBS FRACP FACHI FAIDH CHIA (Director, Queensland Digital Health Centre; University of Queensland)Professor Enrico Coiera MBBS PhD FACMI, FACHI (Director, Centre for Health Informatics, Australian Institute of Health Innovation; Macquarie University).ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Alienated' by ELFL and ‘Little Liberty' by Paisely Pink. Image by Da Kuk licenced from Getty Images.Editorial feedback kindly provided by physicians; Rhiannon Mellor, David Arroyo, Aidan Tan, Joseph Lee, Rachel Murdoch, Michelle Chong, Phillipa Wormald and digital health academics; Paul Cooper and Natasa Lazarevic.Key References The Last Mile: Where Artificial Intelligence Meets Reality [Coiera, J Med Internet Res. 2019] We need to chat about artificial intelligence [Coiera, MJA. 2023]How machine learning is embedded to support clinician decision making: an analysis of FDA-approved medical devices [Coiera, BMJ Health Care Inform. 2021] Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health' in Apple Podcasts, Spotify, Castbox, or any podcasting app.

AI-assisted healthcare is reaching maturity in many applications and could alleviate some of the capacity gap increasingly faced by health systems . Over the next three podcasts we focus on artificial intelligence tools designed to assist directly with clinical practice. Most commonly reported on are the algorithms capable of pattern recognition on medical images, that in some settings perform as well or better than expert diagnosticians at classifying disease. AI models have also been developed to perform regression analyses more complex than classical risk stratification aids.The standard statistical algorithms used to solve these problems struggle when many variables are introduced, in which case deep learning models that mimic brain networks are sometimes a powerful alternative. In this episode we explain how machine learning algorithms are trained on particular tasks and where there are risks of error and bias being introduced. In part 2, we identify the ergonomic issues that affect practical implementation of AI tools in the clinic and in the decision cascade. And in the final episode of the series we discuss the questions that regulators and lawyers should be asking of this new technology and what role natural language processors might have in medicine. GuestDr Ian Scott FRACP MHA MEd (Director of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital; Professor of Medicine, University of Queensland)ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Thyone' by Ben Elson, ‘Broke No More' by Cushy, ‘Desert Hideout' by Christopher Moe Ditlevesen and ‘Alienated' by ELFL. Music courtesy of Free Music Archive includes ‘Capgras' by Ben Carey. Image by Olemedia licenced from Getty Images.Editorial feedback kindly provided by physicians; Rhiannon Mellor, David Arroyo, Aidan Tan, Joseph Lee, Rachel Murdoch, Michelle Chong, Phillipa Wormald and digital health academics; Paul Cooper and Natasa Lazarevic.Key ReferencesDemystifying machine learning: a primer for physicians [Scott, IMJ. 2021]Clinician checklist for assessing suitability of machine learning applications in healthcare [Scott, BMJ Health Care Inform. 2021]Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health' in Apple Podcasts, Spotify, Castbox, or any podcasting app.  

In today's podcast we try and understand the impact that racial bias makes on variation in clinical care. For example, racialized patterns in the use of analgesia were brought to light over 20 years ago but are still occurring today. In research from the UK published in March it was found that women of African or South Asian extraction were significantly less likely to receive an epidural during vaginal birth, or instrumental assistance with the delivery. The direct reasons for this variation were not revealed by the study, and could simply reflect the preferences of different cultural groups. But if that's the case, it behoves us to address gaps in health education in a culturally sensitive way. This podcast highlights the subtle drivers of racialized disparity at different layers of service delivery. At an individual level implicit bias can affect clinical decision-making. At an institutional level there may be known resourcing issues not being addressed, like availability of translators to help diverse patients understand what they're consenting to. And all this takes place within the context of structural racism, the inequity that was long ago baked into society's power structures. That's particularly true in colonised countries like ours, so we also ask what it means to “decolonise” medicine. GuestsWendy Edmondson PhDc (Cultural Advisor, RACP)Dr Kudzai Kanhutu FRACP GAICD MPH (Dean, RACP; Deputy Chief Information Office, Royal Melbourne Hospital) ProductionProduced by Mic Cavazzini DPhil. Recording assistance from Jon Tjhia in Melbourne and Fiona Croall in Adelaide. Music licenced from Epidemic Sound includes ‘You break down' by Czar Donic and ‘Repurposed' by Cody Francis. Music courtesy of Free Music Archive includes ‘New Times' by 4T Thieves and ‘Chasing Shadows' by Scott Holmes. Image by rubberball licenced from Getty Images. Editorial feedback on this episode kindly provided by physicians Sern Wei Yeoh, Aidan Tan, Rachel Murdoch, Priya Garg, Fionnuala Fagan, Phillipa Wormald, Amy Hughes and RACP staff Fiona Hilton, Rebecca Lewis, Michele Daly, Alexandra Kinsey. Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health' in Apple Podcasts, Spotify, Castbox, or any podcasting app.

The first time most of us heard of monkeypox was in May 2022. The smallpox-like infection appeared to spring from nowhere and make its way through Europe then the Americas, largely within the gay and bisexual community. But the first documented human case of mpox actually occurred in 1970 in Central Africa and it's been endemic ever since. Last year's mpox outbreak eclipsed prior case numbers in just a few months thanks to a newly evolved strain. The count of confirmed cases totalled over 86,000 all around the world and it's a testament to well-coordinated community health in the developed world that the outbreak was reigned in within a few months of the index case in Europe. But alongside this success story, there's also a cautionary tale about global health strategy. Because mpox wasn't taken seriously in endemic countries, an incubator was created for this new strain to emerge. We also discuss the stigma associated with sexually transmitted infections and the pros and cons of applying this label. GuestsDr Vincent Cornelisse FRACGP FAChSHM PhD (Royal Prince Alfred Hospital, Royal North Shore Hospital, Sydney; Kirby Institute, UNSW)Dr Massimo Giola FRACP FAChSHM PhD (Te Whatu Ora, Tauranga, Rotorua)ProductionProduced by Mic Cavazzini DPhil. Recording assistance in Tauranga from Melissa Cox, Mockingbird Music Studios. Editorial feedback kindly provided by Dr Aidan Tan and Dr David Arroyo. Music licenced from Epidemic Sound includes ‘Cocktail by Major Tweaks, ‘Broke No More' by Cushy, ‘Temple of Ruhnha' by ELFL and ‘Razzamatazz' by Jules Gaia. Music courtesy of Free Music Archive includes ‘Out of the Skies, Under the Earth' by Chris Zabriskie, Image by Flashpop licenced from Getty Images. Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record time spent listening and reading supporting materials. Subscribe to new episode email alerts or search for ‘Pomegranate Health' in Apple Podcasts, Spotify, Castbox, or any podcasting app. 

Medical and administrative records are normally collected to help the management of patients or institutions, but it can be time consuming to extract metrics useful for practice improvement. The field known as Practice Analytics seeks to transform these data and provide clinicians with a bird's eye view of their case load and performance. Practice Analytics can draw attention to cases that stood out from the trend, not for any regulatory purpose, but simply to help clinicians reflect and improve. This could even act a shortcut to meeting the new requirements for CPD imposed by the medical boards. GuestsProfessor Tim Shaw (University of Sydney; Research Director, Digital Health Cooperative Research Centre) Dr David Rankin (Director Clinical Governance and Informatics, Cabrini Health)ProductionProduced by Mic Cavazzini DPhil. Recording assistance from Jon Tjhia in Melbourne. Music courtesy of FreeMusicArchive includes ‘Transference' by Ben Carey. Music licenced from Epidemic Sound includes ‘Emerlyn' by Valante. Image by Courtney Hale licenced from Getty Images.Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health' in Apple Podcasts, Spotify, Castbox, or any podcasting app. 

In the first year of the COVID-19 pandemic, a handful of international studies showed that there was increased risk of adverse outcomes in hospitalised patients comorbid for diabetes. Odds ratios for mortality conferred by pre-existing diabetes ranged from 1.5 to 3.6. What this relationship might be in Australia was not known until researchers in Melbourne retrospectively examined electronic medical records from the two waves of COVID-19 in that city.  The prevalence of diabetes among Melbourne inpatients is around 35% and in 2020 over 70% of all Australia's case load was in Victoria. This presented an opportunity to observe the relationship between the conditions with substantial statistical power. But while ICU admission and mortality were more common in those with diabetes than those without, neither diabetes nor hyperglycaemia were independently associated with in-hospital mortality. In this podcast the authors speculate as to why there was this deviation from patterns observed internationally. A possible explanation involves the receipt of dexamethasone therapy in patients with hyperglycaemia, which was found by other researchers to be preventative for COVID-19-associated mortality. GuestsAssociate Professor John Wentworth FRACP (Royal Melbourne Hospital, Walter and Eliza Hall Institute) Dr Rahul Barmanray FRACP (Royal Melbourne Hospital; the University of Melbourne)Dr Dev Kevat FRACP (Western Health; Monash University)Dr Mohammad Ashraful Islam (Goulburn Valley Health) Key ReferenceRahul D Barmanray Diabetes IN hospital – Glucose and Outcomes in the COVID-19 pandemic (DINGO COVID-19): the 2020 Melbourne hospital experience prior to novel variants and vaccinationsInternal Medicine Journal 2021; 53(1)Access to IMJ, JPCH and OMJ for RACP membersPlease visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health' in Apple Podcasts, Spotify, Castbox, or any podcasting app.

Pomegranate Health is seeking fresh ears on the Podcast Editorial Group.Responsibilities of group members are to> discuss new podcast topics> suggest themes to explore and people to interview> listen to audio drafts and provide feedback before publicationGroup communication is done informally by email and there's a time commitment of approximately 90 minutes per month. Please download an application form and return it before February 2023 to podcast@racp.edu.au. ******Hospitalisation rates for cirrhosis are increasing in Australia in part associated with the high prevalence of obesity and subsequent non-alcoholic fatty liver disease. More concerning still is the frequency with which discharged patients are readmitted within 30 days. One systematic review put the average readmission rate at 26%, but the studies cited varied greatly in their inclusion and exclusion criteria and not much is known from Australia and Aotearoa-New Zealand. In the December edition of the Internal Medicine Journal researchers at the Austin Hospital Liver Transplant Unit in Melbourne reported a 46% readmission rate among their patients. This was based on a retrospective audit of medical records, which also suggested that a fifth of readmissions might have been preventable. Better adherence to practice guidelines when patients are first hospitalised for cirrhosis may reduce a significant burden on patients and the healthcare system.  GuestsProfessor James O'Beirne FRCP FRACP (Director of Gastroenterology & Hepatology, Sunshine Coast Hospital and Health Service; University of the Sunshine Coast)Dr Karl Vaz FRACP (Victorian Liver Transplant Unit, Austin Hospital)Key ReferenceKarl Vaz et al. Rate of early hospital readmission amongst cirrhotic patients is high in Australia: experience from a single liver transplant centre Internal Medicine Journl 2021; 52(12)Free access to IMJ for members of the RACPPlease visit the Pomegranate Health web page for a transcript and supporting references. To claim learning credits login to MyCPD. Subscribe to new episode email alerts or search for ‘Pomegranate Health' in Apple Podcasts, Spotify, Castbox, or any podcasting app. 

ADAPT is a prospective cohort study that has been following up COVID-19 patients since the earliest days of the pandemic. It has allowed researchers to track the emergence of long COVID, a syndrome that includes symptoms such as ongoing breathlessness, fatigue, chest tightness and "brain fog". Over the course of the study, participants have contributed blood cells, cardiac and brain MRIs, tests of respiratory function and more. The research has uncovered molecular and functional correlates that are helping to explain long COVID. Meanwhile, clinicians at the St Vincents' Hospital, Sydney long COVID clinic are successfully applying rehabilitation strategies drawn from the treatments of chronic pain and other functional disorders. GuestsProfessor Gail Matthews MRCP FRACP (Head of Infectious Diseases, St Vincent's Hospital, Sydney; Kirby Institute)Dr David Darley FRACP (St Vincent's Hospital, Sydney)Professor Steven Faux FRACGP FAFRM FFPMANZCA (Director Rehabilitation and Pain Medicine, Vincent's Hospital, Sydney)Professor Bruce Brew AM FRACP FAAN (Director of the Peter Duncan Neurosciences Research Unit, St Vincent's Hospital Sydney) ProductionRecorded at St Vincent's Hospital for the Curran Foundation.  Post-production by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Tree Tops' and ‘Yellow Lead' by Autohacker and ‘Thyone' and ‘Orthosie' by Ben Elson. Image by PASIEKA licenced from Getty Images.Please visit the Pomegranate Health web page for a transcript and supporting references. To claim learning credits login to MyCPD at this link, review the prefilled activity details then click save. Subscribe to new episode email alerts or search for ‘Pomegranate Health' in Apple Podcasts, Spotify, Castbox, or any podcasting app.ReferencesThe Curran Foundation at St Vincent's Hospital, SydneyImmunological dysfunction persists for 8 months following initial mild-to-moderate SARS-CoV-2 infection [Nat Immunol]Myocardial fibrosis occurs in non-hospitalised patients with chronic symptoms after COVID-19 [Int J Cardiol Heart Vasc]. Limited recovery from post-acute sequelae of SARS-CoV-2 at 8 months in a prospective cohort [ERJ Open Res]Persistent symptoms up to four months after community and hospital-managed SARS-CoV-2 infection [MJA]

Pomegranate Health is seeking fresh ears on the Podcast Editorial Group. Responsibilities of group members are to> discuss new podcast topics> suggest themes to explore and people to interview> listen to audio drafts and provide feedback before publicationGroup communication is done informally by email and there's a time commitment of approximately 90 minutes per month. Please download an application form and return it before February 2023 to podcast@racp.edu.au. ******Clinical complications suffered by patients during hospital stays are assumed to be preventable and to provide some metric of quality of care. To assist in their understanding and mitigation the Australian Commission on Safety and Quality in Healthcare established a national programme to track hospital-acquired complications (HACs) in a formalised way. Comparison data can be found through the Health Roundtable reports and it's been understood that hospitals with higher complication rates may have a have a lower standard of care. While the national HAC program has support from providers across all jurisdictions and makes good use of electronic medical records, some questions remain as to its methodology. In a retrospective audit of medical records published in the Internal Medicine Journal, Dr Graeme Duke and colleagues at Eastern Health Intensive Care Research have sought to validate the clinical significance of HACs identified within their service. Their research suggests that HACs are underreported by coding data and that they are more strongly associated with patient-related factors than with deviation from clinical best practice. Dr Graeme and IMJ editor Professor Ian Scott discuss the research article and its implications for the national hospital-acquired complications programme.  GuestsDr Graeme Duke FCICM, FANZCA (Eastern Health Intensive Care Services)Prof Ian Scott FRACP (University of Queensland, Princess Alexandra Hospital)ReferencesGraeme J Duke et al. Clinical evaluation of the national hospital-acquired complication programme Internal Medicine Journal 2021; 52(11); 1910-1916 Access to IMJ, JPCH and OMJ for RACP membersProductionWritten and produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Reaching for Infinity' by Dawn Dawn Dawn and ‘Nabga Algooah' by Ebo Krdum. Image by SolStock licenced from Getty Images.Please visit the Pomegranate Health web page for a transcript and supporting references. To claim learning credits login to MyCPD at this link, review the prefilled activity details and click save. Subscribe to new episode email alerts or search for ‘Pomegranate Health' in Apple Podcasts, Spotify, Castbox, or 

Pomegranate Health is seeking fresh ears on the Podcast Editorial Group.Responsibilities of group members are to> discuss new podcast topics> suggest themes to explore and people to interview> listen to audio drafts and provide feedback before publicationGroup communication is done informally by email and there's a time commitment of approximately 90 minutes per month. Please download an application form and return it before February 2023 to podcast@racp.edu.au. ******About two thirds of Australians use complementary and alternative medicines but only around half of these people will mention it to their doctor. Patients in palliative care settings may be more inclined than most to try therapies from outside the box. But they are also more vulnerable to side effects and interactions given that their drug metabolism and clearance mechanisms are often impaired. In this podcast you'll hear the authors of a Clinical Perspectives article titled "Complementary and alternative therapies in the palliative setting." It's published in the in the October issue of the Internal Medicine Journal which can be accessed by all RACP members at the login page racp.edu.au/fellows/resources/journals.Professor Jennifer Martin and Joanne Patel describe how cannabinoid products, especially, have become more readily accessible to patients in recent years and often considered a panacea for many different symptoms. But given the wide variety of products each with a different concentration of active ingredients, drug effects are not always as a patient or doctor might expect. These compounds also have suppressive effects on P450 and other clearance enzymes which can alter the outcomes of other prescribed drugs.  But practitioners also need to consider their relationship with a patient when giving advice on the use of complementary medicines.     GuestsDr Jonathan Brett FRACP FAChAM (St Vincent's Hospital, Sydney)Professor Jennifer Martin FRACP (University of Newcastle, John Hunter Hospital)Dr Joanne Patel FRACP FAChPM (University of Newcastle, John Hunter Hospital)ProductionWritten and produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Crossing Borders' by Mindserver Unlimited. Image by DrAfter123 licenced from Getty Images.Please visit the Pomegranate Health web page for a transcript and supporting references. To claim learning credits login to MyCPD at this link, review/amend the prefilled activity details and click save. Subscribe to new episode email alerts or search for ‘Pomegranate Health' in Apple Podcasts, Spotify, Castbox, or any podcasting app.

This is the first episode of a new format called “IMJ On-Air” inspired by the RACP's Internal Medicine Journal. Each episode will be have as guest-host a section editor or reviewer of the IMJ interviewing authors of a recent article. Often these will be Clinical Perspectives reviews which summarise the latest in management of major medical disorders. In this episode we have leading respiratory physicians from the Royal Melbourne Hospital presenting current best practice in the diagnosis and treatment of severe asthma. They explain why inhaled corticosteroids have become so ubiquitous and also the remarkable impact that monoclonal antibodies have made to the field. They also discuss the lifestyle factors that can be modified to improve outcomes, and why so many people with severe asthma go undiagnosed. Finally, they reflect on the lessons learned from the 2016 “asthma storm” that send 3000 people to emergency rooms in over a single evening.  GuestsAssociate Professor Daniel Steinfort FRACP (Royal Melbourne Hospital; Principal Research Fellow, University of Melbourne)Dr Ashleigh Witt (Royal Melbourne Hospital)Associate Professor Nur-Shirin Harun FRACP (Royal Melbourne Hospital; Peter MacCallum Cancer Centre)Professor Jo Douglass FRACP FThorSoc (Director of Research, Royal Melbourne Hospital; University of Melbourne) ProductionWritten and produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Tree Tops' by Autohacker, ‘Crossing Borders' by Mindserver Unlimited. Image by Karl Tapales licenced from Getty Images.Please visit the Pomegranate Health web page for a transcript and supporting references. To claim learning credits login to MyCPD at this link, review/amend the prefilled activity details and click save. Subscribe to new episode email alerts or search for ‘Pomegranate Health' in Apple Podcasts, Spotify, Castbox, or any podcasting app. ReferencesOverview of recent advances in asthma management [Witt 2022, IMJ]Access to IMJ, JPCH and OMJ for RACP membersAsthma action plan templates [Asthma Australia]Global Initiative for Asthma [GINA]Overview of recent advances in asthma management [Witt 2022, IMJ] Thunderstorm-triggered asthma: what we know so far [Harun 2019, J Asthma Allergy]Thunderstorm asthma in seasonal allergic rhinitis: The TAISAR study [Douglass 2022, J Allergy Clin Immunol]

The National Guideline for the Assessment and Diagnosis of Autism Spectrum Disorders in Australia aspires to streamline referral pathways so that children can get the right help as early as possible. But despite the best intentions of many clinicians, there are drivers in the health system that make implementation difficult. There are constraints in the way specialists can be reimbursed for time spent managing a case through the diagnostic process. And the extent of developmental disorders in the community may not be reflected in the depth of training in this area. We also hear about some breaking research into a highly accurate diagnostic screening tool that could reveal just how prevalent ASD is in the community.GuestsDr Paul Hotton FRACP (Staff Specialist in Community Child Health and Child Protection, Sydney Children's Hospital Network; Chair of CCCH at RACP)with input from Associate Professor Josephine Barbaro (Olga Tennison Autism Research Centre, La Trobe University) ProductionWritten and produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Falling from the Clouds' by Sven Lindvall, ‘Lantern Room (Instrumental)' by Torii Wolf and ‘Not Blue' by Kylie Dailey. Image by Elva Etienne licenced from Getty Images.Please visit the RACP website for a transcript and supporting references. RACP members can claim CPD credits for listening via MyCPD. 

The average age at which autism spectrum disorder is four, though signs are often present well before that. Even where families and GPs may have concerns early in a child's development, it can take a year or more for a consult with a paediatrician to become available. There are similar waiting lists to see other allied health and sub-specialists who may contribute opinions to a diagnosis. And there is some inconsistency as to what kind of supporting documentation is required to access support services at different layers if government. The Autism Cooperative Research Centre published a national guideline with 70 recommendations to streamline this process and improve equity for families from different backgrounds and living in different parts of the country. In this podcast we hear from a GP and a paediatrician working in regional practice about how this can help their patients receive early intervention in the critical developmental years. In Part 2 we get a response from the RACP's Chair of Child and Community Health about underlying structural challenges including the paediatric training curriculum and the NDIS. GuestsDr Jo McCubbin FRACP (Fitzpatrick House, Sale, VIC)Dr James Best FRAGCP (Junction Street Medical Centre, Nowra NSW)ProductionWritten and produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Sleeping Starchild' by Daniel Fridell, ‘Falling from the Clouds' by Sven Lindvall, ‘Lantern Room (Instrumental)' by Torii Wolf and ‘Not Blue' by Kylie Dailey. Image by Elva Etienne licenced from Getty Images. Please visit the RACP website for a transcript and supporting references. RACP members can claim CPD credits for listening via MyCPD.  

In the last episode we heard some powerful examples of the challenges faced by some practitioners in medicine. Every situation has its idiosyncrasies, but most people start out with a passion for what they're doing. In today's podcast we hear from doctor-career coaches Ashe Coxon and Sarah Dalton who help medics solve the workplace challenges, and remember what drew them to the profession. Associate Professor Peter Connaughton describes burnout as an occupational health issue, that needs to be solved organisationally. Those presentations were recorded at Congress 2021, but we also get a call from a listener wanting to share a simple gesture that can make a world of difference between colleagues stretched thin at a busy hospital. GuestsDr Stephen Philpot FCICM (Alfred Health, Cabrini Hospital)Dr Ash Coxon FRACGP (Townsville Hospital; Medical Career Planning)Dr Sarah Dalton FRACP (Westmead Children's Hospital; Associate Professor Peter Connaughton FAFOEM (Curtin University; University of Notre Dame) ProductionWritten and produced by Mic Cavazzini DPhil. Written and produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes and ‘Exploring the Lake' by View Points and ‘Into the Bone' by Taylor Crane. Photo image licenced through Getty Images. Feedback on this episode was kindly provided by physicians of the RACP's Podcast Editorial Group; Vicka Poudyal, Michael Herd, Rhiannon Mellor, Nele Legge and Amy Hughes.Please visit the RACP website for a transcript and supporting references. RACP members can claim CPD credits for listening via MyCPD. 

Not a day goes by that there isn't a headline about the overstretched health service and the struggling professionals within it. It isn't COVID that has created this situation. The pandemic was just the straw that broke the camel's back.At the RACP Congress in May, ENT surgeon Eric Levi explained why burnout should be considered not as a mental health condition but as an occupational disorder. And apart from the stressors of the job itself and the work relationships, the medical profession has a way of consuming one's personal life. Associate Professor Michelle Telfer talked about being hounded for two years by the conservative press over her work with young people struggling with their gender identity. And pain specialist Olivia Ong described how she'd been driven by an unhealthy professional identity until a traumatic spinal injury forced her to reconsider the meaning of self-care. Both physicians found the courage to take control of the situation and define their roles on their own terms.GuestsEric Levi FRACS (Royal Children's Hospital; St Vincent's Hospital; Ear, Nose and Throat Victoria)Associate Professor Michelle Telfer FRACP (Director Adolescent Medicine, Director Gender Service at Royal Children's Hospital Melbourne; Murdoch Children's Research Institute)Dr Olivia Ong FAFRM FFPMANZCA (Monash Health, Advance Healthcare)ProductionWritten and produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Into the Bone' by Taylor Crane, ‘Below the Horizon' and ‘Haunted Heart' by Dawn Dawn Dawn and ‘Exploring the Lake' by View Points. Photo image by Paul R. Giunta licenced through Getty Images. WellbeingDoctor's Health Advisory Service Helpline Aotearoa-NZ:  800 471 2654NSW/ACT: 02 9437 6552VIC:      03 9280 8712TAS:     03 9280 8712SA:       08 8366 0250NT:       08 8366 0250QLD:    07 3833 4352WA:     08 9321 3098LifelineAustralia: 13 11 14.Aotearoa-NZ: 0800 54 33 54 Converge International  Aotearoa-NZ: 0800 666 367 Australia : 1300 687 327Subscribe to email alerts or search for ‘Pomegranate Health' in Apple Podcasts, Spotify, Castbox, or any podcasting app. Fellows of the RACP can claim CPD credits for listening via MyCPD. For a transcript and further references please visit our website. 

In episode 78 we heard from some physicians who found themselves taking up the role of advocate, not just for their own patients but for broader system change. And health policy lobbyist Patrick Tobin explained how physicians and the College as whole can best get the attention of parliamentarians. For example, the RACP's Healthy Climate Futures campaign calls on Government to make the healthcare system more resilient against the shocks of climate heating and extreme weather events.To complete this series, this episode focuses on what happens to advocacy issues after they land on an MP's desk, and how they get churned through the Canberra machine to eventually become policy. We hear the perspectives of two physicians turned politicians in interviews that first appeared as part of an RACP documentary called The Advocate's Journey. Dr Mike Freelander practiced for 37 years as a paediatrician in Sydney's southwest before being  elected to the federal Division of Macarthur in 2016. for the Labor party. Dr Katie Allen was elected in 2019 as the Liberal Member for Higgins after practicing at the Royal Children's Hospital and directing the Australian Centre of Food and Allergy Research.While the federal election in May 2022 rearranged some of the chairs at the table, the RACP is proud of all its members who have taken the brave steps of entering the political fray. The represent all colours of the political spectrum and we are grateful to have such influential champions for health policy.Guests Dr Rob Lethbridge FRACP (Perth Children's Hospital) Dr Mike Freelander MP FRACP Dr Katie Allen MP (at time of interview)ProductionWritten by RACP Professional Practice team. Music licenced from Epidemic Sound includes ‘Ikigai' by Twelwe and ‘No Show (Instrumental Version)' by Penny Lane. Photo courtesy of Michael@UnsplashPlease visit the RACP website for a transcript. RACP members can claim CPD credits for listening via MyCPD. 

The globe has already warmed by more than one degree Celsius over pre-industrial levels and is on track to exceed two degrees by the end of the century. It doesn't sound like a lot but this will have profound effects on human health with Australia being particularly vulnerable. Most obviously, Australia's biggest cities will become furnaces in summer with a more than doubling of heat-related mortality. The rising temperatures will also increase frequency of the climate oscillations that delivered us record-breaking temperatures and bushfires in 2019-2020, followed by historic rains and floods last summer.  In this podcast we discuss the effects of this increasingly volatile climate on the health of Australians, from infectious disease to respiratory and even mental health. Professor Lynne Madden explains how the health system can become more resilient to these demands and what measures the RACP is asking Federal Government to commit to in preparation for this.  Find out more about the "Health Climate Future" campaign here.  Guest Prof Lynne Madden FAPHM (University of Notre Dame) ProductionWritten and produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Kauko' and ‘Ikigai' by Twelwe. Music courtesy of FreeMusicArchive includes ‘Nothing Else Matters' by Mystery Mammal, ‘Namaste' by Jason Shaw. Image credit; Jamie Kidston, Multimedia and Production Manager at Australian National University.Please visit the RACP website for a transcript and supporting references. RACP can claim CPD credits for listening via MyCPD.