Pomegranate Health marks ten years of podcasting since its launch in June 2015. This episode will be one of two samplers that dip into the back catalogue of 131 episodes to showcase some of the most compelling stories. You’ll hear how podcast themes are identified from all the domains of medicine and professionalism. And a little bit about the motivations of long-time producer and presenter, Mic Cavazzini.

Pomegranate Health has several thousand listeners in over 150 countries. Three quarters of listeners are, predictably, in Australia and Aotearoa-New Zealand, but a full 14 per cent are located outside the traditional anglosphere. RACP is proud to provide this platform to showcase the great work and dedication of its members. It’s also a place where physicians can learn from the other professionals and patient advocates that make up the health system.

Sampled in this retrospective episode:
Prof Meera Agar from ​Ep33: Early days for medicinal cannabis
Dr Paul Drury and Prof Sophia Zoungas from Ep41: Targeting Diabetes
Prof Rinaldo Bellomo from Ep70: Zeroing in on “the renal troponin”
Dr Nic Szecket and Dr Art Nahill from Ep32: Cognitive biases in diagnostic thinking
Prof Ian Harris and Assoc Prof Louise Stone from Ep25: Dealing with Uncertainty Part 1
Dr Danielle Ofri from Ep38: Making a Connection
Michael Pooley as Dr David Hilfiker from Ep75: Feeling guilty- Medical Injury Part 2 

Credits
Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Le Hustle’ by Polyrhythmics, ‘Your Wave’ by Cospe, ‘Soul Single Serenade’ by Dusty Decks, ‘Hollow Head’ by Kenzo Almond and ‘Illusory Motion’ by Gavin Luke. Music courtesy of FreeMusicArchive includes ‘I got 99 broadswords but this one isn't one’ and ‘Friends’ by Komiku and ‘Cree’ by Satellite Ensemble. Thumbnail image is the copyright of RACP. 

Editorial feedback kindly provided by RACP physicians Zac Fuller and Simeon Wong. Thanks also to RACP staff Kathryn Smith, Michael Davidson and Anne Fredrickson.
 Please visit the Pomegranate Health web page for a list of thankyous over the ten years. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify, Castbox or any podcasting app.

In this podcast we discuss low-value care that has emerged from a decay in the specificity of the terms “cardiac arrest” and “cardiopulmonary resuscitation.” Patients who experience cardiac arrest in hospital are rarely more than a minute or two away from defibrillation. But the proportion of shockable rhythms in these patients is low as the heart has typically stopped after the decline of other systems. In such conditions, chest compressions are more likely to cause unnecessary trauma than improve survival outcomes. 

As retired UK palliative care physician Kathryn Mannix explains, “cardiac arrest” was originally reserved for unexpected events in relatively healthy individuals in the community. She says we need to separate this from the more progressive phenomenon that is better described as “natural dying”.
 
There is also a semantic breakdown in the understanding of what “cardiopulmonary resuscitation” entails. Surveys of Australasian medical practitioners show that the majority consider CPR to include defibrillation and drugs not just chest compressions and ventilation. As a result, Do Not Attempt CPR orders get perceived as being “a stop sign” to other treatments that may be beneficial. We hear from the NZ-based authors of that research, cardiologist Dr Tammy Pegg, intensivist Dr Alex Psirides and palliative care physician Dr Kate Grundy. 

Chapters
4:00 CPR for out-of-hospital cardiac arrest
8:43 Overuse of CPR in hospitalised patients
20:08 Crude algorithms and failed conversations
40:17 Semantic confusion around what CPR entails
48:13 The midwifing of natural dying

Guests
Dr Kathryn Mannix (www.kathrynmannix.com)
Dr Tammy Pegg MRCP FRACP FC CANZ DPhil (Nelson Marlborough Hospital cardiology department)
Dr Alex Psirides FCICM (Wellington Regional Hospital intensive care unit)
Dr Kate Grundy FAChPM FRACP (Christchurch Hospital palliative care service; University of Otago)

Production
Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Awash’ by Gavin Luke, ‘Fields 3’ by Gunnar Johnsén, ‘RGBA’ by Chill Cole and ‘Til All that’s Left is Ash’ by Ludlow.

Music courtesy of FreeMusicArchive includes ‘New Times’ by 4T Thieves and ‘Secret Place’ by Alex Fitch. Image by Yuichiro Chino licenced through Getty Images. Football commentary courtesy of UEFA Euro 2021. 

Editorial feedback kindly provided by RACP physicians Stephen Bacchi, Fionnuala Fagan, Simeon Wong, Hugh Murray and Aidan Tan. 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

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. 

Production
Produced 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.

Misdiagnosis or delayed diagnosis occurs in 10-15 per cent of acute presentations, although fortunately only a tenth of these lead to serious consequences. But of concern is the fact that this figure hasn't changed in three decades, despite progress in clinical knowledge. Errors in diagnostic reasoning occur at the same rate in senior clinicians as they do in juniors, even though mistakes from poor examination or knowledge become less frequent as one gains experience. 

Compared to problems in maths or physics, diagnostic problems are thought of as ill-structured: because information isn't readily available, the problem can keep changing and often you're not certain you've reached a solution and are free to stop searching. Cognitive errors result from jumping to conclusions on the basis of intuition and incomplete information. There are a hundred different types of such bias. On this episode, the most common types will be discussed, as well as strategies to force a more considered process of diagnostic reasoning. 

In about two thirds of cases, systems problems like design and workflow contribute to diagnostic error. These will be discussed in the second episode of this series. 

Guests
Dr Nicolas Szecket FRACP (Auckland City Hospital)
Dr Arthur Nahill FRACP (Auckland City Hospital). 

Production
Written and produced by Mic Cavazzini. Music courtesy of Mystery Mammal ('To be Decided,' 'Data'), RGIS VICTOR ('Lampagisto') and Lobo Loco ('Spook Castle'). Image courtesy of iStock. The production manager was Anne Fredrickson.

Editorial feedback for this episode was provided by RACP members Dr Paul Jauncey, Dr Alan Ngo, Dr Katrina Gibson. Dr Marion Leighton, Dr Michael Herd and Dr Joseph Lee.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

'Ngā Kaitiaki Hauora' translates as 'guardians of health'. This podcast emerged from a meeting near Auckland organised by the RACP's Māori Health Committee in November 2017. Members of various medical colleges and institutions came together to share perspectives on the delivery of health care to New Zealand's population of Māori and Pacific Islander people. This conversation comes in the context of the Wai 262 claim, which is forcing a re-examination of the Crown's obligations to the Māori population under the Waitangi Treaty of 1840.

On this episode, Reverend Hirini Kaa proposes that all institutions of civil society must be committed to recognising Indigenous sovereignty not just over land, but also the natural environment, the language, and cultural practices. GP Dr Peter Jansen and oncologist Dr George Laking describe the variation in medical care that Māori and Pacific Islander patients receive on a day to day basis, and how this can emerge in part through cultural 'mismatches'. And public health physician Dr Elana Curtis describes the successes and future targets of streaming Māori and Pacific Islander students into medical school.

Guests
Dr Peter Jansen FNZCGP FRACMA (Ngāti Raukawa, Mauri Ora Associates, Accident Compensation Corporation)
Dr George Laking FRACP (Te Whakatōhea, Auckland City Hospital)
Dr Elana Curtis AFPHM (Ngāti Rongomai, Ngāti Pikiao, University of Auckland)
Rev Hirini Kaa (Ngāti Porou, Ngati Kahungunu, University of Auckland)
Mr Chayce Glass (Tumuaki, University of Otago).
Commemoration to Matua Leo Buchanan given by Dr Tuwhakairiora Williams.

Production
Written and produced by Mic Cavazzini. Music courtesy of Jason Shaw ('Autumn Sunset'), Doctor Turtle ('Making a Change') and Broke For Free ('Feel Good Instrumental'). Image of the Te Whare Tapa Whā health model by Sir Mason Durie, provided courtesy of NZ Ministry of Health: Manatū Hauora. The production manager was Anne Fredrickson.

Editorial feedback for this episode was provided by RACP Fellows Dr Katrina Gibson and Dr George Laking and RACP staff Ms Harriet Wild, Ms Nicola Fowler, and Dr Cristiana Palmieri.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  
 

The World Medical Association has just updated the Physician's Oath in the Declaration of Geneva to include the clause, 'I will attend my own health, well-being, and abilities in order to provide care of the highest standard.' This is in recognition of the often reported figures about burnout, depression and suicide in the health workforce.

These rates are typically twofold higher than they are in the general population, according to studies from New Zealand, Australia and around the world. Causes often given for psychiatric distress in the medical profession are the gruelling hours, the pressure of perfection, the unforgiving culture and the stigma associated with mental health issues. This episode examines how the system might be shaped to improve physician wellbeing.

If you or someone you know is struggling with mental health issues, please seek help—call Lifeline on 13 11 14. The RACP also provides a confidential, 24-hour support program for its members. Fellows can call 1300 687 327 in Australia, and 0800 666 367 in New Zealand.

Guests
Dr Geoff Toogood FRACP (Alfred Hospital)
Dr Margaret Kay FRACGP (University of Queensland; Medical Director, Queensland Doctors' Health Program)
Dr Hilton Koppe FRACGP.

Production
Produced by Mic Cavazzini. Recording assistance from Michelle Ransom-Hughes and Rebecca Fary. Music courtesy of Kai Engel ('Highway to the Stars'), Cory Gray ('Low Rollers'), Blue Dot Sessions ('Periodicals') and Lee Rosevere ('Here's the Thing'). Photo via iStock. The production manager was Anne Fredrickson.

Editorial feedback for this episode was provided by RACP Fellows Dr Marion Leighton, Dr Alan Ngo, Dr Michael Herd, Dr Phillipa Wormald and Dr Paul Jauncey.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  
 

Adverse drug events cause about five per cent of admissions to a public hospital, although some studies suggest the figure could be as high as 15 per cent. That makes at least half a million patients in Australia and 55,000 in New Zealand every year. 

Drug-drug interactions make up about a fifth of these adverse events. They have become more frequent over the decades, as more medications reach the market. More than half of people over the age of 75 are on five or more prescriptions—a state referred to as polypharmacy. 

This episode examines some of the systems that have led to current rates of polypharmacy, and some strategies for deprescribing. We also discuss Professor Richard Day's recent review of drug interactions from the Internal Medicine Journal, and highlight the combinations physicians should be most concerned about.

Guests
Professor Richard Day FRACP (St Vincent's Hospital, UNSW)
Professor Sarah Hilmer FRACP (Royal North Shore Hospital, University of Sydney).

Production
Produced by Mic Cavazzini. Music courtesy of Daddy Scrabble ('Flying Pea', 'Cherry Blossom'), Doctor Turtle ('Manly Nunn Steps Out'), and Scott Holmes ('Chasing Shadows'). Photo by iStock. The production manager was Anne Fredrickson.

Editorial feedback for this episode was provided by RACP Fellows Dr Paul Jauncey, Dr Marion Leighton, Dr Rebecca Grainger, Dr Alan Ngo, Dr Phillipa Wormald and Dr Michael Herd. 

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

The transition from trainee to consultant marks an exciting and daunting step in a clinician's career. Suddenly you take on responsibility for everyone on the ward—both patients and other staff. And while clinical skills have been hammered in over years of training, the 'hidden curriculum' can be harder to pick up. The College has recently published How to Thrive as a New Consultant, a handbook to help navigate this period with confidence.

For today's show, guest producer Zacha Rosen spoke to four physicians who look back on their transitions, from six months on to nine years on. They capture the experience of striking out as a leader, manager and mentor to others. At the same time, one doesn't need to have all the answers. Recognising limitations and knowing when and how to seek help is all important. This is equally important in the clinic and in regards to one's own wellbeing. The speakers in this episode describe how they maintain a healthy balance within and around their careers.

Guests
Dr Marion Leighton FRACP (Wellington Hospital)
Dr Martina Moorkamp FRACP (Mercy Hospital for Women, Melbourne)
Dr Lawrence Ong FRACP (Westmead Institute For Medical Research)
Dr Ben Vogler FRACP (Cairns Hospital).

Production
This episode was produced by Zacha Rosen, with research assistance from Beverly Bucalon, and hosted by Mic Cavazzini. Recording in Wellington by Ryan Smith. Music courtesy of Lee Rosevere ('Thoughtful', 'Here's the Thing'), Chris Zabriskie ('Wonder Cycle'), and Rosie Catalano ('Waiting'); photo copyright RACP. The production manager was Anne Fredrickson.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Australia and New Zealand have relatively high rates of asthma by international measures, with a population rate of about one in nine. For years the management model has been empirical. The more serious the disease, the more the dose of controller therapy is increased. But this doesn't work for everyone. In at least 10 per cent of patients, there is an excessive symptom burden despite maximum controller therapy. 

Severe asthma is marked by frequent exacerbations that may require hospitalisation, and the chronic narrowing of the airways that can often present like COPD. A rational approach to treatment requires identifying one of three endotypes with distinct pathophysiology. Eosinophilic asthma, allergic asthma, and non-eosinophilic asthma can be differentiated by markers in blood and sputum. And targeted therapies have emerged, such as monoclonal antibodies to stages in the cytokine pathway that underlies eosinophil recruitment. It's also important to consider the co-morbidities and risk factors that contribute to the disease, and to coordinate therapy in a multi-disciplinary way. The guests for this episode published a 'Clinical Perspectives'; review in June's edition of RACP's Internal Medicine Journal.

Guests
Professor Peter Gibson FRACP (Hunter Medical Research Institute, Co-Director of the University of Newcastle's Priority Research Centre for Asthma and Respiratory Diseases)
Professor Vanessa McDonald FRCNA (Co-Director of NHMRC CRE in Severe Asthma at HMRI, University of Newcastle).

Production
This episode was produced by Mic Cavazzini. Music from Jason Shaw ('Namaste', 'Timen Passing By'), Kai Engel ('Wake Up'), Mark Neill ('Shakey'). Photo courtesy iStock. The production manager was Anne Fredrickson.

Editorial feedback was provided by RACP Fellows Dr Michael Herd, Dr Joseph Lee and Dr Tessa Davis, and Dr Steven Maltby, HMRI, University of Newcastle. 

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Uncertainty can be frightening for patients and doctors alike, but it's an unavoidable fact of medicine in every specialty. In this two-part story, we hear from a GP, a paediatrician, a surgeon and a rheumatologist about how they navigate the grey areas of diagnosis and treatment, and maintain a patient's faith throughout. In the first episode, we examine the culture within the profession and general public that expects nothing less that perfection in medicine—technology that appears to make everything soluble, and pressure on doctors to back their hunches or to be heroic in intervention

In this final episode, we look at the stigma and disorientation experienced by patients with medically unexplained syndromes. While the definition of functional disorders still causes some debate, behavioural strategies for intervention can often have a great impact on the lives of these patients. Treatment outcomes are never guaranteed, however, and clinical outcome cannot be the only measure of success. Our guests each give examples from their specialty about how a patient's expectations can be managed from the beginning of the consultation. 

Guests
Dr Louise Stone FRACGP (Australian National University)
Professor Phil Fischer MD (Mayo Clinic, Rochester, Minnesota)
Professor Ian Harris RACS (Liverpool Hospital, UNSW)
Dr Rebecca Grainger FRACP (Wellington Regional Rheumatology Unit, University of Otago).

Production
This episode was produced by Mic Cavazzini. Music from Transient ('Vodka', 'Damascus'), Ben Carey ('Calico', 'Ghost Limb'); photo courtesy iStock. Recording assistance from Ryan Smith and Mark Flaherty. The production manager was Anne Fredrickson.

Editorial feedback was provided by RACP Fellows Dr Paul Jauncey, Dr Marion Leighton, Dr Tessa Davis, Dr Michael Herd, Dr Sherina Mubiru, Dr Pavan Chandrala, and Dr Alan Ngo. 

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Uncertainty can be frightening for patients and doctors alike, but it's an unavoidable fact of medicine in every specialty. In this two-part story, we hear from a GP, a paediatrician, a surgeon and a rheumatologist about how they navigate the grey areas of diagnosis and treatment, and maintain a patient's faith throughout.

In this episode, we examine the culture within the profession and general public that expects nothing less that perfection in medicine—technology that appears to make everything soluble, and pressure on doctors to back their hunches or to be heroic in intervention. We also ask whether hospital training might inadvertently shelter younger doctors from the experience of complex, chronic conditions, and how the simplicity of protocols can be misleading.

In the second episode, we look at the stigma and disorientation experienced by patients with medically unexplained syndromes. While the definition of functional disorders still causes some debate, behavioural strategies for intervention can often have a great impact on the lives of these patients.

Guests
Dr Louise Stone FRACGP (Australian National University)
Professor Phil Fischer MD (Mayo Clinic, Rochester, Minnesota)
Professor Ian Harris RACS (Liverpool Hospital, UNSW)
Dr Rebecca Grainger FRACP (Wellington Regional Rheumatology Unit, University of Otago).

Production
This episode was produced by Mic Cavazzini. Music from Transient ('Vodka', 'Damascus'), Ben Carey ('Calico', 'Ghost Limb'); photo courtesy iStock. Recording assistance from Ryan Smith and Mark Flaherty. The production manager was Anne Fredrickson.

Editorial feedback was provided by RACP Fellows Dr Paul Jauncey, Dr Marion Leighton, Dr Tessa Davis, Dr Michael Herd, Dr Sherina Mubiru, Dr Pavan Chandrala, and Dr Alan Ngo. 

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

It's estimated that socioeconomic (SES) factors are responsible for half of a population's health and wellbeing status. In comparison, medical services might determine only a quarter of health outcomes. Better targeting of social services and health resources is key to addressing this—but it's not just a macro-level problem, according to Professor Ross Upshur FRCPC of the Dalla Lana School of Public Health. He says that merging medical records with SES markers will help physicians manage inequity at every consultation via 'social precision medicine'. In his opening address at Congress, he also spoke about how codes of ethics in medical practice have changed over the years.

Associate Professor Sue Woolfenden FRACP is a paediatrician in the Sydney Children's Hospital Network, and spoke at Congress explaining how the biological and social determinants of health are entwined even before birth, with effects accumulating at every stage of development. Her research for the UNSW School of Women and Children's Health reveals why some culturally and linguistically diverse communities don't access antenatal services and pre-school care, and what clinicians can do to make services more accessible.

The podcast also features Dr Brett Sutton FACTM FRSPH, Deputy Chief Health Officer of Victoria, who participated in a Congress session discussing health advocacy, and dealing with issues that might conflict with political or media interests. 

Production
This episode was produced by Mic Cavazzini. Music from Comma ('Between the Sunset and The Sea'), Gillicuddy ('Adventure Darling'), Blue Dot Sessions ('Downhill Racer'); photo courtesy iStock. The production manager was Anne Fredrickson.

Editorial feedback was provided by RACP Fellows Dr Philip Britton, Dr Rebecca Grainger, Dr Joseph Lee, Dr Marion Leighton, Dr Alan Ngo, Dr Phillipa Wormald, and Advanced Trainee Dr Aaron Wagen. 

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Patients with autism spectrum disorder (ASD) can present unique challenges for the emergency physician. As these patients often have trouble making sense of their own emotional and physical states, they can become very distressed when experiencing pain. Many are also limited in their language abilities, and therefore can’t communicate verbally what is wrong

In this episode of Pomegranate, carer Annette talks about raising her teenage grandson Aaron, who needs continual care. Consultant paediatrician Meenakshi Rattan FRACP (Campbelltown Hospital, NSW), and psychiatrist Kenneth Nunn FRANZCP FRACP (Children’s Hospital Westmead, NSW) share the techniques they use to calm distressed patients living with autism and make medical assessments. They also describe the appropriate sedation that might be used for the most agitated and aggressive cases, and how gaps in the transition of patients to adult care might be filled. 

Production
This episode was produced by Mic Cavazzini. Music from Blue Dot Sessions ('A Path Unwinding'), Loch Lomond ('From Here to Iceland', 'Violins and Tea'), Chris Zabriskie ('Out of the Skies, Under the Earth'); photo courtesy iStock.  The production manager was Anne Fredrickson.

Editorial feedback was provided by RACP Fellows Dr Pavan Chandrala, Dr Tessa Davis, Dr Rebecca Grainger, Dr Michael Herd, Dr Paul Jauncey, Dr Joseph Lee, Dr Marion Leighton, Dr Sherina Mubiru, Dr Alan Ngo, Dr Ellen Taylor and Dr Phillipa Wormald, Advanced Trainee Dr Katrina Gibson and Mr Quentin Abraham MNZPsS. 

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

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.


Production
Produced 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 provided courtesy of FreeMusicArchive. 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 episode looks at one of the biggest steps in a physician's career: retirement. It's common to avoid thinking about retirement, and the idea can sometimes come as a shock—professionally, personally, or financially. This month, we speak with physicians both in and out of retirement, as well as two psychiatrists whose research focuses on medical professionals' identity.

Guests
A/Prof Jill Sewell FRACP (Royal Children's Hospital, Melbourne)
A/Prof Carmelle Peisah FRANZCP (Consultant Old Age Psychiatrist, Conjoint Professor UNSW, Clinical Associate Professor University of Sydney)
Dr Chanaka Wijeratne FRANZCP (Prince of Wales Hospital, Conjoint Associate Professor University of Notre Dame Australia)
Emeritus Professor John Dwyer FRACP (UNSW Medicine).

Production
This episode was produced by Zacha Rosen. Music from Lee Rosevere ('And So Then', 'Quizitive'), Chris Zabriskie ('CGI Snake'), Broke for Free ('Something Elated'); photo courtesy iStock. Pomegranate is presented by Mic Cavazzini, with Anne Fredrickson as production manager.

Editorial feedback was provided by RACP Fellows Dr Rebecca Grainger, Dr Dennis Hain, Dr Paul Jauncey, Dr David McBride, Prof Barry McGrath, Dr Alan Ngo, Prof Kim Oates and Dr Humphrey Pullon. 

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

This is a two-part series looking at how modern genomics is changing clinical practice, and how a physician can hope to keep up with the pace of discovery and technological development. Some single gene tests and gene panels have been available off-the-shelf for years, but whole genome sequencing is becoming more accessible and affordable every day. In the first episode we discussed the differences between these technologies in terms of cost and practical utility, using diagnosis of Mendelian conditions and rare developmental conditions as examples.

The second episode begins with the question of disease risk and how to present uncertain predictive diagnoses. This is particularly relevant to research using genome-wide association studies, which is finding more and more markers with small risks of disease. This increases the likelihood of picking up diagnoses incidental to the ones a clinician might be looking for. The ethics of consenting patients to genome screening and informing them of potential markers are discussed, as well as gene-targeted treatments at the cutting edge of cancer research.

Guests
Associate Professor Kristine Barlowe-Stewart FHGSA(GenCounsel) (Director, Master of Genetic Counselling Program, University of Sydney)
Professor Leslie Burnett FRCPA, FHGSA, FCAP (Chief Medical Officer, Genome One)
Dr Michael Gabbett FRACP (Royal Brisbane and Women's Hospital)
Dr David Thomas FRACP (Director, Kinghorn Cancer Centre; Director, Cancer Division, Garvan Institute for Medical Research).

Production
This episode was produced by Mic Cavazzini. Music from Blue Dot Sessions ('Cloud Line'), Chris Zabriskie ('Is That You or Are You You?'), Alex Fitch ('Celeste'), Cory Gray ('Terminal Two'), and Kromatic ('Club Crunk for Monkeys'); photo courtesy Shutterstock. The production manager was Anne Fredrickson.

Editorial feedback was provided by RACP Fellows Dr Pavan Chandrala, Dr Tessa Davis, Dr Rebecca Grainger, Dr Michael Herd, Dr Paul Jauncey, Dr Joseph Lee, Dr Marion Leighton, Dr Anutosh Shee and Dr Ellen Taylor, and Advanced Trainee Dr Katrina Gibson. 

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

This episode goes back 200 years to tales of the early Sydney colony. The lectures featured on the program were first recorded at the 'Our Healthy Heritage' seminar series, hosted quarterly by the Australian and New Zealand Society of the History of Medicine.

Dr Fiona Starr of Sydney Living Museums retells colourful accounts of the colony's first general hospital, better known as the Rum Hospital. It was built in 1816 by Governor Lachlan Macquarie, who saw an urgent need to maintain the health of the convict workforce. Prof Peter Curson describes the worst infectious diseases that struck the colony over the 19th century—from the measles outbreak that killed over 1,000 children to the plague epidemic that caused panic and social conflict. Peter is Emeritus Professor in Population and Health at Macquarie University. Also on this episode is Dr Lisa Murray, Historian for the City of Sydney Council, discussing the perennial problem of where to bury the dead in an era of incredibly high mortality. 

Production
 This episode was produced by Mic Cavazzini. Music from Sláinte ('Banish'), The OO-Ray ('Barriers'), Studio Noir ('Alma Rubens, Clarine Seymour'), Aislinn ('Sliabh') and Jahzzar ('Notre Dame'); sound recordings from Freesound. Image courtesy of Thomas Fisher Rare Book Library, University of Toronto.  The production manager was Anne Fredrickson.

 Editorial feedback was provided by RACP Fellows Dr Bruce Foggo and Dr Michael Herd.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Sir Harry Burns and Dr Ruth Hussey OBE are public health physicians involved in 'whole-of-system change' in Britain's health and social care. They were invited to Australia in 2016 to advise NSW Health on such delivery models; this episode of Pomegranate features a special lecture presented at the RACP during their trip.

As the former Chief Medical Officer of Scotland, Sir Harry Burns has drawn worldwide attention to the social determinants of health and focused his energy on a citizen-driven scheme for 'salutogenesis.' He continues to comment on health inequalities as Professor of Global Public Health at the University of Strathclyde.

Dr Ruth Hussey was until recently the Chief Medical Officer for the Welsh Government Assembly and prior to that Medical Director for the National Health Service in Wales. In these roles she has pushed for a local approach to delivering high quality clinical services, which she calls 'prudent health care.'

Production
This episode was produced by Mic Cavazzini. Music from Jason Shaw ('Autumn Sunset, Back to the Woods') and Blank Kytt ('RSPN'); photo courtesy Shutterstock. The production manager was Anne Fredrickson.

Editorial feedback was provided by RACP Fellows Dr Bruce Foggo, Dr Michael Herd, and Dr Joseph Lee. 

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Almost three quarters of physicians surveyed in the U.S. admit to ordering at least one unnecessary test, procedure or treatment every week. In Australasia, EVOLVE is the RACP's initiative to minimise clinical practices that aren't supported by the current evidence base, and stems from the international healthcare campaign Choosing Wisely.

EVOLVE has recently published a list of the top five practices in general paediatrics that need to be pulled back. Developed in consultation with Fellows from the RACP Paediatrics and Child Health Division, its recommendations are:

1. Do not routinely prescribe oral antibiotics to children with fever without an identified bacterial infection.
2. Do not routinely undertake chest radiography for the diagnosis of bronchiolitis in children or routinely prescribe salbutamol or systemic corticosteroids to treat bronchiolitis in children.
3. Do not routinely order chest radiography for the diagnosis of asthma in children.
4. Do not routinely treat gastroesophageal reflux disease (GORD) in infants with acid suppression therapy.
5. Do not routinely order abdominal radiography for the diagnosis of non-specific abdominal pain in children.

This episode of Pomegranate explores the rationale behind these recommendations and some alternatives that paediatricians can adopt to improve their practice.

Guests
Prof Harriet Hiscock FRACP (Director, Royal Children's Hospital Health Services Research Unit; Director, Australian Paediatric Research Network)
Dr Sarah Dalton FRACP (President, RACP Paediatrics and Child Health Division; Clinical Leader, NSW Agency for Clinical Innovation)
Dr Hamish McCay FRACP (Paediatrics Clinical Director, Waikato Hospital).

Production
This episode was produced by Mic Cavazzini. Music from Comma ('Between the Sunset and the Sea') and Cory Gray ('Down to the Street'); photo courtesy Shutterstock. The production manager was Anne Fredrickson.

Editorial feedback was provided by RACP Fellows Dr Michael Herd, Dr Joseph Lee and Prof Peter Procopis. 

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

While more than half of all medical students and trainees are women, they make up only about 30 per cent of registered physicians. When it comes to clinical leadership positions it's down to single digits, and medicine's gender pay gap is worse than that of other industries

The reasons for this loss of talent, and disparities in pay, are both cultural and logistical. One significant factor affecting career progression is time taken out for child-rearing; the penalties associated with such an interruption appear to compound more in medical training than they do in other professions. But medical culture, reflecting the wider society, also contains structural biases that affect women. On this episode guests discuss the challenges for gender equity in the profession, and how role-modelling and leadership training may offer strategies to support the next generation of women doctors. 

Guests
Dr Catherine Yelland FRACP (President, RACP)
Dr Stefanie Schurer (University of Sydney)
Dr Elizabeth Sigston FRACS (Consultant Surgeon, ORLHNS, Monash Health)
Prof Helena Teede FRACP (Executive Director, Monash Partners Academic Health Sciences Centre; Director, Monash Centre for Health Research and Implementation).

Production
This episode was produced by Mic Cavazzini, with additional research from Beverly Bucalon and Dr Marion Leighton FRACP. Music from Blue Dot Sessions ('Fervent', 'Downhill Racer'); photo courtesy Sergio Santos. The production manager was Anne Fredrickson.

Editorial feedback was provided by RACP Fellows Dr Sarah Abrahamson and Dr Marion Leighton, and RACP staff member Ms Beverly Bucalon.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Crystal methamphetamine, or ice, has been sensationalised in the media over the past decade. While raising awareness of the drug, such reporting has also stigmatised its users—both on the street and in the wards. 

In this episode of Pomegranate, some of Australia's leading addiction researchers and clinicians explain how misleading the dominant narrative is and put straight some of the facts and figures behind the so-called ice 'epidemic.' They also discuss how characterising crystal methamphetamine as 'the most addictive drug ever' discredits the effectiveness of available and upcoming therapies.

Guests
Prof Alison Ritter (National Drug and Alcohol Research Centre, UNSW)
Dr Gilbert Whitton FAChAM (Bankstown Hospital, Sydney)
Prof Amanda Baker (Calvary Mater Hospital, University of Newcastle)
Assoc Prof Nadine Ezard FAChAM (St Vincent's Drug and Alcohol Service, University of Sydney).

Production
This episode was produced by Mic Cavazzini with music from Ben Carey ('Transference'), Mark Neill ('Threshold', 'Right Strafes Derision'), and David Szesztay ('Snow'); photo courtesy Sean Naber. The production manager was Anne Fredrickson.

Editorial feedback was provided by RACP Fellows Dr Bruce Foggo, Dr Michael Herd, Dr Murray Hunt and Dr David Lloyd-Jones.  This episode was produced in partnership with NSW Health.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Pyrexia, or fever of unknown origin (PUO) is a syndrome that challenges the diagnostic skills of every physician. It is defined by frequent fevers over 38.3 degrees Celsius, persisting for 3 weeks, which have eluded diagnosis by standard baseline tests.

Dr Rohan Beresford, Advanced Trainee in infectious diseases and microbiology and Professor Iain Gosbell of the University of Western Sydney, review the condition in September's issue of the RACP's Internal Medicine Journal. In a recent case series, they write, 22% of PUO cases were auto-inflammatory, 16% were attributed to infection, 7% were neoplastic, and 4% were due to drugs or other miscellaneous causes. But over 51% of patients with PUO were left with no diagnosis at all.

On this this episode, Dr Beresford explains how to rationally investigate patients with persistent fevers and manage their anxiety through the process. He is joined by paediatrician and infectious diseases specialist Dr Philip Britton FRACP (Children's Hospital Westmead), describing some of the conditions that more likely explain PUO in children, and Dr David Spriggs FRACP (Auckland City Hospital), who provides examples of the complexity of PUO in geriatric patients.

This episode was produced by Mic Cavazzini with recording assistance from Justin Gregory. Music from Chris Zabriskie ('I Am Running with Temporary Success from a Monstrous Vacuum in Pursuit'), Jahzaar ('Gramaphone', 'Aisles') and Scott Holmes ('Close to the Distance'); photo courtesy Armle. The production manager was Anne Fredrickson.

Editorial feedback was provided by RACP Fellows Dr Bruce Foggo, Prof David Gordon, Dr Michael Herd, Dr Marion Leighton and Dr Christian Lueck.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

The National Disability Insurance Scheme (NDIS) is designed to provide better care for the 460,000 Australians who have significant and permanent disability. The NDIS supports individuals in making personalised therapy goals, accessing appropriate care, and participating in mainstream life. Since 2013 the scheme has had a staged launch across parts of Australia. This month, the NDIS will start rolling out across New South Wales and Victoria and will have complete coverage by 2019.

On this episode internal medicine physician Dr Robyn Wallace FRACP, of Calvary Hospital in Hobart, explains how the NDIS differs from past disability services, and rehabilitation specialist Dr Elizabeth Thompson FRACP shares the hopes her Sydney clients have for the personal funding. Kerry O'Kane talks of her relief at having found a secure future of care for her son in the ACT, while Dr Katherine Langdon FRACP describes the impact the scheme has had for paediatric therapy models in Perth.

 This episode was produced by Mic Cavazzini with recording assistance from Diana Darmody. Music from David Szesztay ('Farewell', 'The Hangover') and Gillicuddy ('Adventure Darling'); photo courtesy Markus Spiske. Pomegranate's executive producer is Anne Fredrickson.

Editorial feedback was provided by RACP Fellows Dr Stephen de Graaff, Dr Robyn Horsley, Dr Anne Kynaston, Dr Robert Leitner, Dr Jacqueline Small and Prof Graham Vimpa

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  ices

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.

Guest
Prof Josephine Thomas FRACP FRACGP FANZAPHE PhD (Northern Adelaide Local Health Network; University of Adelaide)

Hosts
Associate Professor Stephen Bacchi (Massachusetts General Hospital; University of Adelaide)
Dr Caleb Chong (Northern Adelaide Local Health Network)
 

Production
Produced 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)
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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.

Life expectancy for Aboriginal and Torres Strait Islander people is a decade lower than that of the non-Indigenous population. Addressing this disparity is one of the key priorities of the Closing the Gap initiative agreed upon by the Council of Australian Governments. 

Today's speakers discuss where progress has been made and where resources are still lacking. Associate Professor Noel Hayman FAFPHM, FRACGP is Clinical Director of the Inala Indigenous Health Service in Brisbane. Ms Shannon Daly is an Aboriginal Health Practitioner who often works with Dr Joshua Francis FRACP, a paediatric infectious diseases specialist based at Royal Darwin Hospital. 

 This episode was produced by Anne Fredrickson and Mic Cavazzini, with recording assistance from Johanna Bell. Music from Doctor Turtle ('G of the Bang') and Rebecca Foon ('White Throated Sparrow'); photo copyright  courtesy of Cameron Herweynen.

Editorial feedback was provided by RACP Fellows Dr George Laking, Dr Tamara Mackean, A/Prof Ashim Sinha and Dr Catherine Yelland, and RACP staff member Ms Helen Craig.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

The World Health Organization defines 'adolescents' as anyone between the ages of 10 and 19, and 'youth' as those between 15 and 24. The RACP uses the terms 'young people' and 'adolescent and young adult' to cover the whole range of 10 to 24 years. Regardless of how it's defined, the transition from childhood to adulthood involves a range of physical, mental, and psychosocial issues. If you're a teenager with a chronic health condition, the situation can be even harder.

For physicians in Australia and New Zealand, there has been no specific training to meet the needs of adolescents—until now. Over the past few years, the RACP has been working to create an adolescent and young adult medicine curriculum, which will become a dual training program in 2017. On this episode Prof Kate Steinbeck FRACP, Dr Michelle Telfer FRACP, and Dr Bridget Farrant FRACP talk about why adolescents and young adults need targeted care and the issues they face in the current system. They also discuss the new curriculum, and how interested Fellows and Trainees can get involved.

View the RACP's curated collection on adolescent and young adult health for an expanded guide to CPD tools.

 This episode was produced by Alastair Wilson and Anne Fredrickson, with music from Podington Bear ("Now Son," "Whiplash String Swells," "Filaments"), and Kevin MacLeod ("Funkorama"); image courtesy Andy Maguire.

Editorial feedback was provided by RACP Fellows Prof Shanthi Ameratunga and A/Prof Jane Holmes-Walker, Advanced Trainee Dr Emma Mitchell and RACP staff member Ms Veronica Vogel.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Medical practice is dynamic, and continually changes with evidence and experience. But costly or prolonged treatment doesn 't always translate into better outcomes for patients. In response, the College has launched EVOLVE—a partnership with specialty societies to identify and reduce low-value care.

EVOLVE is part of a growing international movement to examine clinical and consumer decision-making about overused, inappropriate, or potentially harmful medical treatments. As a founding partner of Choosing Wisely Australia, EVOLVE represents the College 's major contribution to the campaign: helping Fellows develop and promote lists of low-value care items for their specialty. On this episode Prof Rachelle Buchbinder FRACP, A/Prof Warrick Inder FRACP, and A/Prof Ian Scott FRACP discuss why they support the campaign, the process of developing low-value lists, and how they work with patients when the best course of action is…to wait.

 This episode was produced by Anne Fredrickson, with music from Jahzzar ( 'Montmartre '), The OO-Ray ( 'Silhouettes '), Deerhunter ( 'Cryptograms ') and Delicate Steve ( 'Butterfly '); image courtesy EVOLVE. 

Editorial feedback was provided by RACP Fellows Dr Bruce Foggo, Dr Catherine Hill, A/Prof Ruth Marshall and Dr Catherine Yelland, and RACP staff members Mr Jason Soon and Ms Siobhan Marren. 

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

The gut microbiome is the subject of increasing research in medicine. Understanding this complex community offers potential new insight for treating a number of diseases—gastrointestinal and otherwise. But what's the evidence base?

In this episode Dr Peter De Cruz FRACP, Head of the Inflammatory Bowel Disease Service at the Austin Hospital, discusses his recent IMJ article 'Characterisation and Therapeutic Manipulation of the Gut Microbiome in Inflammatory Bowel Disease'. To provide further review, the episode also features an interview with Professor Finlay Macrae FRACP, Head of Colorectal Medicine and Genetics at the Royal Melbourne Hospital.

Included in the discussion are: the early establishment of the microbiome and its genetic and environmental influences, pharmacological and nutritional interventions targeting the gut, and some guarded recommendations about faecal microbiota transplantation.

This episode is presented in partnership with the Internal Medicine Journal, the official peer-reviewed publication of the College's Adult Medicine Division. Links to resources mentioned on the show are provided below. Dr De Cruz's full article is available via Wiley Online Library.

This episode was produced by Alastair Wilson, with editing by Anne Fredrickson. Music from Podington Bear ('Caravan'), Kevin MacLeod ('Isolated'), and Adrianna Krikl ('Every Way', 'Wednesday'); photo courtesy Pacific Northwest National Laboratory (via Flickr). 

Editorial feedback was provided by RACP Fellows Dr Christian Lueck, Dr Kathryn Patchett and Dr Bruce Foggo. 

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Obesity can seem like what strategists call a 'wicked problem'—a problem with so many parts that it's impossible to solve. But some things are changing. While prevalence is still high in developed countries, childhood obesity appears to be plateauing. Social movements like 'Health at Any Size' promote body positive approaches. And at Dr Nic Kormas' clinics, obese patients on average are able to lose 10% of their weight.

Dr Kormas FRACP is the senior endocrinologist behind the Metabolic Rehabilitation Programs at Concord, Camden and Campbelltown Hospitals. He's joined on the program by Dr Jacqui Curran FRACP, a paediatric endocrinologist at Princess Margaret Hospital in Perth; Boyd Swinburn FAFPHM, Professor of Population, Nutrition and Global Health at the University of Auckland; and Dr Sophie Lewis, a public health researcher at the University of Sydney. On today's episode, they talk about strategies and pathways available for addressing obesity—from the psychological to the physical.

 This episode was produced by Anne Fredrickson, with music from Chris Zabriskie ('Readers! Do You Read?' and 'The Temperature of the Air on the Bow of the Kaleetan'), David Szesztay ('Point Zero'), and Ayla Nereo ('Oh Love'); photo by Scott Loftesness (via Flickr). 

 Editorial feedback was provided by RACP Fellows Prof Chris Bullen, Prof Hugh Dickson, Dr Bruce Foggo, Dr Jacqueline Hewitt, A/Prof Matthew Links, Dr Rosalie Schultz and Dr Rima Staugas.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  t

By shaping the next generation of physicians, supervision affects the lives and health of patients. In this episode, our guests explore how the role of the supervisor has changed over time (as well as where the role ends), the skills needed for a good supervisor, and some suggestions on how to deliver constructive criticism. With combined decades of experience, they also share their thoughts on how to improve your own performance as a supervisor—and why they find it worthwhile. 

Three experienced supervisors share their views: Dr Peter Davoren FRACP, an endocrinologist and former Director of Physician Education at Gold Coast Hospital; Dr Marion Leighton FRACP, a general physician based in Wellington who supervises both for the RACP and for the MCNZ; and Dr Josh Francis FRACP, a Darwin-based paediatrician who provides remote supervision for doctors in Timor-Leste. We also spoke to Alexandra Greig (AT, Public Health) to hear the thoughts of a doctor who is currently being supervised

Links to resources mentioned on the show are provided below. View the RACP's curated collection on teaching for a larger guide to professional development tools.

This episode was produced by Alastair Wilson, with editing by Anne Fredrickson. Music from Scott Holmes ('Oceans Apart'), Squire Tuck ('Song for the Chameleon'), Cahill Locksmith ('Diamond Variety'), and Julianna Barwick ('I Wish I Could Create'); photo by Isaac Bowen (via Flickr). 

Editorial feedback was provided by RACP Fellows Dr Libby Smales, Dr Lionel Lubitz, Dr Mandy Fletcher, Dr Rachel Wong, A/Prof Matthew Links, Dr Marie-Louise Stokes, and Dr Hamish McCay, and RACP staff member Ms Erin Murphy. 

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.

'One Health' is a contemporary movement based on a long-held observation: that the health of humans, animals, and the environment are inextricably linked. In the current issue of the Internal Medicine Journal, Prof Peter Collignon FRACP has published a One Health-informed clinical perspective: Antibiotic Resistance – Are We All Doomed? But paradoxically, he says, he's optimistic about the future

On this episode, Prof Collignon is joined in a review of his article by fellow ID physician Dr David Looke FRACP. They discuss the sobering trends in global and Australasian resistance rates, mechanisms driving the spread of resistance genes, and practical steps doctors can take for better antibiotic stewardship. 

This episode is presented in partnership with the Internal Medicine Journal, the official peer-reviewed publication of the College's Adult Medicine Division. Links to resources mentioned on the show are provided below. Prof Collignon's full article is available via Wiley Online Library.

 Editorial feedback was provided by RACP Fellows Dr Bruce Foggo, Prof David Gordon and A/Prof Matthew Links.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Most preventive health messages focus on diet, exercise, and stress reduction. But are doctors taking this advice for themselves?

The Doctors' Health Advisory Service, or DHAS, was created in 1981 to offer confidential help to practitioners in both Australia and New Zealand. This episode features Dr Jill Gordon FASPsychMed, president of DHAS New South Wales; Dr Roger Sexton FRACGP, medical director of the South Australia office; and Dr Edwin Whiteside FRACP, director of the New Zealand office. They discuss why doctors may experience higher rates of depression and anxiety, and common fears around mandatory reporting. The conversation also includes Dr Kieran Le Plastrier (Western Sydney University), who is currently completing a PhD on 'the fit professional.

Dr Gordon's 'five steps to help a colleague' are:

1. Don't ignore the situation. Approach the person and the problem and ask if you can help.
2. Listen non-judgementally to what they say.
3. Give emotional support and any information you think might help.
4. Encourage them to seek professional help.
5. Encourage other forms of support.

Links to resources mentioned on the show are provided below. View the RACP's support services page for more organisations supporting doctors' health.

 This episode was produced by Alastair Wilson, with editing by Anne Fredrickson. Music from Podington Bear ('Driftwood'), Nick Jaina ('Mississippi Turn-Around'), Cory Gray ('Low Rollers'), and Doctor Turtle ('G of the Bang'); photo by University of Liverpool Medical Archive (via Flickr).

Editorial feedback was provided by RACP Fellows Dr Hugh Aders, Dr Terence Donald, A/Prof Matthew Links, Dr Martina Moorkamp, Dr Kathryn Patchett, Prof Peter Procopis, Dr Simon Quilty, Dr Elizabeth Smales, Dr Emma-Leigh Synnott and Dr Barry Taylor.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

This month we're presenting a review of stem cell research and stem cell therapies from Professor John Rasko FRACP, head of the Department of Cell and Molecular Therapies at the Royal Prince Alfred Hospital

A self-confessed 'stem cell tragic,' Professor Rasko routinely separates the hope and hype surrounding any new medical research. In this episode, he reviews the stem cell treatments currently available in Australia and New Zealand, and a few of the many clinical trials worth watching. He also discusses why some patients engage with unproven and riskier procedures, and what advice he offers them. 

Production
This episode was produced by Anne Fredrickson, with reporting by Michael Pooley. Music from Lloyd Rogers ('Red Fish on Television'), Podington Bear ('Many Hands'), The Womb ('Amiga Power Viking Funeral'), and Cloud Mouth ('Bedtime'); photo by Eckhard Völcker (via Flickr).

Editorial feedback was provided by RACP Fellows Dr Bruce Foggo, Dr Chris Juttner, A/Prof Matthew Links, Dr Christian Lueck, A/Prof Ruth Marshall and Dr Emma-Leigh Synnott, and A/Prof Megan Munsie (University of Melbourne).

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

In the final of our three-part series on end-of-life decision-making, we're integrating perspectives from the law.

For dying patients, their families, and their medical staff, the majority of decisions are reached without contention. But law in this field is complex, and varies by jurisdiction. As a result, doctors may possess knowledge gaps around end-of-life care. This episode features interviews with Prof Ben White (QUT) and A/Prof Colin Gavaghan (University of Otago). Links to resources mentioned on the show and other tools for continuing professional development (CPD) are provided below. View the RACP's curated collection on end-of-life care for an expanded guide to CPD tools.

Production
This episode was produced by Anne Fredrickson, with music from Lucky Dragons ('Open Melody'), Studio Noir ('Clarine Seymour'), BOPD ('New England Is Interesting'), and Satellite Ensemble ('Agnes'); photo by Julia Manzerova (via Flickr).

Editorial feedback was provided by RACP Fellows Dr Bruce Foggo, Dr Martina Moorkamp, Dr Christian Lueck and Dr Marie-Louise Stokes.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

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.

Guest
Dr Thomas Crowhurst FRACP (Northern Adelaide Local Health Network)

Hosts
Associate Professor Stephen Bacchi (Lyell McEwin Hospital; University of Adelaide)
Dr Brandon Stretton (Central Adelaide Local Health Network)

Production
Produced 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)

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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.

Treating a dying person goes beyond understanding their disease. In the second of a three-part series, we examine the importance of family and culture in end-of-life care—from the ICU to the neonatal unit.

This episode features interviews with Dr Andrew Watkins FRACP and Dr Peter Saul FCICM.

 Production
This episode was produced by Anne Fredrickson, with music from Chris Zabriskie ('I am Running with Temporary Success…'), L.J. Kruzer ('Chantiers Navals 412'), and Sounds of Taraab ('Mahaba Wa Taka Nini'); photo by Alyssa (via Flickr).

Editorial feedback was provided by RACP Fellows Dr Bindu Bali, Dr Habib Bhurawala, A/Prof Matthew Links, Dr Hamish McCay, Dr Martina Moorkamp, Dr Rohan Vora, and A/Prof Nicholas Wickham.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

For our first show we're starting at the end: end-of-life care and decision-making. It's a hard topic to discuss with patients, but it might be the most important conversation we're not having.

This episode features interviews with Dr Amanda Walker FRACP, Dr Charlie Corke FCICM, and Dr Peter Saul FCICM.

 Production
This episode was produced by Anne Fredrickson, with music from Podington Bear ('Into the Unknown,' 'Infant') and Rebecca Foon ('Hearts Mend'); photo by Amrita B (via Flickr).
Editorial feedback was provided by RACP Fellows Dr Sarah Dalton, Dr Bruce Foggo, Dr Emma-Leigh Synnott, Dr Ranjana Srivastava, Dr Stephen Streat and Dr Simon Quilty. lickr).

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

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 Reference
Tenecteplase for Ischemic Stroke at 4.5 to 24 Hours without Thrombectomy [NEJM. 2024]

Guests
Dr 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). 

Production
Produced 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.

Credits
Dr Andrew Vanlint FRACP AFRACMA (Northern Adelaide Local Health Network and University of Adelaide
Associate Professor Stephen Bacchi (Lyell McEwin Hospital; University of Adelaide)
 
Production
Produced 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)
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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 Reference
Hepatitis C Elimination in NSW: Monitoring and Evaluation Report, 2024 [Kirby Institute]
Video Recording from launch event

Guests
Prof 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)

Production
Recorded 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.

Credits

Dr Karan Singh
Staff and patients at Prince of Wales Nuclear Medicine and PET Department

Production
Produced 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.

Guests
Prof 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)

Production
Produced 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 Reference
Causes 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. 

Guests
Associate Professor Stephen Bacchi (Lyell McEwin Hospital; University of Adelaide)
Dr James Triplett FRACP (Flinders Medical Centre, consultant neurologist)

Production
Produced 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)
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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.

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.a

Chapters
1:38 Better support of mothers returning to work
9:09 How leave and part-time work affects the medical workforce and the benefits of flexibility
19:56 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

Guests
Associate 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;

Production
Produced 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 and also to Sarah Anderson of La Trobe University for guiding me through some of the AIHW data.

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 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.

Guests
Professor 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)

Production
Produced 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 Support
College EAP
Member service provided by TELUS Health
Australia: 1300 361 008
Aotearoa-NZ: 0800 155 318 (Aotearoa New Zealand).
See also the TELUS wellbeing app.

Doctor’s Health Advisory Service Helpline
Aotearoa-NZ:  800 471 2654
NSW/ACT: 02 9437 6552
VIC:      03 9280 8712
TAS:     03 9280 8712
SA:       08 8366 0250
NT:       08 8366 0250
QLD:    07 3833 4352
WA:     08 9321 3098
 
Lifeline
Australia: 13 11 14.
Aotearoa-NZ: 0800 54 33 54

From 2024, supervising has been recognised as a Category 2 CPD activity. This short and insightful episode focuses on recent updates to the 2024 MyCPD Framework, highlighting the recognition of supervisory activities as a critical element of Category 2 Reviewing Performance CPD. 

Please join Professor Martin Veysey, a renowned expert in supervision and medical education, and Associate Professor Kudzai Kanhutu, College Dean, as they delve into the practicalities and strategic benefits of integrating supervision into your CPD activities. This podcast offers guidance on planning and recording supervising activities, using MyCPD tools to streamline the process efficiently.

Guests
Associate 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.  

Guests
Dr Chiang Sheng Lee FRACP (Lyell McEwin Hospital; University of Adelaide)
Dr Stephen Bacchi (Lyell McEwin Hospital)
Dr Amitjeet Singh (Lyell McEwin Hospital)

Production
Produced 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)
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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)

Production
Produced 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.

Guests
Dr Sumu Simon FRANZCO (Queen Elizabeth Hospital; Royal Adelaide Hospital)
Dr Brandon Stretton (Royal Adelaide Hospital)
Dr Stephen Bacchi (Lyell McEwin Hospital)

Production
Produced 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. 

Learning points and Key Reference (spoiler alert)
 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. 


The Role of Tocilizumab in Glucocorticoid Resistant Giant Cell Arteritis: A Case Series and Literature Review [J Neuroophthalmol. 2023;43(1)]